Understanding Psychosis

The word “psychotic” is perhaps one of the most misunderstood words in the mental health repertoire. To the public, who are used to hearing it in movies and other media to refer to a violent, remorseless, person, attribute it’s meaning to just that. Someone who is psychotic, by this definition, may be violent, violently “crazy”, or simply lacking empathy and remorse, capable of any wrong and evil doing. But, as so often is the case, Hollywood and the media have gotten it wrong, and in the case of psychosis, they’ve gotten it completely and dangerously wrong. This incorrect usage has led to irreparable stigma for those suffering from actual psychosis, the sufferers of which are far more likely to be victims than perpetrators of violent crime. In this article I will tell you, dear reader, about the real story of psychosis.

According to NAMI, psychosis occurs in about 3% of the population. Psychosis is a debilitating mental condition that affects the way we perceive reality. In a way, people undergoing a psychotic episode live in an “alternate reality”, different from what healthy people experience. They may believe, perceive, and understand things that are not actually in existence, to the sufferer however, this “alternate reality” is as real as the ground beneath our feet.

What is Psychosis?

Psychosis is often called a “break from reality” due to the reasons I described above. There are hallmark symptoms of psychosis that healthcare providers look for when diagnosing a person, such as…

Hallucinations: Seeing, feeling, tasting, and especially hearing things that are not actually there. The most common hallucination is auditory hallucinations, or “voices”. The voices may tell a person to harm themselves and say other negative things.

Delusions: Strong beliefs that do not change despite opposing evidence. For example, a person may believe that someone is stealing their thoughts, that they are being watched or followed, or that they are God.

Causes

Psychosis, like so many things having to do with the mind, is  hard to pin down to a single cause. There are several, intermingling factors that affect someone’s likelihood of developing psychosis.

Drugs: Psychedelic drugs, or even lighter drugs like marijuana, have been shown to trigger or worsen psychotic episodes.

Genetics: Many studies have been carried out that link psychosis and other mental illnesses to genetics. If your parents, family, or siblings have experienced psychosis, you are more likely to experience it.

Illness: Some illnesses and diseases, such as brain cancer, can cause psychosis, or what appears to be psychosis, in a person.

Stress: Stress and trauma can bring on or worsen psychosis.

Warning Signs

There are several early warning signs for psychosis which can be noticed by others, they include the following…

  • Difficulty in school or work
  • Isolation from others
  • Decline in personal hygiene
  • Lack of clear or coherent thoughts

Psychosis and Mental Illness

Psychosis itself is not a mental illness. It is, however, a component, or possible component, of many mental illnesses. It should then, be seen as a symptom rather than an illness. Many illnesses can include psychosis, including post traumatic stress disorder, depression, bipolar disorder, and schizophrenia, the last of which has psychosis as a hallmark symptom.

Treatments

Treatment is paramount for those suffering from an acute psychotic episode. There are a variety of treatments for psychosis, some of which I shall list  below.

Hospitalization: For someone undergoing an acute psychotic episode, the hospital may be the best option. The goal of any psychiatric hospital is to stabilize and rehabilitate enough so that a person may undergo further treatment after discharge.

Cognitive Behavioral Therapy (CBT): CBT is used in a variety of disorders to identify and change thought patterns. In psychosis, CBT can help a person identify triggers, manage symptoms, and identify strategies for getting through it all.

Medication: Medication for psychosis is referred to as antipsychotics, these drugs work by reducing dopamine (a neurotransmitter involved in psychosis) in the brain. While often effective, they can have detrimental side effects. Newer antipsychotics however, called atypical, have less side effects and are more tolerable to take than older drugs.

To Wrap it Up…

Psychosis is a serious mental condition that requires care as soon as possible. Unfortunately, it is also one of the most misunderstood mental conditions in our society today. This makes reaching out for help difficult for those who suffer, the stigma is real and is felt by sufferers every time they turn on the TV to a headline of “psychotic killer”. As someone who has experienced psychosis first-hand, I can tell you that getting help is possible, and it does help…it saved my life.

If you believe you or someone you know is undergoing a psychotic episode, please reach out for professional help, it will improve your life tenfold, and may just save it. Some crisis numbers can be found here.

Exploring the Science of Bipolar Disorder

Melancholy_2

Too often the general public relegates mental illnesses like depression, bipolar disorder, and schizophrenia to just that, mental illness, diseases of the mind. However, with modern science, we are beginning to see more and more the folly of this simplistic viewpoint. We are now seeing the science behind these illnesses;  the changes in brain form, function, and chemical balance that alter how our brain functions and perceives the world around us. For the next month or so, in my “Exploring the Science of…” mini series, I will be talking about how what happens in our brain impacts what happens in our mind. In this post, I will be talking about how subtle changes in the brain can lead to bipolar disorder.


What is Bipolar Disorder?

Bipolar disorder consists of hyperactive episodes called “manic” episodes, as well as episodes of depression called “depressive” episodes. During manic episodes, a person may feel unstoppable, stop sleeping, and generally feel extremely happy, active, and outgoing, sometimes engaging in high risk behaviors. Depressive episodes are similar to those found in depression, and the person may feel tired, in slow motion, or hopeless for extended periods of time.

There are several sub-diagnoses within bipolar disorder. These include Bipolar I, categorized  by full blown manic episodes, as well as Bipolar II, in which depressive episodes and more mild manic episodes are present. Other diagnoses include Cyclothymia and Bipolar Disorder – Not Otherwise Specified (BP-NOS).

It’s All in the Genes

Like so many things, mental illness is often impacted by genes. This has been shown through familial studies for mental illness, along with ever helpful twin studies. These studies give a strong case for mental illness having a genetic component, helping to explain why mental illness so often runs in families. Bipolar disorder is no exception, in fact over half a dozen genes have been implicated in the formation of bipolar disorder. These genes affect everything from your biological clock to how your body handles neurotransmitters like serotonin. Mutations of these  genes can cause anything from anxiety, to depression, to increased chance of alcohol abuse, and leaves the person at a higher risk of developing bipolar disorder.

Those of you who have extensively studied mental illness may have noticed an underlying similarity between the symptoms of many disorders. For instance, psychosis can be present in schizophrenia, depression, bipolar disorder, and sometimes even (in milder forms) extreme anxiety. Similarly, some of the gene mutations in bipolar disorder are the same gene mutations implicated in schizophrenia. Furthermore, mutations in specific genes cause the same symptoms across both disorders. For example, a mutation in a certain gene causes hallucinations in both schizophrenia and bipolar disorder.

Think On It

As mentioned previously, often people with bipolar disorder engage in high risk behaviors during manic episodes. With modern technology, we are now getting a glimpse into why this might be. The (potential) answer lies in two parts of the brain, and their function relative to healthy subjects. These two parts are the medial prefrontal cortex, responsible for decision making and memory, and the anterior cingulate gyrus, correlated with emotional response and control.

In those with bipolar disorder, the medial prefrontal cortex is under active compared to healthy controls, while the anterior cingulate gyrus is overactive. This basically means that less energy is going into decision making, and more into emotion. This difference, however subtle (we’re talking about minor differences in tiny parts of the brain), may lead to clues about the poor decision making often found in bipolar disorder.

Tick Tock

Sleep is an integral part of our mental health, especially so when it comes to bipolar disorder. A decrease in sleep is almost always correlated with an increase in bipolar symptoms, and a return to a normal schedule is usually met with decreased symptoms. But what explains this phenomenon? What exactly is going on in our brain when we go without sleep?

The most important change that happens when we forgo sleep happens inside our amygdala, the brain’s center for emotion. Without sleep, the amygdala becomes overactive, meaning it is more sensitive to emotional stimuli. Remember when we talked about overactivity in the anterior cingulate gyrus which also controls emotion? Now imagine that plus an overactive amygdala. That spells trouble. It’s no surprise then that going without sleep worsens symptoms in those with bipolar disorder.

The Takeaway

Bipolar disorder is a complex disease that is just beginning to be understood by scientists. As we begin to learn more about this disorder, we may find clues into the treatment and early identification of the disorder. With this information, we can help better the lives of millions who have bipolar disorder. Also of interest is bipolar disorders link to other disorders such as depression and schizophrenia. Already scientists have discovered similar genetic roots for these disorders, and who knows what the future holds.


Works Cited:

PsychEducation

The National Institute of Mental Health