Evaluation

Psychosis refers to a collection of symptoms that affect the mind, where there has been some loss of contact with reality. During an episode of psychosis, a person’s thoughts and perceptions are disrupted and they may have difficulty recognizing what is real and what is not.

People with psychosis typically experience delusions (false beliefs, for example, that people on television are sending them special messages or that others are trying to hurt them) and hallucinations (seeing or hearing things that others do not, such as hearing voices telling them to do something or criticizing them). Other symptoms can include incoherent or nonsense speech and behavior that is inappropriate for the situation.

However, a person will often show changes in their behavior before psychosis develops.Behavioral warning signs for psychosis include:

• Suspiciousness, paranoid ideas, or uneasiness with others

• Trouble thinking clearly and logically

• Withdrawing socially and spending a lot more time alone

• Unusual or overly intense ideas, strange feelings, or a lack of feelings

• Decline in self-care or personal hygiene

• Disruption of sleep, including difficulty falling asleep and reduced sleep time

• Difficulty telling reality from fantasy

• Confused speech or trouble communicating

• Sudden drop in grades or job performance

Alongside these symptoms, a person with psychosis may also experience more general changes in behavior that include:

• Emotional disruption

• Anxiety

• Lack of motivation

• Difficulty functioning overall

In some cases, a person experiencing a psychotic episode may behave in confusing and unpredictable ways and may harm themselves or become threatening or violent toward others. The risk of violence and suicide decreases with treatment for psychosis, so it is important to seek help. If you find that you are experiencing these changes in behavior or notice them in a friend or family member and they begin to intensify or do not go away, reach out to a health care provider.

What causes psychosis?

There is no one cause of psychosis. Psychosis appears to result from a complex combination of genetic risk, differences in brain development, and exposure to stressors or trauma. Psychosis may be a symptom of a mental illness, such as schizophrenia, bipolar disorder, or severe depression.

For older adults, psychosis symptoms can be part of a physical or mental illness that emerges later in life. Psychosis can also be a symptom of some diseases of older age, including Parkinson's disease, Alzheimer’s disease, and related dementias.

Other possible causes of psychosis include sleep deprivation, certain prescription medications, and the misuse of alcohol or drugs. A mental illness, such as schizophrenia, is typically diagnosed by excluding these other causes.

Evaluation

As with any other medical or psychiatric condition, the interview is of the utmost importance for guiding the treatment plan. As usual, one starts by obtaining a thorough history. The history should include but is not limited to the following: timeline and severity of symptoms, prior psychiatric history/conditions, hospitalizations, previous medical history/conditions, medications taken (psychiatric and non-psychiatric), history of substance use, detailed social history, history of trauma (emotional, physical, sexual), suicidal ideation with prior attempts, auditory/visual hallucinations

Of equal importance to the history, and an indispensable component of the psychiatric interview is the mental status exam (MSE). One must make a careful observation regarding the patient’s appearance, behavior, speech, mood, affect, thought process, and thought content.

Of equal importance to the history, and an indispensable component of the psychiatric interview is the mental status exam (MSE). One must make a careful observation regarding the patient’s appearance, behavior, speech, mood, affect, thought process, and thought content.

Antipsychotic medications are the gold-standard treatment for psychotic episodes and disorders, and the choice, dosing, and administration of the medication will largely depend on the scenario.

Along with medications, family and caregivers also play an important role in the management of a psychotic patient, including providing a safe and therapeutic environment for the patient, as well as interacting with them in and calm, empathetic manner.