Psychosis is a condition that affects the mind, where there has been some loss of contact with reality. When someone experiences psychosis, they may see, hear, or believe things that are not real or true. Their thoughts and perceptions are altered, often in confusing and frightening ways. There are three main causes of psychosis: schizophrenia, bipolar disorder, and drug abuse. Understanding the root causes of psychotic symptoms is important for getting effective treatment.
1. Schizophrenia
Schizophrenia is one of the leading causes of psychosis. This chronic mental health condition affects about 1% of the population worldwide. Schizophrenia causes hallucinations, delusions, confused and disturbed thoughts, changes in behavior and lack of motivation. The exact causes are not fully understood, but include genetics, brain chemistry and structure abnormalities and environmental factors.
The primary psychotic symptoms of schizophrenia include:
– Hallucinations – seeing, hearing, feeling, tasting or smelling things that are not actually there. Hearing voices is the most common hallucination.
– Delusions – fixed, false beliefs not based in reality that the person firmly holds despite evidence to the contrary. Common delusions include paranoia, grandiose abilities, mind control or thought insertion.
– Disorganized thinking and speech – incoherent or nonsense speech patterns and thoughts that jump between topics. The person may be unable to carry a conversation.
– Abnormal motor behavior – including agitation, strange movements, childlike silliness and lack of restraint.
The onset of schizophrenia typically occurs in young adulthood, between the late teens to mid 30s. Men tend to show the first signs in their early 20s, while women develop symptoms in their late 20s. Schizophrenia comes on gradually in three phases:
– Prodromal phase – subtle behavioral and thinking changes including withdrawal from others, reduced concentration and interest in life, increased anxiety and irritability.
– Active phase – overt psychotic symptoms like hallucinations, delusions and disordered thinking. Behavior is more bizarre.
– Residual phase – psychotic symptoms improve, but negative ones like lack of motivation or emotion persist.
Schizophrenia is believed to stem from problems in brain development and imbalances in neurotransmitters like dopamine and glutamate. Risk factors include genetics, prenatal infections or malnutrition, childhood adversity and cannabis use. While schizophrenia itself is not curable, the psychotic symptoms can be managed with antipsychotic medications and psychosocial treatment. With proper long-term care, many people with schizophrenia can live independently and function well.
Key Points on Schizophrenia and Psychosis:
- Schizophrenia affects about 1% of the population
- Causes hallucinations, delusions, confused thinking and speech
- Related to brain abnormalities and imbalanced neurotransmitters
- Onset is typically young adulthood
- Symptoms develop gradually in three phases
- Managed with antipsychotic medication and psychosocial therapies
2. Bipolar Disorder
Bipolar disorder is another leading cause of psychosis, occurring in an estimated 2.4% of the population. Bipolar disorder was formerly known as manic depression, and involves extreme shifts in mood and energy levels. People experience both “highs” (manic episodes) and “lows” (depressive episodes). Psychosis emerges during acute manic or depressed phases.
Manic episodes involve an abnormally elevated or irritable mood plus increased energy and activity levels. Common psychotic symptoms during mania include:
– Grandiose delusions – beliefs one has special powers or talents beyond realistic possibility
– Paranoia – irrational suspiciousness of others
– Hallucinations – seeing or hearing things not actually present
– Disordered thinking – racing thoughts, distracted easily, impulsive decisions
– Agitated behavior – increased activity levels, reckless actions, hypersexual urges
Depressive episodes involve very low mood, lack of energy and interest, changes in eating and sleeping patterns. Psychotic symptoms may include:
– Delusions of guilt – false beliefs of having done something terrible
– Nihilistic delusions – beliefs that life is meaningless or the world is ending
– Paranoid delusions – fears of being harmed or harassed by outside forces
– Hallucinations telling the person they are worthless, evil, etc.
Mixed episodes can occur where manic and depressive symptoms happen together. Here, the individual experiences unstable moods, racing thoughts, sleeplessness and suicidal thinking all at once. Irrational, changeable psychotic beliefs are common.
Like schizophrenia, bipolar disorder arises from biological factors like genetics and brain changes. Imbalances in neurotransmitters serotonin, norepinephrine and dopamine play a role. Psychosocial stressors and trauma can trigger episodes in those predisposed. Substance abuse also worsens bipolar disorder. Treatment involves mood stabilizing medications and psychotherapy. With proper long-term treatment, most people with bipolar can recover good function between mood episodes.
Key Points on Bipolar Disorder and Psychosis:
- Occurs in 2.4% of the population
- Involves mood episodes – manic “highs” and depressive “lows”
- Psychosis emerges during acute mood phases
- Manic psychosis includes delusions of grandeur, paranoia, hallucinations
- Depressive psychosis includes delusions of guilt, nihilism, hallucinations
- Caused by biological and genetic factors
- Controlled by mood stabilizing medication and psychotherapy
3. Drug Abuse
Substance abuse is the third major cause of psychotic episodes. Both illegal street drugs and prescription medications can induce psychosis when taken in high doses or certain combinations. Drug-induced psychosis involves hallucinations and delusions that arise during intoxication and withdrawal states.
Some drugs known to trigger psychotic symptoms include:
Stimulants:
– Cocaine – paranoia, tactile hallucinations of insects on skin
– Methamphetamine – delusions of persecution, auditory hallucinations
– Prescription stimulants – paranoia, manic symptoms
Psychedelics:
– LSD – visual and auditory hallucinations
– Psilocybin (“magic mushrooms”) – visual hallucinations, mystical delusions
– DMT – vivid visual and auditory hallucinations
Dissociative Drugs:
– Ketamine – hallucinations, out-of-body experiences
– PCP (“angel dust”) – agitation, delirium, paranoia
Cannabis:
– Marijuana – paranoia, distorted perception of time
– Synthetic cannabinoids – anxiety, grandiose delusions
Inhalants:
– Gasoline, glue and paint – hallucinations, delusions
Prescription Drugs:
– Opioid painkillers – vivid nightmares, hallucinations
– Benzodiazepine sedatives – hallucinations during withdrawal
– Dextromethorphan (cough syrup) – dissociative, delusional states
The mechanism by which drugs induce psychotic symptoms involve over-activating dopamine receptors in the brain’s reward pathway. They also disrupt functioning of serotonin, glutamate, acetylcholine and other neurotransmitters. Genetic vulnerabilities and environmental factors make some people more prone to drug-related psychosis.
Unlike schizophrenia and bipolar disorder, substance-induced psychosis starts suddenly after taking the drug and is temporary. The symptoms typically stop once the person is no longer intoxicated or withdrawing. However, chronic substance abuse can trigger lasting psychosis resembling schizophrenia in vulnerable individuals. Treatment involves stopping the substance use and supportive care through the psychotic episode.
Key Points on Drug-Induced Psychosis:
- Many illegal and prescription drugs can cause psychosis
- Stimulants, psychedelics, dissociatives and cannabinoids are frequent causes
- Involves hallucinations and delusions during intoxication and withdrawal
- Caused by overstimulation of dopamine receptors in the brain
- Lasts during the period of intoxication or withdrawal
- Chronic abuse may precipitate lasting psychosis in vulnerable people
Common Psychotic Symptoms
While the causes of psychosis differ, there are many overlapping symptoms:
| Psychotic Symptom | Description |
|---|---|
| Hallucinations | Seeing, hearing, smelling, tasting or feeling things that are not real. Most often visual or auditory. |
| Delusions | False fixed beliefs that are firmly held despite contrary evidence. |
| Disorganized thinking | Incoherent speech and thought patterns. Jumping between topics randomly. |
| Paranoia | Irrational suspiciousness or feelings of persecution. |
| Catatonia | Lack of movement, mutism, rigid or inappropriate posturing. |
| Negative symptoms | Lack of emotion, interest, motivation or speech. |
Psychotic symptoms vary based on the underlying cause, situation and the individual. They range from mild distortions of thinking to very extreme states where one is totally detached from reality. Recognizing the signs and seeking treatment early on gives the best outlook for recovery.
When to Seek Help
Here are guidelines on when to seek medical help for possible psychosis:
– Experiencing any one of the common psychotic symptoms above, especially hallucinations or delusions.
– Catatonia – lack of movement or mutism for over an hour. This requires emergency care.
– Feeling confused, panicked or detached from reality.
– Hearing voices telling you to harm yourself or others. This needs immediate intervention.
– Inability to care for yourself – not eating, drinking, bathing, etc.
– Suicidal thoughts or self-harming behaviors.
– Extreme paranoia, agitation, aggression or risky behaviors.
– After taking recreational drugs or misusing prescription medication.
– If a mental health condition is worsening despite medication and treatment.
– New onset of psychosis symptoms in a child, teen or older adult.
Seek help from a psychiatrist, therapist, or primary doctor. If symptoms seem life-threatening, call emergency services or go to the nearest ER. With prompt care and monitoring, psychotic symptoms can often be stabilized.
Coping with Psychotic Symptoms
Here are some tips for coping with psychosis until proper treatment can be started:
– Avoid drugs and alcohol, which make symptoms worse.
– Get enough rest and sleep regularly. Lack of sleep worsens psychosis.
– Reduce sensory stimulation – bright lights, noise, hectic environments.
– Do relaxing activities like meditation, yoga or listening to calm music.
– Carry a small object like a smooth stone to hold for “grounding” when hallucinations or delusions occur.
– Remind yourself the symptoms are due to illness and will improve with time.
– Keep a journal documenting symptoms to review with your doctor.
– Confide in a trusted friend or family member who can check on you.
– Avoid making major life decisions until stabilized on treatment.
– Call a crisis line if experiencing extreme distress, suicidal thoughts or inability to function.
Though psychotic symptoms are disruptive, many people describe learnings and insights gained from the experience once treated. Having social support and appropriate care early on gives the best chance of recovery.
Diagnosing Psychosis
Psychosis itself is not a diagnosis, but a set of symptoms needing investigation. Diagnosing the underlying cause involves:
– Physical exam and lab tests to rule out infections, neurological issues, thyroid problems, vitamin deficiencies, etc. Mimics of psychosis.
– Substance screening – blood and urine tests check for recreational drugs and medications.
– Psychiatric evaluation – doctor asks about mental health history, family history, symptom timeline. Screens for disorders.
– Psychological testing – assesses thinking patterns, mood, cognitive function.
– Brain imaging – CT, MRI and PET scans help rule out tumors and structural abnormalities. Show brain activity patterns.
– Evaluation of symptom clusters – hallucinations and delusions point more towards schizophrenia, while mania and depression indicate bipolar disorder.
– Considering life context – drug use, major stresses, medical illness? Or emerging mental illness.
– Rating symptom severity using validated scales helps monitor changes with treatment.
The diagnostic process aims to pinpoint the specific driver of psychosis – whether biological illness, substance-related, trauma, or other cause. From there, targeted treatment can begin.
Treatment for Psychosis
Treatment depends on the underlying cause, but generally involves:
Medication – Antipsychotics like haloperidol, risperidone, olanzapine are used to reduce positive symptoms like hallucinations, delusions and disordered thinking. Mood stabilizers like lithium and anticonvulsants treat bipolar-associated psychosis. Some antidepressants and benzodiazepines also have antipsychotic effects. Medication helps stabilize brain chemical imbalances driving symptoms.
Psychotherapy – Cognitive behavioral therapy helps people develop coping skills. Counseling provides support. Group therapy reduces isolation and validates experiences. These aid medication in promoting recovery.
Social support – Having family and community support improves treatment outcomes. Support groups connect people who have lived through psychosis for sharing and stigma reduction.
Hospitalization – For severe, unstable symptoms, or risk of harming self or others, inpatient stabilization in a psychiatric unit may be necessary.
Substance cessation – Stopping drug or alcohol use is crucial, as intoxication and withdrawal worsen psychosis. Detoxification, rehab and peer support groups help achieve sobriety.
Skills training – Learning social, work, and daily living skills promotes functionality on the road to recovery. Occupational therapy and vocational programs are useful.
With coordinated specialty care, 70-80% of people with a psychotic disorder significantly improve, and up to 50% achieve remission from acute symptoms. Early optimal treatment leads to the most favorable outcomes.
Preventing Psychosis
While not all causes of psychosis can be prevented, some key strategies include:
– Avoiding substance abuse, especially of stimulant drugs, psychedelics, cannabis.
– Managing stress through good self-care – diet, exercise, sleep, relaxation skills.
– Taking medications only as prescribed by a doctor.
– Getting proper treatment for emerging mental illness like mood disorders or schizophrenia.
– Having good social support and fulfilling activities.
– Reducing risk factors like childhood trauma and social isolation.
– Catching early warning signs like withdrawal from others, mental confusion.
– Screening children and teens from high-risk families and arranging support or therapy.
– Public education to reduce stigma so people feel comfortable getting help early.
– Making mental health treatment accessible and affordable for all.
While prevention is not always possible, avoiding risks and catching problems early improves outcomes for psychotic disorders.
Conclusion
Psychosis involves losing touch with reality through symptoms like delusions and hallucinations. The three main causes are schizophrenia, bipolar disorder and substance abuse. Exact mechanisms involve brain changes and chemical imbalances. Catching symptoms early and getting comprehensive treatment leads to the best prognosis and recovery. While psychosis itself cannot always be prevented, avoiding recreational drug use, managing stress and getting early intervention for mental illness can reduce the likelihood of severe psychotic episodes.