What is Psychosis?
Psychosis is a state of mind disconnected from reality, characterized by perceiving elements from the environment that do not exist. Psychiatrists and medical professionals characterize a psychosis as a mental illnesses exhibiting a severe mental condition where thought and emotions lose contact with external reality. Psychosis is the ultimate escape from reality by retreating to a place of our mind’s own making. A person suffering from a psychotic episode is unable to distinguish the internal experience of the mind from external realities. Appeals to logic typically fail to puncture the overwhelming sense that the psychotic episode is only a construction of the mind.
Psychosis primarily involves two main disconnections from reality—hallucination and delusions. A hallucination is when we see and hear things that do not exist. A delusion is when we believe things that are not true.
Psychosis may be a primary disorder or a secondary symptom to neurologic or medical conditions. Psychosis may be a brief psychotic episode occurring under extreme distress. or a reoccurring state associated with a mental or physical disease.
Key Definition:
Psychosis is a severe mental condition where thought and emotions lose contact with external reality.
History of Psychosis
Psychosis existed long before the name, even before symptoms of hallucinations were given the name dementia praecox by German psychiatrist Emil Kraepelin in the late 1800’s. Markedly, Psychosis has gone through “a series of labels, from different variations of the French word ‘demence’ or loss of mind in the 1800s, to dementia praecox, and now to a range of diseases, typically found somewhere on the schizophrenia spectrum (Plumptre, 2022).
Symptoms of Psychosis
The symptoms of psychosis typically are hallucinations, delusions, disorganized thoughts and behaviors, and a list of negative symptoms that impact quality of life.
Delusions
Delusions are “tenacious false beliefs that are maintained despite indisputable evidence of the contrary” (Julayanont & Suryadevara, 2021). Delusional beliefs may be bizarre or possible but no supportable evidence exists, to support the belief.
For example, I met a woman who was convinced that intruders surrounded her house, possessing “mind-stealing” lasers. No matter the logical evidence to the contrary, she could not let go of the idea that people were surrounding her house, trying to steal her mind.
A bizarre delusion may be:
- thought insertion, characterized by alien thoughts being unwillingly inserted into the brain
- delusions of control, characterized by an individuals actions being manipulated by an outside force
- thought withdrawal, characterized by the stealing of thoughts by an outside entity (Julayanont & Suryadevara, 2021).
Others create a theory that sounds plausible, and then treat the unsupported theory as if it was fact, reacting with distain when others fail to believe the same. This is a delusion as much as the “mind-stealing” invaders.
Hallucinations
A hallucination is “the false perception of sensation that does not correspond with an external stimulus” (Julayanont & Suryadevara, 2021). We may experience hallucinations in any sensory modality: auditory, visual, olfactory, gustatory, tactile, nociceptive, thermoceptive, proprioceptive, and many others.
Our brains are constantly at work receiving and translating senses, from energy flowing through our system to conscious recognition with a label. When psychosis occurs, our brain begins to create its own stories without the preceding sensory input. We think we hear voices, see visions, our feel an injury. However, all these sensations are created without the normal prompting of an external event.
Disorganized Thoughts
Disorganized thinking is revealed by disruptive patterns of speech, indicating a formal thought disorder. Some common thought disorders are:
- Circumstantiality: Over inclusion of trivial or irrelevant details.
- Clang Associations: Thoughts are associated through sounds of the words rather than by meaning, often using words that rhyme that do not have meaningful relation to each other.
- Derailment (synonymous with loose associations): Lack of goal directed speech, jumping from idea to idea without logical connection, leading to nonsensical sentences.
- Flight of Ideas: Quickly jumping from idea to idea, often through rapid and forced speech.
- Neologism: Inventing new words and phrases; or unconventional use of conventional words.
- Perseveration: Repetitive use of words and phrases, or ideas, throughout a conversation, even after the context is no longer relevant.
- Tangentiality: Responses to questions that refer to the general topic without answering the question.
- ”Did you eat breakfast this morning?” ” I like to eat cereal.”
- Thought Blocking: Disrupting flow of thoughts leading to sudden starts and stops in speech patterns.
Disorganized Behaviors
We may observe lack of hygiene, nourishment, and sleeping patterns. In addition, they may talk to themselves, laugh or yell at socially inappropriate moments. They may become rigid or react with catatonic excitement.
Basically, disorganized behaviors strike the observer as odd, signaling that something is amiss with the individual.
Negative Symptoms
Schizophrenia is characterized by several negative symptoms. These symptoms include:
- little emotional expression
- avolition (lack of motivation)
- alogia (poverty of speech)
- anhedonia (lack of ability to experience pleasure)
- asociality
Negative symptoms seriously impair an individuals ability to function (Schrimpf, Aggarwal, & Lauriello, 2018).
When evaluating symptoms, we must keep in mind, that disfunction always is born from functional behaviors. We all express some of symptoms of disfunction to a lesser degree. When diagnosing an illness, we must determine that the severity of the symptoms are sufficient to be classified as a disorder.
Causes of Psychosis
“A cohesive understanding of the pathophysiology of the major psychotic disorders is lacking, even to the extent of defining whether one or many disease processes are involved” (Corvin and Harold, 2015).
While the exact pathophysiology allude researchers, science is still making progress. Clinicians may identify an underlying disease or specific condition as the cause of psychosis. A few common causes are:
Schizophrenia
We often associate psychosis with schizophrenia because schizophrenia is primarily characterized by its symptoms of hallucinations and delusions. However, a doctor may diagnose a patient with other mental disorders that fall on the schizophrenia spectrum without meeting all the criteria for a schizophrenia.
Bipolar Disorder
“Bipolar disorder is characterized by biphasic mood episodes that alter between depression and mania.” A common delusion is thoughts of grandiosity or indestructability (Murphy, 2022b).
Severe Depression
The DSM characterizes major depressive disorder as a persistent feeling of sadness and emptiness. Some people experience symptoms of psychosis, such as paranoid ideations, together with the other symptoms of a depression.
Other
- a traumatic experience
- extreme stress
- drug misuse
- alcohol misuse
- side effects of prescribed medicine
- a physical condition, such as a
- brain tumour
- traumatic brain injury
- Alzheimer’s disease
Stress and Psychosis
Early theories of psychosis typically relied on psychological explanations such as stress as the underlying cause.
Rollo May (1904-1994) theorized that neurotic and psychotic symptoms “may be viewed as endeavors to adapt to a conflict situation when the problem causing the conflict cannot be solved.” He continues, “in situations of severest conflict the individual may be powerless to cope with the threat by means of the above-mentioned compromises, and may be forced to renounce a large arena of activity or reality (e.g., psychosis)” (2015).
While research has shown that extreme stress is a contributing cause of psychosis, often these breakdowns are temporary in nature. As a result of extreme demands, the mind temporarily finds refuge by fleeing reality. When the challenges of the moment exceed our window of tolerance, something gives. Consequently, in the case of psychosis, the part that gives is our connection to reality.
Other theories, such as the diathesis stress model, propose that that “disorders develop as a result of interactions between pre-dispositional vulnerabilities (the diathesis), and stress caused by life experiences” (Murphy, 2021).
Treatment
Whatever the cause, experiences of psychosis are serious medical issues, signaling a breakdown of normal processes of the mind and require treatment. Many pharmaceutical advancements lesson the impact of negative symptoms associated with psychosis, improving the quality of life for those suffering from psychosis. Therapy also can assist with reducing anxiety, and improving emotional and behavioral symptoms that may impact the individual.
References:
Corvin, A., & Harold, D. (2015). Biomarkers for Psychosis: the Molecular Genetics of Psychosis. Current Behavioral Neuroscience Reports, 2(2), 112-118.
Fusar-Poli, P., Salazar de Pablo, G., Correll, C., Meyer-Lindenberg, A., Millan, M., Borgwardt, S., Galderisi, S., Bechdolf, A., Pfennig, A., Kessing, L., van Amelsvoort, T., Nieman, D., Domschke, K., Krebs, M., Koutsouleris, N., McGuire, P., Do, K., & Arango, C. (2020). Prevention of Psychosis. JAMA Psychiatry, 77(7), 755-765.
Julayanont, P., & Suryadevara, U. (2021). Psychosis. Continuum, 27(6), 1682-1711.
Kirrane, R., & Siever, L. (2000). New perspectives on schizotypal personality disorder. Current Psychiatry Reports, 2(1), 62-66.
May, Rollo (1950/2015). The Meaning of Anxiety. W. W. Norton & Company; Reissue edition.
Murphy, T. Franklin (2021) Diathesis Stress Model. Psychology Fanatic. Published 9-7-2021. Accessed 9-11-2022.
Murphy, T. Franklin (2022a). Schizotypal Personality Disorder. Psychology Fanatic. Published 5-17-2022. Accessed 10-9-2022.
Murphy, T. Franklin (2022b). Mood Disorders. Psychology Fanatic. Published 9-27-2022. Accessed 10-9-2022.
Pumptre, Elizabeth, (2022) What is Dementia Praecox? Verywellmind. Published 2-13-2022. Accessed 6-23-2022.
Schrimpf, L., Aggarwal, A., & Lauriello, J. (2018). Psychosis. Continuum, 24 (BEHAVIORAL NEUROLOGY AND PSYCHIATRY), 845-860.
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