Psychosis
If you were recently told you have a psychotic illness or had a psychotic episode, it is likely that you are experiencing many different emotions. Sometimes people are relieved to know that their (often terrifying) experiences are caused by a treatable condition, but often, people feel overwhelmed. There is little information readily available regarding the treatment and management of psychosis, and the stigma around psychotic illnesses can sometimes be more distressing than the symptoms themselves. People might experience despair as they think about what this diagnosis means for them and their future. Many people are angry. I would be angry too if someone told me that what I believed to be true was false. How would they know; they weren’t there. These are all completely normal and understandable reactions.
What is Psychosis?
The word psychosis is used when an individual has had some loss of contact with reality. They experience what we call positive symptoms. Unfortunately, this name is a bit of a misnomer because these experiences are rarely positive. They are called positive symptoms because they were not present prior to the development of the psychotic episode (i.e., the symptoms are ‘additions’).
A delusion is an example of a positive symptom. These are strongly held beliefs that are improbable or highly unlikely to be true. These could include paranoid (e.g., believing someone is trying to kill them) or grandiose (e.g., believing they are a very important or famous person) beliefs. They might also believe that events, things in their environment, or other people’s behaviour have some special meaning or are meant especially for them. This is called a delusion of reference. There are other types of delusions, but these are some examples.
A hallucination is also a positive symptom. The technical definition of a hallucination is perceiving something that is not really there, but it is important to consider an individual’s culture and past experiences before labelling an experience as psychotic. Hallucinations can occur in any sensory modality, but auditory hallucinations (e.g., hearing voices) are the most common.
I describe some of the most common psychotic disorders below.
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Schizophrenia Spectrum Disorders include Schizophreniform Disorder, Schizophrenia, and Schizoaffective Disorder. An individual with one of these diagnoses experiences delusions, hallucinations, or both. Their emotions might not match the situation; for example, they might laugh in response to sad news. This is called inappropriate affect.
They might also experience disorganization in their behaviour, thinking, or speech. When someone’s thinking or speech is disorganized, it is referred to as thought disorder. Other people might have trouble understanding them, and/or they might have difficulty organizing their thoughts in their mind. When someone’s behaviour is disorganized, they do things that might not make sense to other people.
Individuals with Schizophrenia Spectrum Disorders may also experience negative symptoms. These are things that were present prior to the development of the illness but are no longer there, such as talking less frequently, withdrawing from others, and having little motivation. It might be difficult to tell how they are feeling due to reduced facial expressions. Sometimes this corresponds with a reduction in how much people actually feel their emotions (e.g., they may no longer feel pleasure the way they used to). Negative symptoms are typically observed prior to the onset of positive symptoms and can sometimes be misdiagnosed as a depressive episode.
A diagnosis of Schizophreniform Disorder is made when these symptoms have been present for one to six months, whereas a diagnosis of Schizophrenia is made when these symptoms have been present for more than six months. This means that someone may initially be diagnosed with Schizophreniform Disorder, but it may change to Schizophrenia if the illness persists beyond six months. Individuals with Schizoaffective Disorder experience mood symptoms (i.e., depression or mania) in addition to the symptoms described above.
It is important to remember that people with Schizophrenia Spectrum Disorders do not necessarily experience all these symptoms, and there is considerable variability between individuals.
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Delusional Disorder is a psychotic illness characterized by – you guessed it – delusions. Typically, there is a principal delusion that is elaborate and specific. Sometimes there can be hallucinations, but they are not prominent and are directly related to the delusion. Negative symptoms and disorganization are not part of the clinical picture. From a functional perspective, Delusional Disorder is usually less impairing on the person’s day-to-day activities than is a Schizophrenia Spectrum Disorder.
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Psychosis is observed in several other clinical conditions, such as severe cases of Major Depressive Disorder, Bipolar Disorder, and Post-Traumatic Stress Disorder. These are not psychotic disorders. Psychotic symptoms can also be drug-induced or (for older adults) associated with neurological conditions, such as Alzheimer’s Disease.
It was once thought that ‘healthy’ individuals do not experience psychosis, but current research supports that psychotic experiences exist along a continuum (van Os et al., 2008). Many people have psychotic experiences with no clinical impact (i.e., does not result in distress or help-seeking). When these experiences become more persistent, cause significant distress, and impact a person’s ability to function, we become concerned that they are developing a psychotic disorder. Although research strongly supports that there is a genetic component to Schizophrenia Spectrum Disorders, there are other factors that lead to psychotic experiences (which may or may not develop into a psychotic illness). The video below was developed by Dr. Jim van Os and his collaborators to describe how psychotic experiences develop using a cognitive model (i.e., how our brains process information based on prior experiences).
The Centre for Meaningful Living is not affiliated or associated with PsychoseNet in any way. This video is provided purely for educational purposes.
Treating Psychosis
Antipsychotic medication remains the first-line treatment for individuals with psychotic illnesses, but many people continue to experience psychotic symptoms even when they take their medication regularly (Langlois, Samokhvalov, & Rehm, 2012). As alluded to in the video, however, therapy can assist individuals in taking a step back from these experiences and/or learning to evaluate them, rather than being swept away by them. Research demonstrates that therapy as an adjunct to medication is effective in treating and managing psychotic symptoms (Turner et al., 2017). Psychotherapy can assist individuals cope with distress related to their symptoms, empower a person to take control of how they respond when these difficult experiences show up, and increase awareness of their symptoms. Treatment can also assist individuals in taking steps to build a meaningful life in the face of their diagnosis.
My Approach