Psychosis

Psychosis means a distortion or abnormality of thinking, in which the person perceives things to be real even though they aren’t.  This may be either the thoughts one has, or the way one communicates.  The thoughts on has may be strange, or completely bizarre.  Some common examples of psychotic thoughts include:

Hallucinations  —  most commonly hearing voices, but also sensations of seeing, feeling, smelling, or tasting things.  Voices may  be vague sounds or specific words.  The latter may be general words or comments, but are more serious if they are insulting, or give commands (the worst being to kill oneself or others).

Paranoias  —  Believing that strangers on the street are watching or targeting them.  Sometimes it’s hard for clinicians to tell if paranoias may be really possible, like thinking their partner is cheating.  If a patient believes the mafia is after them, that’s surely bizarre, unless they live in Sicily, or believe that a local gang is threatening.

Delusions  —  bizarre ideas.  Some common types include:

  • grandiosity, like thinking that famous people take their advice, or that they own major companies
  • erotic, like believing that famous people are in love with them
  • physical (also called somatic), like believing they have parasites all over them
  • delusions of control, like thinking the computer watches them or directs their thoughts

Bizarre ways of communicating (with their psychiatric terms)  include:

  • Saying practically nothing
  • Stopping speech abruptly, as if suddenly distracted by voices (blocking)
  • Hopping illogically from topic to topic (tangential)
  • Combining ideas that have nothing to do with each other (loose association)
  • Constant repetition of ideas or words, even when off on another topic (perseveration)
  • Throwing in rhymes that don’t make sense, like “I went to town, frown, the clown frown) (clanging)
  • Babbling words together that don’t make sense (word salad)

When psychosis is worsening, behavior become agitated.  The opposite can also occur, as some patients withdraw and may become virtually motionless (catatonic).  Unless the strange thoughts are urging violence, the patient themselves won’t be violent.  If the thoughts urge self-harm, agitation can signal a risk for suicide. 

Psychosis is a symptom, thatโ€™s caused by a disease.  These include:

  • Schizophreniaย 
  • Bipolar disorder
  • Depression
  • Many medical illnesses that become severe and affect the brain, either directly (like stroke), or by lack of oxygen, or by normal body chemicals being too high or too low
  • Drugs and Medications

It can be impossible to distinguish between a person with schizophrenia in the midst of psychosis, and somebody high on meth or cocaine, and the panic of not being able to breathe.  There were (and maybe still are) cases of asthmatics being placed in ER “quiet rooms,” and dying there.

A brilliant psychiatric nurse once told me that she would ask psychotic patients, after their condition had been controlled by medication, to describe what it felt like.  The word they most often used was “pain.”  So if you ever see anyone in the midst of mental crisis, don’t just think that they’re “acting crazy.”  Think that they’re suffering in pain.

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