psychosis
and Sabine Schrör, medical journalist Updated onJulia Dobmeier is currently completing her master's degree in clinical psychology. Since the beginning of her studies, she has been particularly interested in the treatment and research of mental illnesses. In doing so, they are particularly motivated by the idea of enabling those affected to enjoy a higher quality of life by conveying knowledge in a way that is easy to understand.
More about the expertsSabine Schrör is a freelance writer for the medical team. She studied business administration and public relations in Cologne. As a freelance editor, she has been at home in a wide variety of industries for more than 15 years. Health is one of her favorite subjects.
More about the experts All content is checked by medical journalists.Psychosis is an umbrella term for severe mental disorders in which those affected lose touch with reality. They perceive themselves and their environment differently: Typical signs of a psychosis are delusions and hallucinations. In addition, disturbances in thinking and motor skills can develop.Here you can find out everything you need to know about the clinical picture of psychosis.
ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. F28F25F23F29
Brief overview
- Psychosis - Definition: Collective term for severe mental disorders with a temporarily or permanently disturbed relationship to the environment. Psychosis often breaks out at a young age (between puberty and 35 years of age).
- Symptoms: At the beginning e.g. concentration disorders, thought disorders, listlessness and inner emptiness, loss of performance, sleep disorders, declining zest for life, depression, fears. Later, e.g. obsessive thoughts, sudden, strong interest in religion, mysticism or magic, mistrust, hostility / aggression towards others, strong reference to the ego, hallucinations, ego disorders, emotional and / or motor changes.
- Causes: e.g. an organic disease such as dementia, multiple sclerosis, epilepsy, metabolic disorders, a brain injury, medication, drugs (e.g. LSD, cocaine, also alcohol). In the case of so-called endogenous psychoses, the exact causes are unknown.
- Diagnostics: Doctor-patient conversation to collect the medical history (anamnesis), physical examination, psychological diagnostics using questionnaires
- Treatment: Medication with antipsychotics, in addition, if necessary, mood stabilizers such as lithium, antidepressants. Supplementary psychotherapeutic treatment (psychoeducation, cognitive behavioral therapy).
- Prognosis: depends essentially on the form / cause of the psychosis. In general, the following applies: With early diagnosis and appropriate, consistent treatment, the outcome is often favorable.
What is a psychosis?
The term psychosis encompasses various severe mental disorders in which the relationship to reality is disturbed. How this is expressed can be very different. For example, psychotics can suffer from ego disorders, anxiety, depressed mood and / or agitation, even hallucinations and delusions. Often those affected do not show any insight into the disease, but rather are convinced that changes in the environment are responsible.
Psychoses can have very different causes (illnesses, injuries, medication, drugs) or their origin can be completely unexplained (endogenous psychosis). It can be a temporary (acute) or an ongoing (chronic) disorder.
Experts assume that around one percent of the global population will develop a psychosis once in a lifetime (lifetime prevalence). This usually happens between puberty and the age of 35. Women are just as often affected as men.
Forms of psychosis
There are many different forms of psychosis. An organic psychosis (exogenous psychosis) is based on an organically identifiable cause such as an injury or inflammation of the brain, a brain tumor or epilepsy. A psychosis caused by medication or drugs (alcohol, LSD, cannabis etc.) is referred to as substance-induced psychosis or - in the case of drugs - also as drug psychosis.
In the case of a non-organic psychosis (endogenous psychosis) such as schizophrenia, the exact cause is still unknown.
Experts describe the combination of symptoms as schizoaffective psychosis, each of which fulfills the criteria of schizophrenia and an affective disorder. An affective disorder is a mental disorder in which the mood is abnormally changed - it is noticeably elevated (mania) or depressed (depression) or alternates between these extremes (bipolar disorder).
A paranoid psychosis (delusional disorder) is an acute psychotic disorder in which delusions (such as paranoia) are in the foreground. The boundaries to other mental disorders with delusional symptoms are fluid.
The term postpartum psychosis stands for psychosis that occurs in the puerperium.
There are also mixed forms of different psychoses.
Psychosis: symptoms
The clinical picture of a psychosis is very diverse - the symptoms of a psychosis can be very different depending on the type and extent of the disorder.
Psychosis: first signs
Years before a psychosis manifests itself, the first signs of the onset of the disease can point to it. These include, for example:
- Concentration disorders: People at risk of psychosis are often nervous, restless and have trouble concentrating. They are easily distracted and often cannot pay attention to several things at the same time.
- Thought disorders: So-called thought interferences and blockages can also be early signs of the onset of psychosis. Those affected have repeated incoherent thoughts that slip between other thoughts and are difficult to shake off. Some also suffer from a sudden flood of thoughts that can hardly be channeled.
- Loss of drive and inner emptiness: People at risk of psychosis are often unmotivated, indifferent and feel empty inside. Many withdraw from family, friends and acquaintances and avoid social contacts.
- Performance slump: School or professional performance can decrease significantly. However, this symptom is not typical of an emerging psychosis, but can also indicate the onset of depression.
- sleep disorders
- declining zest for life
- depressions
- fears
Psychosis often develops as early as teenagers. Symptoms such as concentration disorders, listlessness and a drop in performance are then often misinterpreted as typical puberty problems that pass by themselves over time. But symptoms of psychosis cannot "grow out". In fact, they become more and more pronounced over time.
But keep in mind that the symptoms mentioned can also have causes other than the onset of psychosis.
If you have the slightest suspicion of a psychotic illness in your child, see a doctor (family doctor or psychiatrist). You should also take even vague signs in your child if other family members are already suffering from psychosis.
Psychosis: symptoms in the further course
Over time, symptoms that may indicate psychosis develop more clearly. This includes:
- irrational thoughts (for example obsessive-compulsive thoughts)
- sudden, strong interest in religion, magic, or mysticism
- Suspicion, hostility and aggression towards others
- Strong self-reference, actions of others (including strangers) are inappropriately related to oneself
- Hallucinations
- Thinking disorders
- Ego disorders
- emotional changes
Psychosis symptoms: hallucinations
Many psychotic patients suffer from hallucinations. Basically all senses can be affected, but the most common are acoustic hallucinations. Those affected typically hear voices commenting on their behavior or giving them orders. Usually these voices are perceived as threatening.
Other patients see objects, people, colors or faces that are not there in reality (optical hallucinations). Sometimes olfactory or sensory hallucinations also occur, in which the patient perceives non-existent smells or touches.
Psychosis symptoms: thought disorders
Thinking disorders are another typical sign of psychosis. A distinction is made between mental disorders of a content-related and a formal nature. The content-related thought disorders include delusions such as paranoia and relationship delusions, megalomania and delusions of guilt:
- For example, paranoid patients feel persecuted by aliens or believe that other people are trying to harm them.
- Patients who suffer from delusional relationships relate general events to themselves or interpret certain objects or people as a threat. A typical sign is, for example, when those affected believe that speakers on television or radio are conveying secret messages to them.
- There is megalomania when someone believes, for example, to be a famous personality or a misunderstood genius.
- In delusional guilt, those affected are convinced that they are responsible for the suffering of others, although objectively there is no reason to do so.
Content-related thought disorders can also express themselves in the form of fixed ideas - experts speak of overriding ideas here. It is characteristic that the sick mentally only revolve around one and the same topic. Obsessive thoughts (such as the conviction that you have to perform a certain action again and again) are also part of the content-related thought disorders.
In the case of formal thought disorders, on the other hand, the flow of thoughts is disturbed. This can be expressed in:
- indistinct, confused, incomprehensible language
- frequent, incomprehensible leaps in thought
- sudden tearing off of thoughts (tearing off thoughts)
- slowed thinking
- inventing new terms and word combinations (neologisms)
- the bypassing of the actual topic
- Brooding
- constantly repeating the same sentences and thoughts
- distracted thinking, incoherent sentences (incoherent thinking)
- the inability to separate the important from the unimportant (awkward thinking)
- a limited vocabulary as well as restricted thinking that is limited to a few topics (lack of thoughts)
- the feeling that certain thoughts impose themselves (thought-pressing)
Psychosis symptoms: ego disorders
In the case of an ego disorder, the line between the self and the outside world becomes blurred. Sufferers are convinced that their thoughts can be heard by others (thoughts expressed), that others withdraw their thoughts from them (withdrawal of thoughts) or that their thoughts and actions are controlled and influenced by other people. Some perceive their environment as unreal (derealization) or are strangers to themselves. For example, these patients do not experience their own arm as part of their body (depersonalization).
Psychosis Symptoms: Emotional Changes
Psychotics experience emotions differently than healthy people. Often their emotions are less intense, so that they appear almost emotionless. Some patients are very irritable during acute psychosis. Inappropriate reactions are also possible, for example suddenly laughing in a sad situation.
Other symptoms of psychosis
Psychosis can also lead to motor changes. Those affected then suffer, for example, from severe restlessness and an extreme urge to move, or else freeze and remain motionless.
Many people with psychosis withdraw completely. They neglect their appearance and no longer devote themselves to their previous interests. They break off their social contacts and can no longer cope with everyday life alone, let alone exercise a job. Some don't leave the house anymore.
Violent acts against oneself or others are rare.
Stages of psychosis
Psychosis: causes and risk factors
Some psychoses can be traced back to a specific cause, such as an illness or drug use. For others, the exact causes are unknown.
Physical illness
Various organic underlying diseases can change the brain functions and trigger an organically caused (exogenous) psychosis. These include, for example:
- Dementia: Structures in the brain change in dementia patients. These changes can lead to psychotic disorders. Alzheimer's dementia in particular is often accompanied by hallucinations and delusional symptoms.
- Epilepsy: During an epileptic seizure, the nerve cells in the brain discharge in an uncontrolled manner. Sometimes psychosis occurs before and during it. Most often, however, psychotic symptoms appear immediately after an epileptic seizure.
- Multiple sclerosis: In this disease, the protective covering of nerve fibers (myelin layer) is gradually destroyed, which can impair brain functions. Psychotic symptoms are the possible consequence.
Infections (e.g. encephalitis = encephalitis), metabolic disorders and injuries (such as a traumatic brain injury) can also be the origin of a psychosis.
Medication
Sometimes drugs temporarily trigger psychotic symptoms, such as severe confusion or hallucinations. The most common drug-induced psychosis triggers include Parkinson's medication:
In Parkinson's disease, certain nerve cells in the brain gradually die, which leads to a deficiency in the neurotransmitter dopamine. This triggers the typical Parkinson's symptoms such as slowed movements, muscle stiffness (rigidity) and tremors (tremor). Parkinson's medication increases the level of dopamine in the patient's blood. If the dopamine content is then too high, however, psychological problems such as psychosis can arise. Very old Parkinson's patients are particularly often affected. Stress and lack of fluids can make symptoms worse.
Very rarely is a psychosis based on cortisone preparations, which - in high doses - can have a euphoric effect. However, the likelihood that this will cause psychosis is very small. Symptoms are temporary, if any.
Drugs
LSD (lysergic acid diethylamide) can trigger a drug psychosis with hallucinations and delusions (LSD psychosis or amphetamine psychosis). Depending on how much and what type of drug was consumed, the symptoms disappear after a few hours or persist for a few days.
Cocaine and cannabis can also be responsible for drug-induced psychosis - as can the legal drug alcohol. It is not always clear whether the symptoms were present before or were caused by drug abuse. Studies show, for example, that cannabis users with a genetic susceptibility to psychosis have a significantly higher risk of actually developing such a mental disorder (cannabis psychosis). In addition, cannabis and other drugs can also significantly aggravate the course of an existing psychosis.
Endogenous psychosis
The best known form is schizophrenia. Experts assume that several factors are involved in their development (e.g. genetic predisposition, stress, negative experiences, changes in the balance of neurotransmitters such as dopamine and serotonin). Read more about it here.
Affective psychoses are also endogenous psychoses. These are affective disorders (= mental disorders with pathological changes in mood: mania, depression, bipolar disorder) in connection with psychotic symptoms that do not meet the criteria of schizophrenia.
Other psychoses
Schizoaffective psychosis manifests itself in episodic disorders in which symptoms of schizophrenia and an affective disorder (such as mania or depression) occur simultaneously or sequentially in the same episode of the disease. The cause of this form of psychosis is also seen in an interplay of various factors (such as genetic predisposition, social factors).
In the case of paranoid psychosis, a combination of several factors such as heredity and environmental influences is assumed to be the cause.
Postpartum psychosis (puerperium psychosis) occurs in the first few weeks after the birth and can last a few days to months. Symptoms include excitement, confusion, mood swings, euphoria, depression, hallucinations, perceptions and possibly also acts of violence (therefore constant monitoring is important). Researchers suspect that the extreme sleep deprivation of the new mother favors the onset of the disease.
Postpartum psychosis must be treated immediately by a doctor, as the mother's loss of reality can endanger both herself and the child.
Psychosis: examinations and diagnosis
If you suspect a psychosis, you should urgently consult a doctor. The loss of the relation to reality carries the risk that you endanger yourself or others.
The first point of contact for suspected psychosis is the family doctor. If necessary, he will refer you to a resident psychiatrist or to a psychiatric clinic.
In order to get an idea, the doctor will ask you, for example, the following questions in the initial consultation (anamnesis):
- Do you hear voices or see things that others cannot hear or see?
- Do you feel like you are being followed?
- Do you have a lot of contact with family members and / or friends?
- Have you been unusually irritable lately?
- Do you often feel depressed or excited?
After the initial interview, a physical examination is due. If necessary, it can provide clues to an organic cause of the psychosis. Using blood and urine samples, the doctor can determine whether drug abuse, inflammation or metabolic disorders are behind the symptoms. Neurological tests can be used to detect diseases of the nervous system such as multiple sclerosis and epilepsy.
If the doctor cannot determine the cause, a professional (such as a psychiatrist) can examine you for possible mental illnesses such as schizophrenia, bipolar disorder, or depression.Clinical questionnaires, which are based on the classification systems of mental disorders, help him with this.
Psychosis: treatment
What the psychosis treatment looks like in the individual case depends on the cause of the mental disorder. If possible, the trigger (underlying illness such as epilepsy, bipolar disorder, drug addiction, etc.) is treated. In addition, the symptoms of psychosis can be alleviated with the help of medication.
Medication
Psychoses are treated with so-called typical antipsychotics such as haloperidol. These medicines work very well against hallucinations and delusions, but they have strong side effects. The most common include:
- fatigue
- Listlessness
- Weight gain
- Movement disorders
- Muscle twitching
In order to avoid these side effects, newly developed so-called atypical antipsychotics are now often prescribed. They are usually better tolerated, but in individual cases can also lead to fatigue and weight gain.
Despite the possible side effects, it is very important that the patient consistently takes the prescribed antipsychotics - for as long as the doctor has prescribed. That prevents relapses. Some patients also have to be treated with drugs for the rest of their lives.
Patients whose psychosis is based on bipolar disorder are also treated with mood stabilizers such as lithium. If the psychosis is accompanied by depression, antidepressants help.
psychotherapy
In addition to drug treatment, psychotherapy can further stabilize the patient. Two psychotherapeutic methods are particularly suitable for psychotherapy: psychoeducation and cognitive behavioral therapy.
Psychoeducation
The diagnosis of "psychosis" can make patients and relatives very insecure and afraid. The targeted, comprehensive education about the illness (psychoeducation) helps those affected to cope with their fears and to reduce prejudices, misconceptions and feelings of guilt. In addition, patients and their relatives are trained to recognize the first signs of psychosis so that they can be made aware of any relapses at an early stage.
Cognitive behavioral therapy
Patients learn special techniques with which they can control delusions and reduce depressive symptoms, fears and stress. Because even drugs cannot always protect against a new flare-up.
In addition, the patients train their social skills in order to reduce stress, strengthen social contacts and deal more calmly with stressful situations.
Psychosis: disease course and prognosis
For a long time, psychoses were considered difficult to treat or even incurable. However, thanks to improved therapy options, this has now changed in many cases. Basically, the prognosis depends largely on the type of psychosis. For example, there are often good prospects in the case of acute organic psychosis, while chronic organic psychosis often takes a chronically progressive course. In the case of endogenous psychoses, affective psychoses generally have a more favorable prognosis than schizophrenia.
In individual cases, however, the prognosis for a psychosis can be different. In general, it is important to treat a psychosis as early as possible (medication, psychotherapy). Anything that adds stability to the life of those affected further improves the prognosis. This includes stable social ties and a professional environment that does not overwhelm patients with psychosis.
Additional information
Books:
- Psychosis - Analysis and Therapy, Ursula Schnieder, ersa Verlag, 2011
- Psychoses from the schizophrenic circle of forms: Advice for patients and relatives, guidelines for professional helpers, introduction for interested laypeople, Josef Bäuml, Springer, 2008
- Before the voices come back: Prevention and self-help in psychotic crises, Andreas Knuf and Anke Gartelmann, Balance buch + medien verlag, 10th edition 2020
