Psychosis

Psychosis is a mental state in which a person cannot distinguish between reality and their imagination. Rather than being a condition in itself, psychosis is a symptom of other conditions, the most common of which are schizophrenia or bipolar disorder (manic depression).

What are the symptoms of psychosis

Psychotics often experience hallucinations and delusions, or have confused, disturbed and disrupted thoughts.

Hallucination

This is the perception of something that does not exist in reality. It can occur in any or all five senses:
• Sight
Seeing colours and shapes, or imaginary people or animals
• Sound
Hearing voices that are angry, unpleasant or sarcastic
• Touch
Psychotics often feel that insects are crawling on their skin
• Smell
Experiencing a strange or unpleasant smell
• Taste
Having a constant unpleasant taste in the mouth

Delusion

This is an unshakable belief in something that is implausible, bizarre or obviously untrue. There are two common types of psychotic delusion:
• Paranoid delusion
Psychotics often believe that an individual or organisation is making plans to hurt or kill them. This may lead to unusual behaviour, where, for example, a sufferer may refuse to be in the same room as a mobile phone because they believe it is a mind-control device
• Delusions of grandeur
A psychotic may believe that they have an imaginary power (such as to bring people back from the dead), or hold a position of authority (such as being president of a country)

Confusion of thought

Signs of this include:
• rapid and constant speech
• random topics of speech, sometimes switched in mid-sentence
• sudden stops in a train of thought, causing an abrupt pause in conversation or activity
• lack of the self-awareness to recognise that their behaviour is in any way strange, or that their delusions or hallucinations could be imaginary – even though they may be capable of recognising delusional or bizarre behaviour in others. Often, psychotics being treated in a psychiatric ward complain that their fellow patients are mentally ill, whereas they are perfectly normal

What causes psychosis

There are three main causes of psychosis:
1. Psychological illness, such as schizophrenia or bipolar disorder
2. General medical conditions, such as Parkinson's disease or severe depression
3. Substance abuse, such as taking drugs or alcohol, or withdrawal from drugs

Where there is a psychological cause, its nature will often influence the type of psychotic episode experienced. For example, someone with bipolar disorder is more likely to have delusions of grandeur, whereas depression or schizophrenia is more likely to lead to paranoid delusions.

General medical conditions that have been known to trigger psychotic episodes include severe stress or anxiety, severe depression, lack of sleep, Parkinson's disease, Alzheimer's disease, HIV/AIDS, malaria, syphilis, hypoglycaemia, lupus, Lyme disease, multiple sclerosis, and a brain tumour.

Drugs that are known to trigger psychotic episodes include cannabis, alcohol, cocaine, amphetamine (speed), methamphetamine (crystal meth), MDMA (ecstasy), LSD (acid), psilocybins (magic mushrooms), and ketamine.

Research has shown that regular cannabis users are twice as likely to develop a psychotic illness than people who do not take the drug. Cannabis is known to increase the levels of dopamine in the brain, so long-term use may cause permanent brain chemistry changes that could lead to psychosis. People who regularly use skunk (high-strength herbal cannabis) are thought to be most at risk. Recreational drugs such as cocaine and ecstasy also increase the risk of psychosis.

Psychosis may also (rarely) occur as a side effect of some medications, or as a result of a medication overdose.
The duration of a psychotic episode will depend on the underlying causes. Drug- or alcohol-induced psychosis many only last for a few days, whereas psychosis caused by schizophrenia or bipolar disorder may last indefinitely unless it's treated.

What treatments are available for psychosis

Treatment involves a combination of antipsychotic medicines and psychological therapies. Antipsychotics, which work by blocking dopamines, are usually recommended as the first-line treatment for psychosis. Psychological treatment, such as counselling or cognitive behavioural therapy (CBT), can help to reduce the intensity of feelings and the anxiety caused by psychosis.