Statistically, about one percent of German citizens suffer from psychosis at least once in the course of their lives. However, the term itself is very complex and must not necessarily be confused with schizophrenia, but this happens very often. At the same time, a psychotic illness does not have to mean a devastating diagnosis nowadays. A psychso is to be distinguished from a neurosis.
What is a psychosis?
The term psychosis is an umbrella term, whereby a distinction is made on the one hand between organic and non-organic psychoses, but also between affective psychoses and psychoses from the schizophrenic form group. Organic psychoses can, for example, be triggered by a brain injury (such as craniocerebral trauma). Non-organic psychoses, on the other hand, include manic-depressive episodes, so-called schizoaffective disorders (disorders of emotional experience) and psychoses of the schizophrenic type. The hallmark of all psychoses is always a persistent or temporary loss of reality (hearing voices, overestimating or underestimating oneself, delusions, etc.). The term is therefore very comprehensive and differential diagnoses for a more detailed definition of the clinical picture are inevitable.
Causes
Currently, science assumes a vulnerability-stress model as the cause model of psychosis. According to this model, some people are more sensitive (vulnerable, hurt) than others and tend to develop psychosis in certain situations (for example, prolonged stress). This model correctly includes the genetic aspects, as it refers to the fact that not everyone develops psychosis under the same circumstances. For this reason, it is also a fact that in some people drug use such as hashish leads to psychosis, but in others it does not. Overall, drug use, difficult social conditions, prolonged stress, traumatic experiences, as well as a strong genetic makeup can all be causes of psychosis. In most cases, however, it is a mixture of several factors. In the meantime, it has been established that during an outbreak of psychosis, the brain metabolism of the affected person is not in balance. In particular, an excessive amount of the neurotransmitter dopamine is held responsible for a psychosis. Of course, social components or drug use, for example, also have an effect on dopamine metabolism.
Typical psychoses
- Schizophrenia
- Affective disorders
- Depression
- Drug psychosis
Symptoms, complaints and signs
Psychosis includes a very extensive repertoire of symptoms and for this reason is difficult to standardize. Nevertheless, frequently appearing characteristics of the disease exist. In the early stages, patients suffer from increasing nervousness and lack of concentration. This also includes slightly pronounced communication problems when communicating with other people. In addition, intellectual performance is impaired by thought blocks or a veritable flood of incoherent thoughts. In the later course, delusions and hallucinations manifest themselves. Persons with psychosis have an unusually pronounced tendency to distrust, hear voices in their head, and feel constantly watched by real or imaginary people. In ego disorder, sufferers become convinced that other people hear their thoughts and deliberately influence them. Great irritability or a conspicuous lack of emotion occur as a result. In severe cases, this leads to hostility and aggression towards fellow human beings or the environment. Often patients develop an unusual interest in contents of mystical background or follow a strongly religious way of life. The symptoms do not always worsen gradually. They can also appear completely unexpectedly and quickly subside again. Social contacts also suffer from the strange behavioral changes. People in the immediate environment often perceive them as unreasonable or threatening and therefore increasingly withdraw from the affected person.
Disease progression
Statistically, about one-third of those affected experience psychosis only once in their lives, the second third become ill twice or more, and in the last third the clinical picture becomes chronic and manifests as permanent schizophrenia.Normally, a psychosis announces itself by the affected person initially perceiving their environment as alien, feeling strange and not being able to explain this properly. Subsequently, the affected person tries to put together a therapy to explain what is happening. This is usually the beginning of delusions and loss of reality. This, in turn, can lead to the affected person’s hostile perception of their environment and may become violent because of it – they are, after all, victims of an alleged “conspiracy.”
Complications
Psychoses, especially hallucinations and delusions, are always frightening for the patient himself and his social environment, so they should be treated in any case. However, psychotic disorders usually only become problematic when the affected person is no longer able to cope with his or her job and everyday life on his or her own because of the illness, or when he or she poses a danger to himself or herself or to others. Complications result in particular from actions that endanger oneself or others and from inadequate care of one’s own body. Psychotic disorders also make sufferers more susceptible to abuse of alcohol and other drugs, which can exacerbate the symptoms of psychosis. Hallucinations often take extreme forms under the influence of drugs. Here, there is a risk that the patient, fleeing from what he sees, will seriously injure himself or take measures of resistance that also endanger others. In severe cases, the patient may also attempt suicide to escape a perceived worse danger. Delusions, especially in the presence of concurrent substance abuse, can take such severe forms that patients attempt to fly or walk on water and suffer life-threatening injuries or drowning.
When should you see a doctor?
People who show abnormalities of behavior should be further observed. A distinction should be made between personality traits and true disorders. If generally accepted social rules are permanently disregarded or seemingly deliberately ignored, a visit to the doctor should be made. Unpunctuality, gratuitous insults, perceptual disorders or uncontrolled actions are alarming signs of a disorder. If interaction with other people regularly triggers conflict, discomfort or fear in the other person, a check-up visit with a doctor or therapist is indicated. Hearing voices, intuitions of an imaginary power or seeing objects that are not there are considered worrisome. The indications are to be distinguished from spiritual or believing perceptions. In the case of psychosis, the affected person does not behave in conformity with the social norm. He overreacts, has problems with impulse control, harms himself and others in his behavior. If he becomes a danger to himself or the environment, emergency services should be alerted. Affected individuals are unable to perform everyday duties due to their symptoms. If drug-induced behavioral disorders are detected, medical help is needed. A physician should be consulted if withdrawal behavior, apathy, loss of appetite, or a depressive demeanor are observed. Problems of concentration or attention as well as delusions should also be clarified.
Treatment and therapy
Psychosis is usually treated as an inpatient with neuroleptics. In contrast to the drugs used in earlier decades, the so-called atypical neuroleptics of the newer generation are preparations with fewer side effects, which is why they are preferred for therapy. In recent years, a large number of new neuroleptics have come onto the market. In the case of psychosis, however, psychotherapy is also necessary in addition to drug therapy. The right medication and a coherent psychotherapy are often the key to success, i.e. to the subsiding of the psychosis. Above all, there is no alternative to drug therapy; psychotherapy has proven effective only in combination with the right medications. It is now considered outdated to try to cure psychosis only with psychoanalysis or only with psychotherapy. In order to find the right medication or the right combination of medications, often only trial and error is possible at first, since psychoses and metabolic processes in the brain run very differently.However, the drugs available on the market are usually very effective, which was not necessarily the case with older generation neuroleptics. In the acute phase of psychosis, hospitalization in a psychiatric hospital is often necessary.
Prevention
To prevent psychosis, it is important not to overdo things, i.e., keep stress in check and solve social problems. Prevention also includes not using drugs because, after all, no one knows if they have a genetic predisposition to psychosis that can be caused by intoxicants. In particular, people who have already experienced one or more psychoses should handle their powers with care and not take drugs under any circumstances. It is also necessary to regularly take the prescribed medication and regularly consult a specialist to avoid a relapse.
Aftercare
Suffering a relapse in psychosis is not only very stressful for the person affected, but also for his or her social environment. However, this can be prevented by appropriate aftercare. During the follow-up examinations, it is determined whether the patient is still well adjusted to the medication prescribed during treatment. In addition, the treating physician holds appropriate discussions with the patient about the modes of action and side effects of the antipsychotics. The problem with the unauthorized discontinuation of the medication is that there will be improvements in the state of health during the first period. After that, however, the same symptoms will reappear during a relapse. This can be prevented by consistent aftercare. During aftercare, psychological support is important in addition to general medical and neurological therapy. Social contacts that were lost during the disease can be re-established in this way. Cognitive abilities, such as memory and the ability to concentrate, are also regained and stabilized. Therapies to reduce stress and avoid excessive demands are also advisable. The basis for successful aftercare is that the patient engages with the team of doctors and therapists. This is how psychosocial aftercare treatment is then successful.
Here’s what you can do yourself
To improve the situation, a healthy lifestyle is important. This includes a very sparing intake of stimulants such as coffee, tobacco and sugar, as well as abstaining from illegal and legal drugs. Healthy food and drink as well as sufficient and regular sleep are better alternatives. The daily routine should be clearly regulated. The social factor is also crucial. Discussing a crisis plan with close friends or relatives is just as much a part of this as regular contact with mentally stable people. These do not necessarily always have to come from the closest social network. They can be found in numerous activities that also do good. These include sports, hiking and volunteer activities. Since stressful or otherwise stressful situations can always arise, relaxation should always be provided as a counterbalance. This should not be postponed until later. In order to discuss a situation that is perceived as stressful with others or to obtain new tips for dealing with psychosis, it may be advisable to join a self-help group. These and similar contacts should be maintained permanently, as this is the only way to ideally address a later crisis situation.
