Diagnosis | Psychosis

Diagnosis

The diagnosis of a psychosis does not initially require any apparative medicine but is a purely clinical diagnosis and is made on the basis of the patient’s behavior and symptoms. Once the diagnosis has been made, however, further diagnostics must be carried out to narrow down the possible causes of the psychosis. In order to exclude the presence of organic psychosis, it is first of all important to take an exact anamnesis.

Since the affected persons are hardly able to hold an adequate conversation even during a psychosis, the attending physician is often dependent on the foreign anamnesis, i.e. the questioning of close relatives, acquaintances and friends. Important for the anamnesis is the question of previous illnesses, both somatic and psychological. It is also very important to find out whether a psychotic episode has ever occurred.

Furthermore a possible drug consumption should be questioned exactly. Also the question of regularly taken medication is important. After the anamnesis follows the taking of blood samples.

Here, too, physical illnesses may be revealed, which may be a possible trigger for the psychosis. In many cases, it is also useful to take an image of the head in order to rule out space-consuming processes in the brain or, for example, diseases such as multiple sclerosis. In older patients – depending on the issue at hand – the more quickly available computed tomography (CT) can be used, which can be used to exclude space-occupying processes relatively reliably.

For younger patients and special questions, however, magnetic resonance imaging (MRI) is more likely to be used. An electroencephalogram (EEG), i.e. an examination of the brain waves, may also be necessary. Which further examinations are necessary depends on the current examination results.

TreatmentTherapy

In the case of a psychosis, it is important to start treatment quickly. Depending on the severity of the psychosis, the treatment can be carried out on an outpatient or inpatient basis. Often, however, in-patient treatment is recommended due to the severity of the symptoms that cause the patient to endanger himself.

The first choice for the treatment of psychosis are drugs, the so-called antipsychotics or neuroleptics. The group of these drugs includes numerous different active substances, but almost all of them intervene to a greater or lesser extent in the dopamine metabolism in the brain and thus lead above all to the rapid containment of delusions and hallucinations. In most cases, antipsychotics should continue to be taken even after the symptoms have subsided, as they significantly reduce the probability of a recurrence of the psychosis.

How long the medication should be taken must be decided individually. Particularly in the case of psychoses with a recurrent (recurrent) course, such as schizophrenia, it is often necessary to take the medication permanently. A distinction is made between typical and atypical antipsychotics.

Nowadays, atypical antipsychotics such as risperidone, quetiapine, clozapine, olanzapine and aripiprazole are increasingly used. Typical antipsychotics such as Haloperidol are nowadays mainly used in the acute phase. However, which antipsychotic is used must be decided individually.

Psychotherapeutic procedures play only a minor role in the acute phase of psychosis, but can help in the course of the disease. Patients who have experienced a psychosis can also participate in psychoeducation groups. Here they are informed about the topic of psychosis and how to deal with it and meet with like-minded people.

In the case of organic psychoses, the treatment of the triggering illness is the first priority. Zyprexa is a drug from the group of antipsychotics.It contains the active ingredient olanzapine and is one of the atypical neuroleptics. It is mainly used for the treatment of psychoses that occur in the context of paranoid schizophrenia.

It is also used to treat bipolar disorders. In addition, olanzapine can be used as a second drug in depression for so-called augmentation therapy. The theory here is that an increase in a second drug, in this case olanzapine, has an additional mood-lifting effect. Very common and frequent side effects of olanzapine are weight gain, fatigue, dry mouth, dizziness, nauseavomiting, constipation, insomnia and restlessness, increase in certain blood levels, edema (water retention), unusual movements (dyskinesia), skin rash, joint pain and disorders of sexual function.