Psychosis

Psychosis is a mental health condition characterised by a disconnection from reality, which can include experiencing hallucinations, delusions, and difficulty thinking clearly. It is a complex and challenging condition that affects individuals differently, often requiring comprehensive treatment and support. In the UK, psychosis is not uncommon, with significant efforts made by the NHS to provide care and assistance to those affected.
According to the NHS, around three in every 100 people will experience psychosis at some point in their lives. The onset of psychosis typically occurs in late adolescence or early adulthood, but it can also occur later in life. The condition can have a profound impact on individuals, their families, and their communities, making early detection and intervention crucial.

What is Psychosis?

Psychosis is not a single disorder but rather a symptom of various mental health conditions, including schizophrenia, bipolar disorder, severe depression, and certain substance use disorders. It is characterised by a range of symptoms that can vary in severity and duration. Common symptoms of psychosis include:

Hallucinations

Hallucinations involve perceiving things that are not actually present in the external environment. They can occur in any of the five senses:

• Auditory hallucinations: Hearing voices, sounds, or noises that others do not hear. These voices may be critical, commanding, or conversational.
• Visual hallucinations: Seeing objects, people, or images that are not real. Visual hallucinations can range from vague shapes or colours to detailed, lifelike images.
• Olfactory hallucinations: Smelling Odors or scents that have no identifiable source.
• Gustatory hallucinations: Experiencing abnormal tastes or sensations in the mouth.
• Tactile hallucinations: Feeling sensations of touch, pressure, or movement on the skin in the absence of any external stimuli.

Hallucinations can be distressing and disruptive, leading individuals to question their perception of reality and causing significant emotional distress.

Delusions

Delusions are false beliefs that persist despite evidence to the contrary. They are typically illogical, irrational, and resistant to change, and they often involve themes of persecution, grandiosity, or paranoia. Common types of delusions include:

• Paranoid delusions: Believing that one is being persecuted, harassed, or conspired against by others.
• Grandiose delusions: Holding exaggerated beliefs about one’s own abilities, importance, or identity.
• Delusions of reference: Believing that ordinary events, objects, or behaviours have special significance or meaning directed at oneself.
• Somatic delusions: Believing that one has a physical illness or defect that is not supported by medical evidence.

Delusions can lead individuals to engage in bizarre or dangerous behaviour as they attempt to make sense of their beliefs and protect themselves from perceived threats.

Disorganised Thinking

Disorganised thinking refers to difficulties with thought processes, organisation, and coherence. Individuals experiencing disorganised thinking may have trouble concentrating, following a conversation, or connecting ideas logically. They may speak incoherently, jump from topic to topic without a clear connection, or use neologisms (made-up words) or tangential language.

Disorganised thinking can impair communication and social interactions, making it difficult for individuals to express themselves clearly or engage in meaningful conversation.

Disorganised Behaviour

Disorganised behaviour involves acting in a way that is unpredictable, inappropriate, or unusual. Individuals experiencing disorganised behaviour may exhibit a range of abnormal or dysfunctional behaviours, including:

• Catatonia: A state of immobility or unresponsiveness, or excessive, purposeless movement.
• Agitation: Restlessness, pacing, or fidgeting, often accompanied by emotional distress or agitation.
• Impulsivity: Acting without considering the consequences, engaging in risky behaviours, or making impulsive decisions.
• Odd or eccentric behaviours: Engaging in unusual or socially inappropriate behaviours, rituals, or mannerisms.

Disorganised behaviour can interfere with daily functioning and social relationships, leading to difficulties in work, school, or interpersonal interactions.

Negative Symptoms

Negative symptoms involve a decrease in emotional expression, motivation, or ability to experience pleasure. Unlike positive symptoms, which involve the presence of abnormal experiences or behaviours, negative symptoms reflect deficits or reductions in normal functioning. Common negative symptoms of psychosis include:

• Flat affect: Reduced emotional expression or blunted affect, including a lack of facial expressions, vocal inflections, or gestures.
• Anhedonia: Diminished ability to experience pleasure or enjoyment from activities that were previously enjoyable or rewarding.
• Avolition: Decreased motivation or initiative to pursue goals, engage in activities, or complete tasks.
• Social withdrawal: Reduced interest in social interactions or relationships, leading to isolation or social detachment.

Negative symptoms can significantly impair quality of life and functioning, making it challenging for individuals to engage in meaningful activities or maintain social connections.

These symptoms of psychosis can vary in severity and duration, and individuals may experience a combination of different symptoms at different times. Early recognition and intervention are essential for effective management and treatment of psychosis, as prompt treatment can help minimise the impact of symptoms and improve long-term outcomes.

Causes of Psychosis

The exact cause of psychosis is not fully understood, but it is believed to involve a combination of genetic, biological, and environmental factors. Some of the factors that may contribute to the development of psychosis include:

Genetics

Genetic factors play a significant role in the development of psychosis. Individuals with a family history of schizophrenia, bipolar disorder, or other psychotic disorders have a higher risk of experiencing psychosis themselves. However, genetics alone are not determinative, and the interaction between genetic predisposition and environmental factors is also crucial.

Neurochemical Imbalance

Imbalances in neurotransmitters, which are chemicals in the brain that facilitate communication between nerve cells, have been implicated in psychosis. Dopamine, in particular, has been extensively studied in relation to psychosis. It is believed that an excess of dopamine activity in certain areas of the brain may contribute to the development of psychotic symptoms. However, the precise mechanisms underlying these neurochemical imbalances are still not fully understood.

Brain Structure and Function

Structural and functional abnormalities in the brain have been observed in individuals with psychosis. These abnormalities can affect regions of the brain involved in perception, emotion regulation, and cognitive processes. For example, abnormalities in the prefrontal cortex, which is responsible for higher order thinking and decision-making, have been linked to cognitive deficits and disorganised thinking in individuals with psychosis.

Environmental Factors

Environmental factors, such as early life stress, trauma, and substance abuse, can significantly increase the risk of developing psychosis, particularly in individuals who are genetically predisposed. Adverse experiences during childhood, such as physical or sexual abuse, neglect, or the loss of a parent, can disrupt normal brain development and increase vulnerability to mental health problems later in life. Similarly, exposure to chronic stressors, such as poverty, discrimination, or social isolation, can contribute to the onset of psychosis.

Substance Use and Abuse

Substance use, particularly of psychoactive substances such as cannabis, cocaine, and hallucinogens, has been strongly associated with the development of psychosis. These substances can alter brain chemistry and increase the risk of experiencing psychotic symptoms, especially in individuals who are already vulnerable due to genetic or environmental factors. Chronic substance abuse can also exacerbate existing psychotic symptoms and make treatment more challenging.

Developmental Factors

The timing of exposure to certain risk factors may also influence the development of psychosis. For example, exposure to maternal infections or complications during pregnancy, birth-related trauma, or disruptions in early childhood development can increase the risk of later developing psychosis. Additionally, developmental milestones, such as puberty, adolescence, and young adulthood, are critical periods of brain maturation and vulnerability to the onset of psychotic disorders.

NHS Support

The NHS provides a range of services and support for individuals experiencing psychosis. This may include:

• Early intervention services: Specialised teams that provide assessment, treatment, and support for individuals experiencing a first episode of psychosis.
• Community mental health teams: Multi-disciplinary teams that provide ongoing support and treatment for individuals with psychosis in their local community.
• Crisis resolution and home treatment teams: Teams that provide intensive support and treatment for individuals experiencing a mental health crisis, including psychosis, in their own home.

Treatment Options

Treatment for psychosis typically involves a combination of medication, psychotherapy, and support services. Common treatment options include:

• Antipsychotic medication: Medications that help reduce or manage psychotic symptoms, such as hallucinations and delusions.
• Psychotherapy: Therapeutic approaches, such as cognitive-behavioural therapy (CBT) or family therapy, that help individuals cope with their symptoms and improve their functioning.
• Supportive services: Practical support with daily living activities, housing, employment, and social integration.
• Hospital Treatment: In severe cases where individuals are at risk of harm to themselves or others, hospitalisation may be necessary for stabilisation and intensive treatment.