Psychosis Diagnosis

  • Diagnosis

    Psychosis is a psychiatric condition that causes a person to lose his or her sense of reality. People with psychosis have hallucinations, delusions, or disorganized thinking that cause them to lose touch with reality. Someone who is psychotic may hear voices that no one else can hear, or perceive threats that are not real. Psychosis can be very disturbing when it happens to someone you know and care about. The person might not acknowledge that anything is wrong, and may resist efforts to help.

    An array of medical and psychiatric problems can cause psychosis Table 01. Psychosis can result from a variety of psychiatric and medical problems. When psychosis stems from a mental illness, it is best handled by a psychiatrist. However, a family doctor or neurologist can manage cases of psychosis that are triggered by an underlying medical problem.

    Drug and alcohol use and withdrawal have been linked to psychotic episodes. Symptoms that are drug— or alcohol—induced sometimes fade after the intoxicating effect of the substance has worn off.

    Physical illnesses that interfere with brain function may cause psychosis as well. Psychosis is associated with infections, brain tumors, metabolic abnormalities, nutritional deficiencies, and dementia.

    Psychiatric illnesses, most commonly schizophrenia, frequently lead to psychosis. Delusional disorder, marked by unshakable false beliefs, is another psychotic condition. Psychosis sometimes accompanies affective disorders such as depression and bipolar disorder (manic depression). In such cases, the symptoms tend to conform to the patient’s mood. For example, depressed patients may hear voices telling them to end their life. Bipolar patients in the throes of the illness’s extreme highs may believe they can fly or perform other superhuman feats.

    Finally, a stressful event — such as witnessing a violent act or being sexually abused — can produce psychotic symptoms.

    Table 1.  Possible Causes of Psychosis

    Cause Comments
    Drugs and alcohol The use or withdrawal of drugs and alcohol can cause intense visual hallucinations and confusion. Symptoms usually come on suddenly and may disappear once the intoxicating effect of the substance has worn off.
    Physical illness AIDS, encephalitis, brain tumors, dementia, metabolic problems, and nutritional deficiencies sometimes bring on visual hallucinations and fragmented delusions.
    Schizophrenic disorders Schizophrenia (psychotic behavior that lasts for at least 6 months) and schizophreniform disorder (psychotic behavior that lasts for less than 6 months) typically cause auditory hallucinations. Delusions tend to be well?formed and may be elaborate. The ability to socialize and function typically becomes impaired.
    Affective disorders Bipolar disorder and depression can have psychotic manifestations that reflect the patient?s mood: delusions of grandeur during mania and delusions of worthlessness during depression.
    Paranoid states Delusional disorders might make people who are otherwise mentally sound have false beliefs that are paranoid in nature. For example, patients may believe the FBI is watching them or that someone is out to get them.
    Reaction to severe stress Psychotic symptoms sometimes arise after a major life stress, such as a pregnancy or a death in the family. Postpartum psychosis usually occurs a month after giving birth. Being subjected to violence also can trigger psychosis.

    Psychosis produces emotional and behavioral changes in patients. Tell—tale symptoms include hallucinations, delusions, and confusion Table 02. Psychotic hallucinations are often visual or auditory. Patients may see things that are not there or hear voices. Occasionally, hallucinations involve the other senses — taste, touch, and smell. Psychotic patients suffering from delusions are so convinced of their false belief that even the most rational argument cannot dissuade them. A patient may believe he is George Washington or think that she has magic powers. Delusions are sometimes paranoid; patients might feel that their lives are in danger, and call the police repeatedly. Confusion is also common in psychosis; thoughts tend to be muddled, and speech stops making sense.

    Radical shifts in emotions and behavior may accompany psychosis, but are not considered to be psychotic symptoms. The patient might become incredibly happy and overactive, or severely depressed and lethargic. He or she may laugh at odd times, or become angered and upset for no apparent reason.

    Table 2.  Symptoms of Psychosis

    Confused thoughts
    Speech that is hard to understand
    Delusions (firmly held false beliefs)
    Hallucinations (seeing, hearing, smelling, tasting, feeling something that is not there)
    Altered emotions (overly emotional, not showing any emotion at all, depression, mania)
    Unusual behavior (laughing at inappropriate times, becoming angry for no reason)
    Neglect of personal hygiene
    Inability to function
    Loss of interest in daily activities

    Although psychosis can affect all age groups, it often occurs in younger people. Psychosis caused by a psychiatric disorder such as schizophrenia or manic depression usually starts during the teen years or in early adulthood. In young people, psychosis can be mistaken for normal teenage rebellion, or can be associated with drug and alcohol use. Depression—related psychosis typically begins after adolescence, and may appear during the second or third decade.

    Having a family history of schizophrenia puts you at risk for psychosis.

    When determining the cause of psychosis, a doctor will take a careful history. It is important for the doctor to determine whether psychosis is the result of a psychiatric illness such as schizophrenia, or whether it is secondary to an underlying medical problem. Because the patient may not be able to communicate reliably, relatives and friends should accompany the patient to the doctor’s office to provide accurate information.

    The doctor will perform a physical evaluation to rule out an underlying medical problem. Physical and neurological examinations can unearth a medical disorder that may have triggered psychosis. To determine whether psychosis is secondary to some sort of brain dysfunction, the doctor will evaluate the patient’s sense of smell, vision, and hearing; strength and reflexes, and stance and gait. Radiological studies, such as x—rays, CT scans, or MRI scans, can reveal a structural problem in the brain. Blood tests and urinalysis can indicate a possible thyroid or other metabolic problem, vitamin deficiency, drug use, or infection.

  • Prevention and Screening

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