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Psychosis and schizophrenia

 

Psychoses can be considered as serious "states of confusion", and actually signify very profound nervous breakdowns. Schizophrenia is the name of a disease that is characterized by a prolonged psychosis.

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What is psychosis?

Psychoses can be considered as serious "states of confusion", and actually signify very profound nervous breakdowns. Psychosis is a process in which the psychotic breakthrough or breakdown is a stage in the development of the disease. Before the psychosis occurs, the patient has often had more general and non-specific signs of mental illness, such as sleep disorders, anxiety, depression, and social isolation.

It can take a long time from a person developing such a serious "state of confusion" for the first time, until he or she receives treatment. Many patients can go for several years from the first signs of illness appear until the patient receives treatment in mental health care. We are talking about a delay in treatment.

study from Rogaland county in Norway showed that it took an average of two years from the patient showed symptoms of mental illness until they received treatment.

Psychosis is a term for the disturbed perception of reality mentioned above, while schizophrenia is the name of a disease that is characterized by a long-term psychosis.

  

Common symptoms of psychosis

People with psychosis may have one or more of the following symptoms: hallucinations, delusions and / or thought disorders:

 

Hallucinations

A hallucination is a sensory experience without external stimuli. Hallucinations are different from illusions or sensory distortions, which are misinterpretations of external stimuli. Hallucinations can occur in any of the five senses and can include simple sensory impressions (such as light, colors, tastes and smells) to more meaningful experiences such as seeing and interacting with animals and humans, hearing voices, and having complex tactile experiences.

Auditory hallucinations, especially hearing voices, are a common and often prominent feature of psychosis. Hallucinatory voices can talk about or to the person, and can include several "speakers" with different personalities. Hearing hallucinations are often particularly troublesome when they are condescending, commanding or disturbing.

Not everyone who hears voices is psychotic. A research study has shown that the majority of people who hear voices are not in need of psychiatric help. "The hearing voices movement" is established to support voice listeners, regardless of whether they have a mental illness or not.

 

Delusions

Psychosis can lead to delusions, and sometimes these can be paranoid in nature. A delusion is an explanatory model or perception of reality that is not shared by (especially many) others. Karl Jaspers has classified psychotic delusions into primary and secondary types. Primary delusions occur suddenly and cannot be understood as normal mental processes, while secondary delusions can most often be understood as a result of background or situation (eg, ethnicity, sexual orientation, religious belief, superstition).

 

Thought disorder

Thought disorder is a disturbance of conscious ongoing thought processes, and is most clearly expressed by the influence on speech and writing. The person may lose control of their associations, and become runny. If the associations occur several times in the same sentence, this leads to the breaking of semantic content. In the most serious form, the speech becomes incomprehensible, and is then called "word-salad".

 

What is schizophrenia?

The health library writes:

- Schizophrenia is usually a long-term mental health problem. If you have schizophrenia, your brain works a little differently than other people's brains. The disease affects thoughts, feelings and the way you experience the world. You may at times find it difficult to understand the difference between what is really happening and what you are imagining. Doctors call this psychosis. The confused thoughts cause you to behave in an unusual way.

Medications can help control symptoms. Medications taken over a long period of time can prevent the symptoms from returning. Some people experience only one period of psychosis, while others experience repeated episodes. Periodically you may be free of symptoms, in other periods you may have troublesome symptoms that do not go away.

Doctors do not know why some people get schizophrenia, but there are some factors that increase the likelihood:

 

  1. Having a close relative with schizophrenia
  2. Early life experiences, including not getting enough oxygen during birth
  3. The environment around you, such as living in a city rather than in the countryside

These factors increase the risk of developing schizophrenia. But doctors believe that events that also occur as one gets older can help trigger an episode of symptoms of schizophrenia. These events can be:

 

  1. To experience a lot of stress
  2. Use of drugs such as cannabis, or a lot of alcohol
  3. To be socially isolated and not have the support of networks

Sources: TIPS - Wikipedia  - The Health Library

 

The signs that give cause for concern about psychosis or schizophrenia

The following signs should give reason to think that the person needs help, and that there may be reason to initiate early help in relation to a possible psychosis.

 

  1. Retiring from family and friends
  2. Afraid to leave the house
  3. Sleeps poorly and eats little
  4. Is preoccupied with a particular topic, such as death, politics or religion
  5. Neglects personal hygiene
  6. Achieves poorer results at school
  7. Having trouble concentrating and remembering things
  8. Talks about, or writes things, that make no sense
  9. Panic, are extremely anxious, noticeably depressed or have suicidal thoughts
  10. Loses mood swings
  11. Lacks expression of emotions
  12. Has marked fluctuations in mood
  13. Has inappropriate emotional reactions
  14. Hear voices that no one else can hear
  15. Believes, for no reason, that others are conspiring against, spying on or following one
  16. Believe that one is hurt, or influenced to do things against one's will, by television, the devil etc.
  17. Believe that one has special abilities
  18. Believe that thoughts are affected or that one can influence the thoughts of others 

 

What helps with psychosis / schizophrenia?

We can distinguish between measures that help prevent the development of psychosis (prevention), and the measures that are necessary once a psychosis has occurred (treatment).

 

Prevention of psychosis

Early intervention in psychosis is a relatively new concept based on the observation that identifying and treating someone in the early stages of a psychosis can improve the long-term prognosis. This approach supports the use of an intensive interdisciplinary approach during what is called the critical period, where interventions are most effective, and prevent the development of chronic psychotic illness.

Recent research on the effects of cognitive behavioral therapy in the early stages of psychosis (also known as the prodromal phase) suggests that such measures may prevent or delay the onset of psychosis.

 

Treatment of psychosis

The treatment of psychosis depends on the cause or diagnoses (eg schizophrenia, bipolar disorder and / or substance-induced psychosis). First-line treatment for many psychotic disorders is antipsychotic medication (oral or intramuscular injection), and sometimes hospitalization is necessary. There is growing evidence that cognitive behavioral therapy and family therapy can be effective in dealing with psychotic symptoms. When other treatments for psychosis are ineffective, electroconvulsive therapy (ECT) can sometimes be used to relieve the underlying symptoms of depression. There is also increasing evidence to suggest that animal-assisted treatment may contribute to the improvement of general well-being for people with schizophrenia.

The usual treatment for symptoms of schizophrenia is to take medication called antipsychotics. The side effects of the medication are the main disadvantage of treatment for schizophrenia. Your doctor will help you find the medicine and dose that keeps your symptoms under control, but at the same time causes the least possible side effects for you.

 

Medication for psychosis / schizophrenia

Antipsychotics calm you down when you are upset or angry. The medication can also reduce the symptoms of schizophrenia, such as strange or disturbing thoughts, or hearing voices.

There are two groups of antipsychotics. There are traditional antipsychotics such as chlorpromazine, haloperidol and flupentixol, and newer antipsychotics such as olanzapine, risperidone and quetiapine. The two groups work about equally well, but can have different side effects. It is somewhat uncertain whether newer antipsychotics as a whole give less side effects than the traditional ones. If you have recently been diagnosed with schizophrenia, you will probably be offered a newer antipsychotic first.

Most antipsychotics are taken as tablets, but some can be taken as long-acting injections. The long-acting ones can be helpful if you find it difficult to remember to take medication. If you continue to take the medication after the symptoms are under control, you reduce the risk of getting symptoms in the future. Most people with schizophrenia need to take antipsychotics regularly. Stopping taking them can lead to a new episode of psychotic symptoms (called a relapse). However, it can be difficult to continue taking antipsychotics due to side effects.

Side effects you may experience with any antipsychotic medication include dry mouth, constipation and weight gain. About one in four people taking olanzapine gain weight.

Newer antipsychotics can also cause high cholesterol, low blood pressure (which can cause dizziness) and decreased sexual desire (more likely with risperidone). They may also present a certain risk of getting diabetes.

The main disadvantage of traditional antipsychotics is the difficulty in coordinating physical movements. You may experience unusual movements, muscle stiffness and / or twitching. You may also experience inner turmoil and tremors. These problems are called movement disorders. Between one in ten and three in ten people who take traditional antipsychotics get movement disorders. Movement disorders can be alleviated by adding another anticholinergic drug.

If you have any side effects, talk to your doctor. Sometimes the side effects disappear after taking the medicine for a while. You can also try another drug, or a lower dose. You do not have to accept troublesome side effects.

A newer antipsychotic drug called clozapine is sometimes used when other drugs have not worked. This medicine works well for most people, but in rare cases, clozapine can damage white blood cells. White blood cells are an important part of the immune system and help you fight infections. Therefore, you must take regular blood tests when taking clozapine. Due to the possible influence of the white blood cells, it is not suitable for everyone.

 

Psychotherapy for psychosis / schizophrenia

When the condition is under control, talk therapy (psychotherapy) can help prevent relapse, but most people will still have to continue taking their antipsychotic medication.

Research has shown that going into family therapy can help you avoid a relapse of symptoms of schizophrenia.

If you go to family therapy, you and your family will see a therapist regularly. You will all learn more about schizophrenia. You will also learn ways to communicate better and how to solve problems together. Research shows that family therapy reduces the chance of relapse, up to four years after therapy.

Learning more about your illness from a professional can help you stay healthy. You can participate in a training program, either on your own or with others, where you learn about schizophrenia and how to master the condition. Here you can also learn about how to detect the signs of relapse and what you can do then. You will usually attend about ten meetings, either on your own or with others. Research shows that people who participate in such programs have a lower risk of relapse, or less risk of having to be hospitalized, over the next five years. Ask your doctor if there are any such training programs in your area.

Other types of conversation processing can also have an effect. It includes cognitive behavioral therapy (CBT) and social skills training. CBT helps you to look more positively at your life and to find ways to cope with schizophrenia symptoms. Social skills training helps you learn, or re-learn, ways to get along with other people. Exercise can help if you have become socially isolated due to the disease. However, there is not enough research to conclude with certainty that these treatments prevent relapse.

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Written by

ove heradstveit

Ove Heradstveit

Psychologist, specialist in clinical community psychology. PhD.
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