Psychosis can be defined in general terms as a “set of serious psychopathological conditions characterized by the loss of contact with reality and the ability to criticize and judge, by the presence of pervasive disturbances of thought, perceptions and affectivity and by an impairment skills and social relationships. ” (Treccani Medical Dictionary).
In connection with this definition, a variety of illnesses that can cause psychosis or psychotic symptoms come to mind, such as schizophrenia, schizotypal personality disorder, drug-induced or drug-induced psychotic disorders, and psychotic disorders due to other illnesses.
What is psychosis?
Spectrum disorders of schizophrenia and other psychotic disorders are characterized by abnormalities in one or more of the following areas: delusions, hallucinations, disorganized thinking (speech), disconnected or abnormal motor behaviors (including catatonia) and other negative symptoms (from the Diagnostic Manual and statistician of mental disorders ). Let’s find out the characteristics of these symptoms of psychosis together.
Delusions are fixed beliefs that are not susceptible to change, even in the face of irrefutable evidence against them. The theme of delusions can touch various areas (persecutory, referential, somatic, religious, of greatness, etc.). Although it is wrong to simplify, they can be defined as “stories invented” by people who are unaware of their fictional character. The person is, therefore, led to express what he is really convinced of and to act accordingly, even when it does not correspond to reality.
Delusions are considered extravagant when they are clearly improbable, incomprehensible and not related to current life experiences. An example of an extravagant delusion is the belief that an external force has stolen the individual of his internal organs and replaced them with those of another person, leaving no wounds or scars. An example of a non-extravagant delusion is an individual’s belief that he is under police surveillance without any convincing evidence of this.
Hallucinations are perceptions that occur without the presence of an external stimulus. They are vivid and clear, with all the force and impact of normal perceptions, and are not subject to voluntary control. They can occur in any sensory modality, although the most common in schizophrenia and other related disorders are auditory hallucinations.
“Auditory hallucinations are usually experienced in the form of voices, known or not, perceived as separate from one’s own thought” (from the Diagnostic and Statistical Manual of Mental Disorders ). There are also tactile, olfactory and visual hallucinations.
Disorganized thinking (speech)
Disorganized thinking (formal thought disorder) usually occurs from the individual’s capacity for dialogue. It is very difficult to maintain a conversation with patients with psychosis, as they can change the subject at any moment. Their answers may not be related to our questions and the speech can be so disorganized that it becomes virtually incomprehensible.
Disconnected or abnormal motor behaviors (including catatonia)
Disconnected or abnormal motor behavior can manifest itself in a number of ways, from typically infantile actions to unpredictable manifestations of agitation. Problems may arise in carrying out any goal-directed behavior, resulting in difficulties in carrying out daily activities.
The catatonic behavior is characterized by the marked reduction of reactivity towards the surrounding environment. It can range from resistance to following instructions, to the adoption of a rigid, inappropriate or extravagant posture, to the total absence of verbal or motor responses.
Other characteristics are the repeated stereotyped movements, the fixed gaze, the grimaces, the silence and the echolalia (repetition of words or syllables).
Two of the most pronounced negative symptoms in schizophrenia are reduced emotional expression and apathy. The first case consists of a reduction in the ability to express emotions through facial movements, eye contact, the pitch of the voice tone and the movements of the hands, head and face that normally bring emphasis to speech.
Abulia is the reduction of activities born from one’s own initiative and motivated by a purpose. The individual can remain seated for a long period of time without showing any interest in any work or social activity.
What is the cause of psychosis?
It is a very difficult question to answer: the cause is not just one, it is rather a multitude of factors or causes that can determine the onset of psychosis. Today we will try to answer this question by analyzing the different “diseases” that can cause psychotic symptoms.
Genetic factors can go a long way in determining the risk of developing schizophrenia, although most individuals with this diagnosis are found to have no family history of it. The predisposition to suffer from this disorder is given by a range of risk alleles, both common and rare. Each allele contributes only to a small fraction of the total population.
Complications during pregnancy and neonatal asphyxia (birth with lack of oxygen), as well as a high age of the mother, are associated with an increased risk of suffering from schizophrenia. Other adverse situations during pregnancy, such as stress, infections, malnutrition, diabetes in the mother and other medical ailments, can also affect.
The season in which the child is born has also been associated with the onset of schizophrenia. For example, in some areas the worst time would be between late winter and early spring. Furthermore, the incidence of schizophrenia and other similar disorders is higher in children born in an urban environment, as well as within some ethnic minorities.
It is defined as an uninterrupted period of illness during which major depressive disorder, delusions, hallucinations, disorganized speech, disjointed behavior or negative symptoms occur .
The risks of presenting a schizo-affective disorder are greater in the case of first-degree relatives already suffering from schizophrenia, bipolar disorder or schizo-affective disorder.
Brief psychotic disorder
The risk factors in this case are given by pre-existing personality disorders and traits, such as schizotypal personality disorder, borderline personality disorder or other characteristics of the person, such as distrust. Brief psychotic disorder is usually triggered following a stressful event, but this does not mean that any stressful event causes this disorder to occur.
Other disorders of psychosis
In general, it is possible to state that psychosis will not present itself in an individual who is not predisposed to it. The major risk factor is of biological origin, and the main determinant of the disease is usually a situation of high stress or the consumption of certain substances (drugs).
Not all psychotic episodes are caused by drug use, but drugs certainly increase the risk of them occurring. Some drugs, such as cannabis, can trigger psychotic episodes. Furthermore, people who have already been victims of them will be particularly sensitive to the harmful effects of drugs, especially if such episodes were related to drug use.
There are many studies on the possible causes and, although the mechanisms involved in the onset and evolution of symptoms are not yet known with certainty, the model of vulnerability and stress is the one that has had the most evidence in recent times. According to this model, the individual with psychotic symptoms is more likely to suffer from this disease than others. All this can be due to a biological aspect as well as to a life event that generated its development.
Treatment of psychosis
The treatment program for a psychotic disorder must be multidisciplinary, coordinated and integrated, and usually involves the intervention of several professionals. Recommendations for an adequate treatment program are as follows:
- Evaluation and diagnosis of symptoms.
- Development of the treatment program. The basic treatment is pharmacological, but it can be enhanced by psychological interventions that will have a greater impact on negative symptoms, psychosocial functioning, cognitive function and, ultimately, the quality of life of people with psychosis.
- Achieve an optimal doctor / psychologist-patient relationship and ensure that the latter is actively involved in the treatment.
- Disease education for the patient and family members.
- Intervention on other related alterations.
- Intervention on the social functioning of the patient.
- Integration of the different treatments to which the patient is subjected.
- Findings of the treatments carried out.
The administration of drugs is always the main choice for the treatment of subjects with psychosis, however the intervention will be much more effective if combined with the entry on the scene of a psychologist. The drugs that are administered in these cases are antipsychotics or neuroleptics, but anxiolytics and antidepressants are also used in order to treat anxious and / or depressive symptoms.
Family education interventions
It is essential to carry out an intervention on the family sphere so that the family itself is aware of the symptoms of the affected person, so that they can better manage them. Some goals of psychoeducation consist in finding an adequate explanation for the disorder, reducing the emotional burden of family members, generating a positive atmosphere, improving communication and so on.
Social Skills Education
People with psychosis have, in most cases, a deficit in social skills which leads to an increase in relapses and symptoms, as well as poor social skills. The treatment will include work on gestures, fluency in speech, tone and speed of language, posture, expression and emotional and social perception.
Integrated Psychological Therapy (IPT) by Roder and Brenner (2007)
IPT is a rehabilitation intervention for schizophrenia. It is carried out in groups of 5-7 patients three times a week for a minimum duration of three months. The intervention consists of 5 modules which include cognitive rehabilitation (cognitive differentiation, social perception and verbal communication) and education aimed at social skills (social skills and solving interpersonal problems).
Ultimately, as already mentioned, the treatment of psychotic disorders is fundamentally pharmacological and supported by psychological interventions to increase its effectiveness. In this sense, pharmacological treatment is fundamental: it allows the reduction of symptoms in the individual and contributes to the maintenance of a phase of stability. In other words, it helps generate positive conditions for working with that person in therapy.