Psychosis is a mental state characterized by a loss of contact with reality, where an individual experiences disturbances in thoughts, perceptions, and emotions, often resulting in impaired functioning and behavior.
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Key takeaways
- Psychotic symptoms can arise from medical conditions affecting the brain, hormones, metabolism, or immune system.
- Diagnosis requires evidence connecting the symptoms to the underlying condition rather than assuming a primary psychiatric disorder.
- Treating the medical cause may reduce psychosis, although symptoms can sometimes persist.
Psychosis Symptoms
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The primary symptoms of psychosis may include:[1]
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- Hallucinations
- Delusions
- Disorganized thinking
- Difficulties in communication and problem-solving
- Abnormal motor behavior, including agitation or catatonia
- Negative symptoms like reduced expression of emotions, lack of motivation, social withdrawal, and diminished speech or thought processes.
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Much like other mental health conditions, psychosis can progress from mild to severe, with early signs of psychosis being:
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- Unusual or irrational beliefs, suspicion, paranoia, or problems concentrating
- Sudden mood swings
- Increased agitation
- Social withdrawal
- Heightened sensitivity to stimuli
- Experiencing unusual sensations
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Early intervention can help manage psychosis effectively. If you or someone you know is experiencing early signs of psychosis, such as changes in thought, behavior, or perception, seek help immediately. Early treatment can significantly improve outcomes and help people regain control of their lives.
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Psychosis Due to a Medical Condition
This diagnosis is made when a patient's medical history, physical examination, or laboratory test results suggest that one or more medical conditions have caused brain changes that might create psychotic symptoms, and those psychotic symptoms (e.g., hallucinations, delusions) are in fact present since the medical condition has occurred. A surprisingly large number of different medical conditions are capable of creating psychosis. Neurological conditions that may cause psychosis include brain tumors, cerebrovascular disease, Huntington's disease, multiple sclerosis, epilepsy, auditory or visual nerve injury or impairment, deafness, migraine, and infections of the central nervous system. Endocrine disturbances include increases or decreases in the activity of the thyroid, parathyroid, or adrenocortical system. A decrease in blood gases such as oxygen or carbon dioxide or imbalances in blood sugar or electrolytes are some metabolic causes of psychosis. Finally, autoimmune disorders with central nervous system involvement such as systemic lupus erythematosus have also been known to cause psychosis.
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Psychosis caused by a medical condition may be a single isolated incident or may be recurrent, cycling with the status of the underlying medical condition. Although treating the medical condition often results in the remission of the psychosis, this is not always the case. Psychotic symptoms may persist long after the medical conditions that have caused them are cured.
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The following diagnostic criteria must be met before a diagnosis of Psychosis Due to a Medical Condition is warranted, according to the DSM-IV-TR:
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A) Prominent hallucinations or delusions
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B) There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct physiological consequence of a general medical condition
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C) The disturbance is not better accounted for by another medical disorder
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D) The disturbance does not occur exclusively during the course of a delirium
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Causes and Risk Factors
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Some common triggers and medical conditions that can cause psychosis include:
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- Epilepsy
- Brain tumors
- Stroke
- Brain infections like encephalitis or meningitis
- Metabolic disorders like vitamin deficiencies and thyroid imbalances
- Autoimmune disorders affecting the central nervous system
- Heavy use of drugs like marijuana, cocaine, methamphetamine, or hallucinations
- Alcohol abuse or alcohol withdrawal
- Long-term use of prescription medications or misuse of over-the-counter drugs
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Substance abuse can trigger or exacerbate psychosis by altering brain chemistry and impairing judgment and perception. Likewise, environmental stressors like trauma or social isolation can increase emotional distress and disrupt coping mechanisms, contributing to the development of psychosis.
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Genetic factors also play a significant role in predisposing individuals to psychosis, as certain genetic variations may increase susceptibility to mental health disorders.
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Further, imbalances in brain chemistry, including neurotransmitter dysregulation, can influence the onset and severity of psychotic symptoms.
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These factors interact in complex ways, and individuals may experience psychosis due to a combination of genetic, environmental, and biological influences. It’s important to seek professional evaluation and treatment for psychosis to address underlying causes and promote recovery.
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Psychosis Caused by Mental Illness vs. Medical Condition
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The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) distinguishes between psychosis caused by a mental illness and psychosis caused by a medical condition primarily by the underlying etiology and the duration of symptoms.
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Psychosis caused by a mental illness:
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- Etiology: Psychosis typically arises from psychiatric disorders like schizophrenia spectrum disorders or mood disorders with psychotic features.
- Duration: Symptoms of psychosis are enduring and may persist over extended periods of time, often contributing to chronic impairment in social, occupational, or other important areas of functioning.
- Criteria: Diagnosis of psychosis in mental illness is based on specific symptom clusters and duration criteria outlined in the DSM-5 for each relevant disorder, such as schizophrenia.
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On the other hand, psychosis caused by a medical condition differs in several ways:
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- Etiology: Psychosis of this type is caused by physiological disturbances or pathophysiological changes associated with medical illnesses, such as delirium or substance-induced psychotic disorder.
- Duration: Symptoms of psychosis may be acute and fluctuating, typically correlating with the course of the underlying medical condition or substance intoxication/withdrawal.
- Criteria: Diagnosis requires evidence that the psychotic symptoms are a direct physiological consequence of the medical condition or substance use, and the symptoms typically remit when the medical condition is treated.
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While both types of psychosis involve disturbances in perception, thinking, and behavior, they differ in their underlying causes, length, and clinical presentation. Proper diagnosis and treatment planning necessitates careful evaluation to determine whether psychosis is attributable to a mental illness or medical condition.
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Sources
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- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
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