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Psychosis

Definition

( )

Plural: psychoses

[ + osis, condition]

A mental disorder in which there is severe loss of contact with reality, evidenced by delusions,
hallucinations, disorganized speech patterns, and bizarre or catatonic behavior.

Psychotic disorders are common features of schizophrenia, bipolar disorders, and some
affective disorders. They can also result from substance abuse (e.g., the use of hallucinogens),
substance withdrawal (e.g., delirium tremens), or side effects of some prescription drugs.

Symptoms: In psychotic states patients may express unusual ideas (e.g., that they can read the minds of
others, send radio messages directly to God or inanimate objects, travel to distant galaxies). These ideas are
called delusions. Psychosis also is marked by patient reports of hearing voices (auditory hallucinations) or
seeing objects or persons not visible to others (visual hallucinations). Auditory hallucinations are hallmarks
of schizophrenic and manic states, while visual hallucinations are characteristic of drug intoxication or
withdrawal. Disturbances in thought content and form, perception, affect, sense of self, volition,
interpersonal relationships, and psychomotor behavior occur. Thorough physical and psychiatric
examinations rule out organic causes of the patient symptoms and establish the diagnosis.
Treatment: Treatment goals focus on meeting the patient’s physical and psychosocial needs, and usually
combine drug therapies with behavioral therapies, long-term psychotherapy, psychosocial rehabilitation,
and/or vocational counseling, requiring use of community resources. Patients with psychosis are treated
effectively with neuroleptic drugs (which appear to work by blocking postsynaptic dopamine receptors),
such as haloperidol, risperidone, or chlorpromazine. Side effects of some of these medications include
dystonic reactions and tardive dyskinesia. The newer agents produce fewer of these extrapyramidal
symptoms. Treatment drugs also have sedative, anticholinergic, and orthostatic hypotension effects, and
about 1% of patients taking these agents experience neuroleptic malignant syndrome (life-threatening fever,
muscle rigidity, and altered level of consciousness).
Patient care: The psychotic patient should be treated gently and with respect. A safe environment should
be maintained, with suicide precautions instituted if needed. Trusting relationships are gradually developed,
while avoiding promotion of dependence. Engaging the patient in reality-oriented activities that involve
human contact and employing reality-orientation is helpful. Attempts to correct delusional thinking should
be avoided because delusions are resistant to logical argument, and discussion about them may be
misinterpreted. Because psychotic patients behave violently on occasion, careful practitioners eschew
confrontation with them, and obtain immediate help to protect the safety of all involved.
CAUTION:
1 Unfamiliar religious experiences and rituals may have all the hallmarks of psychosis when viewed by
. individuals from different cultures. What constitutes an especially meaningful experience in one society
may be recognized as psychosis by another.
2 When assisting a psychotic patient, most clinicians sit close to a door, so that if they feel the need to leave
. the room quickly, they can do so unimpeded.
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Clinicians need to be honest and dependable, and should never make promises that cannot be kept. The
family needs to be involved in therapies, taught to recognize adverse drug effects and signs of relapse, as
well as ways to manage patient symptoms. Patients are taught to manage their drug regimens, and advised
to report any adverse reactions they experience, but not to discontinue a drug without specific direction
from the primary care provider. If blood testing is required, the patient is taught when and where this
monitoring will take place. If slow-release formulations are used, the patient needs to know when to return
for the next dose.

alcoholic psychosis Loss of contact with reality that results from acute or chronic alcohol use.
Examples are pathological intoxication, delirium tremens, Korsakoff's psychosis, and acute
hallucinosis.

SEE: acute alcoholism; acute alcoholic hallucinosis; delirium tremens; intoxication; Korsakoff's
syndrome

depressive psychosis Psychosis characterized by extreme depression, melancholia, and feelings

of unworthiness.

drug psychosis Psychosis caused by intoxication.

exhaustion psychosis An acute state of confusion and delirium that occurs in relation to
extreme fatigue, chronic illness, prolonged sleeplessness, or tension.

functional psychosis A psychosis in which there is no apparent pathology of the central nervous
system.

gestational psychosis Psychosis that occurs during pregnancy.

involutional psychosis Psychosis occurring during the period of bodily and intellectual decline.

manic depressive psychosis Bipolar disorder.

organic psychosis Psychosis induced by structural brain changes. Emotional instability,

irritability, angry outbursts, and inattention are typical symptoms. At any time in the course of
the disease, memory, comprehension, ideation, and orientation may become defective. Possible
causes include alcohol, narcotics, trauma, syphilis, drugs, poisons, chronic infections,
encephalitis, and brain tumors, among many others.

polyneuritic psychosis Koraskoff's syndrome.

postinfectious psychosis A psychosis following an infectious disease such as meningitis,

pneumonia, or typhoid fever.

postpartum psychosis A psychosis that develops during the 6 months following childbirth, the
highest incidence being in the third to sixth day after delivery through the first month
postpartum. The symptoms and signs include hallucinations, delusions, preoccupation with
death, self-mutilation, infanticide, distorted reality, and interpersonal dependency. Therapies
used to treat this condition include estrogens, electroconvulsive therapies, lithium, and
neuroleptic drugs. SYN: puerperal psychosis SEE: depression, postpartum

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puerperal psychosis Postpartum psychosis.

senile psychosis Psychosis in which onset occurs in an aged individual. This term is rarely used
in the English-language health care literature but remains in use in non English-speaking
countries.

situational psychosis Psychosis due to excessive stress in an unbearable environmental

situation.

steroid-induced psychosis

Variant: steroid p.

A psychosis that follows the administration of corticosteroids (e.g., prednisone or

methylprednisolone) and cannot be clearly ascribed to another cause. The psychosis may remit
after steroids are withheld or may respond to neuroleptic drugs or electroconvulsive therapy.

toxic psychosis Psychosis brought on by intoxication.

traumatic psychosis Psychosis or schizophrenia-like illnesses occurring in people who have

suffered traumatic brain injury.