Psychosis
What is Psychosis?
Psychosis is a brain disorder characterized by an early abnormal mental state. Patients experience dysfunction in their brain's neural functions, leading to an overactivity of the chemical "dopamine," which causes confusion in "thoughts" and "feelings," resulting in a disconnection from reality. If not addressed promptly, psychosis can lead to more severe symptoms of mental illness. Individuals of any age can develop psychosis, but it is more commonly seen during adolescence and early adulthood.
What is the Difference Between Psychosis and Schizophrenia?
The term "schizophrenia" comes from Greek roots:
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schizein = split
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phren = mind
Thus, schizophrenia translates to the "splitting of the mind."
For a long time, schizophrenia has been perceived as a very serious illness, often leading people to believe that patients are "crazy" or "hopeless." This naming can contribute to societal misconceptions and negative labeling of the condition. As a result, many patients are reluctant to disclose their mental health status, refuse treatment, or are hesitant to continue therapy.
In 2001, the Hong Kong Hospital Authority created the term "psychosis" (Early Psychosis) to describe patients in an early abnormal mental state, aiming to reduce stigma. In other regions, such as Taiwan, schizophrenia has been renamed to psychotic disorder to reflect a more compassionate understanding of the condition.
Phases of Psychosis
The onset of psychosis can be divided into three stages:
1. Prodromal Phase
Before the onset of psychosis, patients may experience several months or even years of warning signs. These early symptoms can include insomnia, suspicion, difficulty concentrating, feelings of depression, anxiety, irritability, and social withdrawal. These symptoms may be subtle and not easily noticed by those around them. During this phase, the patient's psychological, social, academic, or work abilities may decline.
2. Active Phase
In this phase, patients exhibit clear symptoms, including hallucinations and delusions. Their thoughts and speech may become disorganized, with content that is sparse, off-topic, or even nonsensical, making it difficult for others to understand them. This can severely affect their daily life and work.
3. Recovery or Residual Phase
The recovery process varies from person to person. Most patients will gradually recover after treatment. However, the longer the duration of untreated psychosis, the less favorable the recovery outcome tends to be. Early detection and appropriate treatment can reduce the harm associated with psychosis and prevent the onset of more severe mental illness. Some patients may continue to experience residual or negative symptoms after recovery, such as diminished speech, neglecting self-care, loss of motivation, and social withdrawal.
Main Symptoms of Psychosis
1. Disorganized Thoughts and Speech
Thinking becomes incoherent and lacks logic; speech can become sparse, off-topic, or even nonsensical, making it difficult for others to understand the patient.
2. Hallucinations
Patients may see, hear, or feel things that do not exist; these sensations feel very real to them.
Hallucinations can be categorized into different types, such as auditory, visual, tactile, and olfactory hallucinations. Auditory hallucinations are particularly common in clinical settings; for example, a patient may hear a voice speaking to them when they are alone. The content of these voices can range from casual conversation to persistent personal attacks or harsh criticisms, and in severe cases, the voices may issue commands to the patient. This can lead to behaviors such as talking to oneself or responding to the voices as if they were real.
3. Delusions
Delusions are false beliefs held by the patient despite a lack of evidence supporting them. Patients may stubbornly cling to these beliefs, considering them true even when others present contradictory evidence.
There are various types of delusions commonly observed in clinical settings, including:
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Persecutory Delusions: Believing that someone is trying to harm them.
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Referential Delusions: Thinking that strangers on the street are watching or discussing them.
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Passive Delusions: Feeling that their thoughts or actions are being controlled by external forces.
Treatment of Psychosis
1. Medication
Medication plays a fundamental role in treatment. It primarily works by improving the excess secretion of dopamine in the brain, helping patients reorganize their thoughts and reconnect with reality. Medication types include oral medications and injectable drugs. Injectable medications can enhance patient compliance, typically administered once a month to improve symptoms. Most patients experience improvements in delusions and hallucinations within a few weeks of starting medication, with about 80% gradually recovering. Patients should continue taking medication even after improvement to reduce the risk of relapse.
2. Psychotherapy or Counseling
Appropriate counseling can provide patients with knowledge about their condition, including causes, symptoms, and treatment methods. This helps increase their awareness of the illness and improves medication adherence. Patients also learn skills for positive thinking, emotional management, and stress handling to reduce the chance of relapse.
3. Occupational Therapy
Occupational therapists assist patients in developing skills to reintegrate into family and society, providing vocational training and arranging supported employment if necessary.
What to Do if Side Effects Occur?
If side effects occur during medication, patients should not ignore them but should report them to their doctor. Patients must avoid secretly reducing or stopping their medication. Relapse in psychosis is relatively severe compared to other mental illnesses. Doctors can adjust the type and dosage of medication, change the timing of administration, or prescribe adjunct medications to alleviate side effects.
How Can Family Members Help Patients with Psychosis?
Recovery from psychosis can take a long time. During this period, the care and support of family and friends, as well as the understanding and acceptance of society, are crucial. Research indicates that the interaction style between family and patients can influence the patient’s condition. If family members exhibit high emotional expression, it may increase the risk of relapse. High emotional expression can include:
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Excessive criticism (e.g., blaming the patient for burdening the family)
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Excessive blame (e.g., holding the patient responsible for their emotional illness)
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Excessive protection (e.g., overly accommodating due to concern for the patient’s condition)
These behaviors should be avoided by family members when supporting a patient’s recovery.