Psychosis & Schizophrenia
 

Overview

The word psychosis is used to describe conditions that affect the mind, where there has been some loss of contact with reality. When someone becomes ill in this way it is called a psychotic episode. During a period of psychosis, a person’s thoughts and perceptions are disturbed and the individual may have difficulty understanding what is real and what is not. This could be because of hallucinations (seeing, hearing, or sensing something that doesn’t exist) or delusions (false beliefs that the person is convinced are true or real). A person in a psychotic episode may also experience depression, anxiety, sleep problems, social withdrawal, lack of motivation, and difficulty functioning overall.

A person can have a single episode of psychosis or more over a lifetime. Psychotic symptoms can occur as a part of a mental disorder like schizophrenia, neurocognitive conditions like dementia, as a result of substance intoxication, and in many other conditions that affect the brain (e.g., Parkinson’s disease, epilepsy, migraine). Effective medical, psychological and community treatment is available and a person who has experienced psychosis can live a fulfilling life. 

Causes

Psychosis can affect people of any gender, age, race or education. Psychosis often begins when a person is in his or her late teens to mid-twenties.

There is no one specific cause of psychosis. The causes are complex: genetics, early childhood development, adverse life experiences, physical illness or injury, drug use and other factors increase chances of experiencing psychosis.

Symptoms & Signs

Psychotic symptoms vary from one person to another and even between one episode and another. Symptoms include:

  • Delusions: False ideas or beliefs that can’t be changed by evidence.
  • Hallucinations: Seeing, hearing, feeling, tasting or smelling something that isn’t there
  • Disordered thinking: It can sometimes be hard for someone else to understand what the person with psychosis is trying to say.
  • Disordered behavior: Agitated, act inappropriately given the situation they’re in. In severe cases, they may become unresponsive to the world around them, this is sometimes referred to as catatonia
  • Negative symptoms: reduced emotional expression, motivation, talking, or experience of enjoyment and pleasure. 

Diagnosis

In most cases, psychosis is experienced as an ‘episode’: a period of acute symptoms of delusions or hallucinations, the length of an episode varies from person to person and depends on factors such as the type and cause of the episode. Episodes can be as brief as a few hours (in the case of some drug-induced episodes), while for a diagnosis of schizophrenia someone needs to experience these symptoms for a period of six months. 

Psychosis can also develop gradually over time, beginning in ways that are subtle or hard to pin-point. Some common signs to look out for are:

  • Changes in emotion

    depression, anxiety, irritability, suspiciousness, and flattened or reduced emotional responses. 

  • Changes in thinking

    trouble with concentration or attention, changed sense of self or the world, and odd ideas.

  • Changes in behavior

    changes in sleep or appetite, withdrawing socially, or having troubles at work, school, or socially. 

If untreated, these symptoms can develop into a full psychotic episode. 

The best place to start in getting a diagnosis is the psychiatrist. Psychiatrists are the most qualified to assess the person and reach a diagnosis or put a treatment plan.

Treatments 

People with psychosis may behave in confusing and unpredictable ways and may become threatening or violent. However, people with psychotic symptoms are more likely to harm themselves than someone else. If you notice these changes in behavior, and they begin to intensify or do not go away, it is important to seek help.

Effective medical, psychological and community treatment is available and a person who has experienced psychosis can live a fulfilling life. 

Treatment involves the following components: 

  • Medications: helps reduce psychosis symptoms. Medication selection and dosing are tailored to patients with early psychosis and their individual needs. Like all medications, antipsychotic drugs have risks and benefits. Patients should talk with their psychiatrists about side effects, medication costs, and dosage preferences (daily pill or monthly injection). 
  • Individual or Group Psychotherapy: This therapy is tailored to each patient’s needs and emphasizes resilience training, illness and wellness management, and building coping skills. 
  • Family Support & Education: This is to teach family members about psychosis, coping, communication, and problem-solving skills. Family members who are informed and involved are more prepared to help loved ones through the recovery process

What Is Schizophrenia?

Schizophrenia is a serious mental illness that affects how a person thinks, feels, and behaves. People with schizophrenia may seem as though they have lost touch with reality, which can be distressing for them and for their family and friends. The symptoms of schizophrenia can make it difficult to participate in usual, everyday activities, but effective treatments are available. Many people who receive treatment can engage in school or work, achieve independence, and enjoy personal relationships.

The complexity of schizophrenia may help explain why there are misconceptions about the disease. Schizophrenia does not mean split personality or multiple-personality. Most people with schizophrenia are not any more dangerous or violent than people in the general population. While limited mental health resources in the community may lead to homelessness and frequent hospitalizations, it is a misconception that people with schizophrenia end up homeless or living in hospitals. Most people with schizophrenia live with their families or on their own.

Symptoms

When the disease is active, it can be characterized by episodes in which the person is unable to distinguish between real and unreal experiences. As with any illness, the severity, duration and frequency of symptoms can vary; however, in persons with schizophrenia, the incidence of severe psychotic symptoms often decreases as the person becomes older. Not taking medications as prescribed, the use of illicit drugs, and stressful situations tend to increase symptoms. Symptoms fall into three major categories:

  • Positive symptoms: (those abnormally present) Hallucinations, such as hearing voices or seeing things that do not exist, paranoia and exaggerated or distorted perceptions, beliefs and behaviors.
  • Negative symptoms: (those abnormally absent) A loss or a decrease in the ability to initiate plans, speak, express emotion or find pleasure.
  • Disorganized symptoms: Confused and disordered thinking and speech, trouble with logical thinking and sometimes bizarre behavior or abnormal movements.

Cognition is another area of functioning that is affected in schizophrenia leading to problems with attention, concentration and memory, and to declining educational performance.

Symptoms of schizophrenia usually first appear in early adulthood and must persist for at least six months for a diagnosis to be made. Men often experience initial symptoms in their late teens or early 20s while women tend to show first signs of the illness in their 20s and early 30s. More subtle signs may be present earlier, including troubled relationships, poor school performance and reduced motivation.

Before a diagnosis can be made, however, a psychiatrist should conduct a thorough medical examination to rule out substance misuse or other neurological or medical illnesses whose symptoms mimic schizophrenia.

Treatments

A variety of antipsychotic medications are effective in reducing the psychotic symptoms present in the acute phase of the illness, and they also help reduce the potential for future acute episodes and their severity. Psychological treatments such as cognitive behavioral therapy or supportive psychotherapy may reduce symptoms and enhance function, and other treatments are aimed at reducing stress, supporting employment or improving social skills. 

Diagnosis and treatment can be complicated by substance misuse. People with schizophrenia are at greater risk of misusing drugs than the general population. If a person shows signs of addiction, treatment for the addiction should occur along with treatment for schizophrenia. 

Does everyone with schizophrenia need to take medication? Can therapy help someone with schizophrenia?

All persons with schizophrenia need drugs some of the time and most will do better with continued use of medication to help control symptoms and prevent relapse. But the drugs are not effective for all aspects of the illness. Cognitive behavioral therapy may help with certain symptoms and supportive psychotherapy can support personal strengths and improve quality of life. Family psychoeducation can give patients and family members a better understanding of the disorder and what will be helpful. 


So, yes, drug treatment is important, but many patients will not take medication continuously for long periods and many experience side effects that have to be addressed. An integrated, comprehensive approach works best. 

What are the first symptoms someone would notice if they had schizophrenia?

The earliest signs and symptoms that come before a diagnosis can be certain. There is now a growing emphasis on identifying young people at high risk for a psychotic disorder and offering treatment in advance of a full psychotic experience. At this stage symptoms and signs include problems with personal relationships and school or work performance, experiencing odd phenomena such as hearing a voice or noise but being uncertain if it was really heard, or becoming excessively suspicious. Also, some people may develop a “loner” lifestyle, a sense that something is wrong and that one’s mind is playing tricks, and other things that mark a change in life course. These are not always early schizophrenia symptoms, but it is an indicator that it is a good time for clinical assessment and care in hopes of preventing a progression to a full first episode of psychosis. 

At first episode of schizophrenia, common symptoms include paranoia, hearing voices or seeing visions, disorganization of thoughts and behaviors, low motivation and reduced experience of pleasure, anxiety, fear, depression, sleep disturbance, social withdrawal and sometimes poor emotional control seen as anger and hostility. 

All the signs and symptoms can occur at a mild level in people who are not ill. A diagnosis must look at the severity of the symptoms, their impact on function and resulting distress. It is critical to rule out other possible causes of these symptoms before a diagnosis of schizophrenia. 
So, yes, drug treatment is important, but many patients will not take medication continuously for long periods and many experience side effects that have to be addressed. An integrated, comprehensive approach works best.