Psychosis

The term psychosis encompasses a whole range of different mental disorders. The answer to the question “Psychosis - what is it?” Is therefore not very easy to give. The current classification systems - the ICD-10 of the World Health Organization and the DSM-5 of the American Psychiatric Association (APA) - do not give a clear definition. There, under the designation “psychotic disorder”, you will find the clinical picture that is commonly described as psychosis.

Typically, a psychosis describes a phase in which a person's perception of reality, insight and performance are so severely impaired that they experience problems in everyday life and at work. Typical symptoms of psychosis are hallucinations, delusions and severe thought disorders . Men and women suffer from psychosis about equally often. Around three to four percent of the population will develop it in the course of their life.

Doctors differentiate between two forms of psychosis - depending on the cause:

• Exogenous psychosis : Here the symptoms come from an organ or brain disease. They can also arise from the use of drugs such as alcohol, cannabis, or LSD
• Endogenous psychosis : On the other hand, it arises without a recognizable physical cause.

Psychosis: Symptoms are often delusions and hallucinations

A psychosis often announces itself with certain early symptoms. Often those affected and relatives do not interpret this as the first sign of psychosis, but rather suspect another cause behind it. However, if those affected seek help from the doctor with these early symptoms, the further course of the psychosis can often be weakened or the psychosis can sometimes even be prevented.

Such early signs of psychosis can be:

• Withdrawal from social ties
• decreased zest for life
• decreased efficiency
• Problems in education or work
• Fears and depressive moods
• Nervousness, anxiety, restlessness

Psychosis: symptoms when the disease breaks out

When the psychosis breaks out, it is linked to a variety of symptoms. The classic signs of psychosis are delusions and hallucinations. For example, you can express yourself like this:

• Those affected often imagine they are hearing things or voices.
• The imaginations can also concern smells, tastes, things seen or the sense of touch.
• Likewise, sufferers often think during a psychosis that they are being persecuted (paranoia) or that everything they notice has something to do with them (delusional relationship).
• Some are also convinced that the environment is not real and that they are not themselves at all (ego disturbances).

Other symptoms of psychosis are:

• disorganized thinking and speaking
• disorganized behavior and impaired motor skills
• Ego disorders

However, the symptoms also depend on whether the psychosis is endogenous or exogenous. In the case of endogenous psychosis, delusions and hallucinations are usually in the foreground. Exogenous psychosis, on the other hand, is often associated with confusion, disorders of consciousness, and memory problems.

Types of psychosis - exogenous or endogenous

Psychiatrists and psychotherapists basically differentiate between two different types of psychosis: exogenous and endogenous psychosis. The division is based on what the trigger for the psychosis is.

Endogenous psychosis

Endogenous psychosis means that doctors cannot determine a clear physical cause. It is also called primary psychosis or inorganic psychosis.

The most common form of endogenous psychosis is schizophrenia (schizophrenic psychosis). It is mainly characterized by formal and substantive thought disorders. Perception disorders also often occur in those affected. On average, around two to three in 1,000 people in Germany suffer from schizophrenia.

There are also numerous other endogenous types of psychosis:

• Schizoaffective psychosis : This is a psychosis in which schizophrenic symptoms such as delusions or hallucinations mix with manic or depressive symptoms.
• Paranoid psychosis : Paranoid symptoms such as persecution anxiety can occur in various mental disorders, such as schizophrenia or borderline disorder. However, there is also an independent diagnosis of "paranoid personality disorder ".
• Polymorphic Psychotic Disorder : Delusions, hallucinations, and perceptual disorders can change within days or even hours.
• Postpartum psychosis (also postpartum psychosis or postpartum psychosis) : Doctors understand this to be a psychosis that occurs within four weeks of the birth.
• Psychotic depression : Behind it is a depression that is associated with psychotic symptoms.

Mental disorders were previously described as affective psychoses, in which mainly the emotional state or mood is disturbed. Today this category is called “mood disorders”.

Exogenous psychosis

An exogenous psychosis arises from physical causes, for example a disease of organs or the brain. Medicines or drugs (drug psychosis, drug-induced psychosis) can also trigger an exogenous psychosis. This form is also called secondary psychosis or organic psychosis.

The following diseases can be associated with psychosis:

• neurodegenerative diseases such as dementia (e.g. Alzheimer's disease), paralysis ( Parkinson's disease) or multiple sclerosis .
• epilepsy
• Traumatic brain injuries
• Brain tumors
• Metabolic disorders
• Infectious diseases

Ultimately, exogenous psychosis can also be traced back to the consumption of drugs such as alcohol, cannabis or LSD. In the case of severe drug addiction, it can even result from withdrawal. The use of some medications is also associated with psychosis.

Psychosis: causes are different

The causes and triggers of psychosis can be very different. It depends crucially on whether a person suffers from an endogenous or exogenous psychosis. In exogenous psychoses, organic causes are responsible. These include, for example, brain and organ diseases, medication or drugs. In the case of endogenous psychosis, doctors usually cannot determine any physical causes for the psychosis.

It is known, however, that some people are more susceptible to endogenous psychoses than others. Other psychoses are more likely to occur in the families of those affected. This suggests that a certain risk of psychosis is inheritable. In the meantime, researchers have identified some genes at risk for the occurrence of schizophrenia. However, the genetic influence seems to be only minor in individual cases. Ultimately, researchers suspect a complex interplay of many different hereditary factors and environmental influences.

Psychosis: progress in different phases

Psychoses can occur at any age, but they often develop between puberty and the age of 35. The course of an endogenous psychosis can be divided into four different sections. These phases of psychosis are:

• Prodromal phase: This is the period before the actual psychosis, but in which the first early symptoms appear. It lasts between two and five years.
• Phase of untreated psychosis: time in which the psychosis is already present, but those affected are not yet seeking therapeutic help. The duration of this psychosis phase is on average six to twelve months.
• Acute phase: complete outbreak, psychosis flare-up
• Long-term phase: The time after the psychosis in which the symptoms disappear and negative symptoms may persist. These include, among other things, a lack of emotions, disorders of drive or lack of motivation. This phase can last for several years.

The course of an exogenous psychosis depends heavily on the triggering cause. If doctors can treat the underlying disease, the course is usually good and the prognosis is favorable. Nevertheless, the course of the psychosis is very different from person to person. Long-term studies with patients who suffered from various forms of schizophrenic disorder showed, for example, these courses:

• The psychosis occurred once in 10 to 15 percent.
• 30 percent had additional psychoses, but did not develop any psychotic symptoms between episodes.
• Several acute psychoses occurred in 30 percent. Those affected also experienced psychotic symptoms between the episodes.
• In 10 to 20 percent, the psychotic symptoms persisted immediately after the first episode.

Psychosis: Treatment Using Multiple Strategies

Psychosis can be cured. Whether this succeeds, however, depends on various factors. The severity of the illness and the treatments play a role, but also the respective living conditions and the patient himself. The most important thing in psychosis therapy is that the treatment begins as soon as possible. Seek medical help quickly if you have psychosis.

How do you get out of a psychosis?

Doctors usually use multiple treatment strategies to help their patients effectively and quickly. The treatment can be carried out on an outpatient basis in a doctor's office. Sometimes it is better for those affected to seek treatment in a day clinic. In the case of severe psychosis, an inpatient stay in a clinic is advisable. The duration of treatment for a psychosis cannot be given in general terms because it also depends on the severity of the illness. The following treatment options are available:

• In exogenous psychosis, doctors first treat the underlying condition or substance abuse . If the psychosis can be traced back to a side effect of medication, doctors discontinue the medication - if possible - and switch to another preparation.
• Medicines - so-called antipsychotics - help against psychotic symptoms, such as delusions and hallucinations. Patients often continue to take it even after the psychosis has subsided. This is how doctors try to prevent further episodes. Some medical professionals recommend continuing to take the psychosis medication for several years. Antipsychotics are also called neuroleptics. Today there are modern second generation neuroleptics. These atypical neuroleptics have fewer side effects and are very effective.

Treatment of psychosis without medication is rare. Doctors usually combine medication and other therapies, such as psychotherapy . It can help those affected to better cope with the effects of psychosis. This in turn usually has a positive effect on the further course.