Psychosis: what is it and how is it treated?

Psychosis is a complex mental condition that can vary in severity from mild to very serious.

Symptoms of psychosis

People experiencing psychosis may have distorted thoughts, perceptions, and bizarre emotional responses and behaviours, causing them to lose touch with reality. The condition can be caused by various factors, including mental illnesses like schizophrenia, bipolar disorder, severe depression, or even substance abuse. Psychosis can cause these symptoms:

• Hallucinations – false perceptions, e.g., hearing voices or seeing things that aren't there
• Delusions – false, unreasonable beliefs, e.g., having special powers or being persecuted
• Disorganised thinking and speech
• Impaired communication
• Agitation or aggression – unusually severe agitation, anxiety, or even aggressive behaviour due to altered perceptions
• Withdrawal – isolation or withdrawal from social interactions can be a sign of underlying psychosis.

Differentiating psychosis from other conditions

Not all instances of an altered mental state mean the person is experiencing psychosis, as conditions like intoxication, medical conditions such as a severe infection or electrolyte imbalance, or even extreme stress, can lead to an altered mental state. Distinguishing between these situations and genuine psychosis is essential to provide appropriate care.

How is psychosis diagnosed?

Psychosis can be diagnosed by a mental health professional or GP. A full psychiatric assessment and physical examination are the main methods used to diagnose a psychotic illness. During the assessment, a full patient history is taken, including medical and social aspects. They’ll ask in detail about the presenting problem to find out when, and under what circumstances, it began, how it affects daily functioning, and its specific symptoms. With the patient’s consent, a family member may be asked to help clarify information.

A diagnosis will then be made and treatment suggested. If it’s unclear whether a psychiatric illness is present, the person might be referred for further investigations, or a second opinion. Sometimes testing is needed to exclude treatable causes, e.g., a brain tumour.

Treatment

Treatment depends on the cause of the psychosis, but usually consists of a combination of medication, education, support and counselling. It is possible to control most psychotic disorders with appropriate long-term treatment. Care in a hospital is sometimes necessary during the acute phase. Involvement and support of the patient’s family will help facilitate the treatment and recovery process

Some causes of psychosis are treatable and people may recover, either partially or fully. But this varies for different types of psychosis. The recovery process is affected by factors like the treatment environment, medication, psychological therapies, as well as the family and social environment.

Outcomes

Many people who experience a first episode of psychosis recover well or completely. Others will develop recurring episodes of psychosis, but will be relatively well in between and able to pursue a productive life.

With brief reactive psychosis, symptoms usually respond to treatment within a week, and have good outcomes. Repeat episodes may occur in response to ongoing or new stresses.

Chronic or recurrent psychosis may interfere with normal functioning. People who suffer psychotic illness are at increased risk of suicide.

In all cases, early treatment usually results in a better outcome.

Can psychosis be prevented?

This depends on the type of psychosis. For example, abstaining from drugs avoids drug-induced psychosis. Some disorders, such as schizophrenia, have no proven prevention strategies.

However, some cases of psychosis can be alleviated, and even prevented, if treatment is started early in people who show signs they may be at risk. A psychotic episode may be imminent when someone experiences a persistent change in behaviour or functioning, particularly when other risk factors are present, such as a family history of psychotic illness.

Someone thought to be in a pre-psychotic phase should be monitored so treatment can be started without delay if psychotic symptoms develop. In the meantime, possible causes, such as drug abuse and family problems, can be addressed to reduce the risk of progression to psychosis.

For people who are prone to brief reactive psychosis, counselling in times of stress may help prevent an episode.  

To find a mental health professional near you, go to www.mediclinic.co.za

Mediclinic has inpatient mental health facilitie at: Mediclinic Denmar Mental Health Services; Mediclinic Crescent Mental Health Services; Mediclinic Legae Mental Health Services; and Mediclinic Newcastle’s Kintsugi Centre.