Psychotic disorders are a group of serious mental illnesses. They lead to a violation of clarity of thinking, the ability to make correct judgments, emotionally respond, communicate with people and adequately perceive reality. People with pronounced symptoms of the disease are often unable to cope with everyday tasks. Interestingly, most often such deviations are observed among residents of developed countries.
However, even severely occurring types of diseases are more or less amenable to medical treatment.
Definition
Psychotic level disorders cover a number of diseases and related symptoms. In fact, such disorders are some forms of altered or distorted consciousness that persist for a considerable period of time and interfere with the normal functioning of a person as a full member of society.
Psychotic episodes may occur as an isolated case, but more often they are a sign of a significant deviation in mental health.
Risk factors for the occurrence of psychotic disorders include heredity (especially schizophrenia), frequent cases of drug use (mainly hallucinogenic drugs). The onset of a psychotic episode can also trigger stressful situations.
Kinds
Psychotic disorders have not yet been fully considered, some points are different depending on the approach to their study, so there may be some disagreement in the classifications. This is especially true for schizoaffective disorders, due to conflicting data on the nature of their occurrence. In addition, it is not always possible to clearly determine the cause of a particular symptomatology.
Nevertheless, the following main, most common, types of psychotic disorders can be distinguished: schizophrenia, psychosis, bipolar disorder, polymorphic psychotic disorder.
Schizophrenia
This disease is diagnosed in cases of manifestation of symptoms such as delusions or hallucinations for at least 6 months (with at least 2 symptoms should subside continuously for a month or more), with corresponding changes in behavior. Most often, as a result, difficulties arise with the performance of everyday tasks (for example, at work or during training).
Diagnosis of schizophrenia is often complicated by the fact that similar symptoms can occur with other disorders, and often patients can be cunning about the degree of their manifestation. For example, a person may not want to admit that he hears voices due to paranoid delirium or fear of stigma and so on.
Also distinguish:
- Schizophreniform disorder. It includes symptoms of schizophrenia, but lasts a shorter period of time: from 1 to 6 months.
- Schizoaffective disorder. It is characterized by symptoms of both schizophrenia and diseases such as bipolar disorder.
Psychosis
It is characterized by some distorted sense of reality.
A psychotic episode may include the so-called positive symptoms: visual and auditory hallucinations, delusions, paranoid reasoning, disorientation of thinking. Negative symptoms include depressed mood, difficulties in constructing indirect speech, commenting on and maintaining a coherent dialogue.
Bipolar disorder
Affective disorder characterized by sudden mood swings. The condition of people with a similar disease usually changes dramatically from maximum arousal (mania and hypomania) to minimal (depression).
Any episode of bipolar disorder can be characterized as “acute psychotic disorder”, but not vice versa.
Some psychotic symptoms can only disappear during a manifestation of mania or depression. For example, during a manic episode, a person can experience tremendous feelings and believe that he has incredible abilities (for example, the ability to always win in any lottery).
Polymorphic Psychotic Disorder
It can often be mistaken for a manifestation of psychosis. Since it develops like a psychosis, with all the accompanying symptoms, but also it is not schizophrenia in its original definition. It belongs to the type of acute and transient psychotic disorders. Symptoms appear unexpectedly and constantly change (for example, a person sees new hallucinations that are completely different from each other), the general clinical picture of the disease usually develops quite quickly. A similar episode lasts, usually from 3 to 4 months.
Allocate a polymorphic psychotic disorder with and without symptoms of schizophrenia. In the first case, the disease is characterized by the presence of signs of schizophrenia, such as prolonged persistent hallucinations and a corresponding change in behavior. In the second case, they are unstable, visions often have a fuzzy orientation, the mood of a person is constantly and unpredictably changing.
Symptoms
And with schizophrenia, and with psychosis and all other similar types of diseases, a person always has the following symptoms characterizing a psychotic disorder. Often they are called "positive", but not in the sense that they are good and useful to others. In medicine, a similar name is used in the context of the expected manifestations of the disease or the normal type of behavior in its extreme form. Positive symptoms include hallucinations, delirium, strange body movements or lack of movement (catatonic stupor), peculiar speech and strange or primitive behavior.
Hallucinations
They include sensations that do not have a corresponding objective reality. Hallucinations can occur in various forms parallel to human feelings.
- Visual hallucinations include optical illusion and the vision of non-existent objects.
- Auditory, the most common form, include voices in the head. Sometimes these two types of hallucinations can mix, that is, a person not only hears voices, but also sees their owners.
- Olfactory. A person feels odors that do not exist.
- Somatic. The name comes from the Greek "catfish" - the body. Accordingly, these hallucinations are bodily, for example, a sensation of the presence of something on the skin or under the skin.
Mania
This symptom most often characterizes an acute psychotic disorder with symptoms of schizophrenia.
Mania is a strong irrational and unrealistic beliefs of a person that are difficult to change, even if there is undeniable evidence. Most non-medical people believe that mania is only paranoia, persecution mania, overly suspicious when a person believes that everything around him is a conspiracy. However, this category also includes unfounded beliefs, manic love fantasies and jealousy bordering on aggression.
Mania of greatness is a widespread irrational belief, as a result of which the importance of man is exaggerated in various ways. For example, a patient may consider himself president or king. Often delusions of grandeur takes on a religious connotation. A person may consider himself the messiah or, for example, sincerely assure others that he is the reincarnation of the Virgin Mary.
Misconceptions related to the characteristics and functioning of the body can also often occur. There were times when people refused to eat because of the belief that all the muscles in the throat are completely paralyzed and all that they can swallow is water. However, there was no real reason for this.
Other symptoms
Other signs, as a rule, characterize short-term psychotic disorders. These include strange body movements, constant grimaces and facial expressions uncharacteristic of humans and situations, or, as the opposite, a catatonic stupor - lack of movement.
There are distortions of speech: the wrong sequence of words in a sentence, answers that make no sense or do not relate to the context of the conversation, mimicking the opponent.
Also often present are aspects of childishness: singing and jumping in improper circumstances, moodiness, non-standard use of ordinary objects, for example, creating a foil cap.
Of course, a person with psychotic disorders will not have all the symptoms at the same time. The basis for diagnosis is the presence of one or more symptoms over time.
Causes
The following main causes of psychotic disorders are distinguished:
- Reaction to stress. From time to time, with severe prolonged stress, temporary psychotic reactions may occur. In this case, the cause of stress can be either situations that many people encounter throughout life, for example, the death of a spouse or divorce, or more severe ones - a natural disaster, being in places of military operations or in captivity. Typically, a psychotic episode ends as stress decreases, but sometimes this condition can drag on or become chronic.
- Postpartum Psychosis In some women, significant hormonal changes as a result of childbirth can cause an acute psychotic disorder. Unfortunately, such conditions are often misdiagnosed and treated, as a result of which there are cases when a new mother kills a child or commits suicide.
- The protective reaction of the body. It is believed that people with personality disorders are more susceptible to stress, they are less adapted to adulthood. As a result, when life circumstances are tightened, a psychotic episode may occur.
- Psychotic disorders due to cultural characteristics. Culture is an important factor in determining mental health. In many cultures, what is usually considered a deviation from the generally accepted norm of mental health is part of traditions, beliefs, a reference to historical events. For example, in some regions of Japan, there is a very strong belief, up to mania, that the genitals can contract and become drawn into the body, causing death.
If this or that behavior is acceptable in a given society or religion and occurs under appropriate conditions, then it cannot be diagnosed as an acute psychotic disorder. Treatment, respectively, under such conditions is not required.
Diagnostics
In order to diagnose a psychotic disorder, the general practitioner needs to have a conversation with the patient and also check the general state of health in order to exclude other causes of such symptoms. Most often, a blood and brain test is performed (for example, using an MRI) to exclude mechanical damage to the brain and drug addiction.
If no physiological reasons for such behavior are found, the patient is referred to a psychiatrist for further diagnosis and to determine whether this person really has a psychotic disorder.
Treatment
Most often, a combination of medication and psychotherapy is used to treat psychotic disorders.
As a medicine, specialists most often prescribe antipsychotics or atypical antipsychotics, effective for stopping such alarming symptoms as delirium, hallucinations and distorted perception of reality. These include: Aripiprazole, Azenapine, Brexpiprazole, Clozapine, and so on.
Some drugs are available in the form of tablets that must be taken daily, others in the form of injections, which are enough to put once or twice a month.
Psychotherapy includes various types of counseling. Depending on the personality of the patient and how the psychotic disorder proceeds, individual, group or family psychotherapy can be prescribed.
Most people with psychotic disorders undergo outpatient treatment, that is, they are not constantly in the medical institution. But sometimes, in the presence of severe symptoms, the threat of harm to oneself and loved ones, or if the patient is not able to take care of himself, hospitalization is performed.
Each patient undergoing treatment for a psychotic disorder may respond differently to therapy. Someone's progress is noticeable from the first day, someone will need months of treatment. Sometimes, in the presence of several severe episodes, it may be necessary to take medication on an ongoing basis. Usually, in such cases, the minimum dose is prescribed to minimize side effects.
Psychotic disorders cannot be prevented. But the faster you ask for help, the easier it will be to undergo treatment.
People with a high risk of such disorders, such as those who have schizophrenics among close relatives, should avoid drinking alcohol and any drugs.