What is Psychosis?
Psychosis is the psychiatric term used to describe a state of mind in which thought and emotion are highly disrupted. Psychosis is the perception of one's own feelings and thoughts, oneself, the environment, and reality as different from normal. At the same time, losing touch with reality makes adaptation to the environment difficult. It causes disruptions in the person's daily life, work and social relationships, that is, in their functionality.
In Which Diseases Are Psychotic Episodes Occurred?
While it is often associated with schizophrenia, bipolar disorder, and severe chronic depression, it can also be seen in physical disorders such as cases where the brain or nervous system is directly affected, neurological disorders that may lead to a psychotic state, and substance use.
How Common Is a Psychotic Episode Occurring?
Psychosis may occur in 10-15 out of every 100 people at some point in their lives. There is no difference in incidence and risk between men and women. However, there are different risk factors that may increase the likelihood of psychosis.
Various Risk Factors That May Cause Psychosis
Genetics Just because a person has a gene does not mean that person will experience psychosis, but it may contribute to the development of psychosis.
Trauma A traumatic event such as sexual assault, death, injury, or war can trigger a psychotic episode. The type of trauma and the person's age, as well as the presence of a traumatic event, may affect the risk of psychosis.
Substance Abuse The use of marijuana, LSD, amphetamines, and other substances can increase a person's risk of psychosis.
Physical Diseases Symptoms can sometimes be seen in the context of diseases in which brain functions are impaired, such as encephalitis (inflammation of the brain), AIDS, tumor or epilepsy.
Psychological Disorders Sometimes psychological disorders such as schizophrenia, bipolar disorder or depression can cause psychosis.
What are Psychotic Symptoms?
Symptoms that negatively affect functionality and can be seen during psychosis are called symptoms, and symptoms may continue despite the use of medication in sufficient dosage and duration. It should not be forgotten that the symptoms and intensity may vary from person to person, depending on the psychological disorder and the type of psychosis. During a psychotic episode, the person may not necessarily engage in aggressive behavior; on the contrary, the person may be so stressed and detached from reality that they may not understand what they are doing.
Symptoms of psychosis:
Hallucinations are defined as the perception of unreal sensations that only the person can hear, see, touch and smell, without any object or stimulus. Hallucinations are more auditory than visual.
Delusions are defined as having unrealistic thoughts and beliefs that are inconsistent with one's culture.
Changes in Mood: Even though there is no specific reason, the person's emotions may change and at the same time, he may see the world and his environment as foreign and his own body as if it has changed.
Thought Disorder is defined as a serial disorder or disorder in the use of language that is thought to be a reflection of faulty thinking .
What are the Possible First and Early Symptoms of Psychosis?
Although the early symptoms of psychosis are not clear, they may differ from person to person. Symptoms include dysphoric mood, sleep disorder, suspiciousness, thought disorder, perceptual abnormalities, impairment in functionality, social withdrawal, limitation in emotional expression, subjective limitation in feeling emotions, delusions, hallucinations, disorganized thinking, and disorganized behavior.
At the same time, denying symptoms or acting detached from reality are common situations.
Psychotic Episode and Patient Relative
It is very important to provide psychological education to the patient's relatives and the patient himself at the first stage. It is very important for both the patient and the patient's relatives to have accurate information about diagnosis, treatment and the progress of the treatment. The severity of the episode should be reduced as soon as possible and necessary treatments should be applied to enable patients to regain their functionality.
So, what should (or should not) be done during a psychotic episode?
If someone you know is experiencing a psychotic episode, stay calm, evaluate the situation, and first protect yourself and the person experiencing the episode from dangerous situations.
If the person experiencing the episode is behaving aggressively, it is important to remove sharp objects and dangerous materials from the person and the room and to lock unbarred windows and balconies.
When the patient sees hallucinations or states that he hears voices, it is very important not to discuss this situation and not to try to convince him that it is not happening.
You can help individuals stay in touch by asking them questions. However, it is very important that you do this calmly and without judgment. If the psychosis is not very severe, you can ask them to describe how they feel or the situation they are experiencing.
(You can ask the person if they have had these types of seizures before or if they have taken any over-the-counter medications.)
If the person experiencing this psychotic episode is able to answer, you can ask him/her if he/she has had similar episodes before and what medications he used or the numbers he called when he had them.
Do not raise your voice or threaten the patient during the episode.
Do not apply physical force or ignore the episode.
You can make sure that there are no onlookers around during the psychotic episode. The feeling of being watched can make the situation worse.
If the person behaves aggressively during the episode, it is very important to ensure the safety of yourself and those around you.
The person experiencing a psychotic episode may not be aware of the situation, in such cases you need to call for help.
For immediate interventions, call the person's mental health professional or emergency services.
If you see a person you do not know having a psychotic episode, call emergency services directly.
If the person experiencing a psychotic episode does not receive therapy or medical treatment, you can encourage him/her to get professional support after the psychotic episode has passed, or you can accompany him/her to encourage him/her.
Psychotic Episode Treatment and Pharmacological and Non-Pharmacological Interventions
Early treatment after the first attack is very important. Psychosis can occur in different intensities depending on the cause. Although the causes differ, the treatment methods are the same. The most effective treatment is the combination of psychotherapy and medication. Psychosocial treatments traditionally come after pharmacological treatments. Various types of therapy successfully help individuals learn to manage their condition, while medications target symptoms and help reduce their effects. The important thing is not only to prevent psychosis but also to improve the individual's quality of life and restore functionality.
It is also important to determine the differential diagnosis before making a decision during the first attack. When determining the differential diagnosis, mood disorders with psychotic features and psychotic disorders secondary to substance use or a general medical condition should be kept in mind.
Non-Pharmacological Interventions:
Cognitive Behavioral Therapy (CBT) is a therapy method used in many psychiatric disorders. It is the most effective therapy method in preventing the transition to psychosis and reducing symptoms.
Family-Focused Therapy It is important for family members to participate in psychotherapy because individuals at high risk for psychosis are in adolescence/young adulthood and individuals live with their families. It consists of activities aimed at increasing the communication and problem-solving skills of family members in coping with stress.
Integrated Psychological Interventions Intervention method consists of individual CBT applications, social skills training, and individual studies on thought and perception disorders.
Pharmacological Interventions:
Psychiatric medications affect brain chemicals that regulate emotions and thought patterns. It has been proven that its effect is greater when applied together with one of the psychotherapy methods. Antipsychotic medications may be used in treatment and may reduce symptoms so other treatment plan methods may be more effective. But doctors also take family history and side effects into consideration when prescribing medication. Therefore, it is not appropriate to use any medication without consulting a doctor.
When stopping a medication, work with your doctor to taper appropriately. Sudden discontinuation of the drug may cause disturbing side effects. Planning the treatment process, taking a break or discontinuing the drug should proceed with the guidance of doctors. Because discontinuing antipsychotic medication in patients whose psychosocial functionality has not improved may be risky in terms of exacerbation. Do not start, interrupt or stop taking the medication without consulting your doctor.