Psychosis

Introduction to Psychosis

Psychosis is a broad term in general usage, but from a medical standpoint is a symptom or feature of mental illness typically characterized by radical changes in personality, impaired functioning, and a distorted or nonexistent sense of objective reality.[1]

Causes of Psychosis

The dopamine hypothesis

While the exact mechanisms of psychosis are not fully understood, there is substantial evidence for the role of over-activity of dopamine synapses in the mesolimbic pathway in the development of psychosis.[2]

In the middle of the twentieth century the first antipsychotic medication, chlorpromazine was discovered which was found to have a dramatic effect on eliminating or diminishing the positive symptoms (those associated with psychosis) of schizophrenia. Other antipsychotics have since been developed with similar effects. The commonality between the drugs is that they all block the activity of dopamine D2 and D3 dopamine receptors.[2]

It has similarly been identified that another category of drugs exacerbates and triggers the positive symptoms of schizophrenia. That category of drugs is stimulants, which includes cocaine and amphetamines. Stimulants increase activation of dopamine synapses by causing increased levels of dopamine release.[2]

Dopamine is a neurotransmitter that has a vital role in the reinforcement of behaviour in learning. It has been suggested that psychosis may be a consequence of the unintended reinforcement of the kind of irrational thoughts we all have from time to time, but usually dismiss.[2] Paranoid delusions may be the result of increased dopaminergic transmission to the amygdala.[3] The amygdala is a limbic system structure that receives strong dopaminergic projections from the mesolimbic pathway, and is involved in conditioned responses to aversive stimulus (fear etc).[2]

Symptoms & Types/Variations of Psychosis

Hallucination - Hallucinations are perceptual disturbances that distort or have no basis in reality. While they are commonly portrayed as visual disturbances they can be of any sense and auditory hallucinations are much more common than visual hallucinations.[4]

Delusion - Delusions are false beliefs that remain firmly held to despite contradictory evidence.[4]

Loosened lines of associations - An individual experiencing psychosis may express themselves more metaphorically without the intention to do so.[4] For example, a rational person might describe a friend by saying "Joe was irritable". With a loosening of lines of association a psychotic person might associate irritable with an animal notorious for irritability and say "Joe was a rhinoceros".

Treatments of Psychosis

Natural

Cannabidiol

There is emerging evidence that CBD may have some application as a natural antipsychotic.[5] Please note, this research applies to CBD, not to the entire cannabis plant. Cannabis use in the developing brain has been correlated with increased instances of schizophrenia, in a dose dependent correlation [6][7]

Psychotherapy

There is evidence that psychotherapy may be effective for managing the symptoms of psychosis. Several different kinds of therapy have been evaluated and found to be efficacious in those studies.[8][9][10]

Medical

Antipsychotic medications

The first line treatment for psychosis is with antipsychotics. In an emergency setting the person may be hospitalised and treated with very high doses. Antipsychotics may be prescribed in a maintenance dosage indefinitely to prevent a recurrence of psychotic episodes.[1]

Ethical considerations

An important ethical consideration for medical professionals treating a case of psychosis is whether or not the person has the capacity to refuse treatment. Because delusion is a persistently held belief despite the available evidence it may be necessary to admit and treat patients against their consent in jurisdictions where such treatment is permissible in cases of diminished capacity.

The Dangers & Health Risks of Psychosis

The major physical risk of psychosis is that of the person causing themselves or others harm due to delusion or hallucination.

If left untreated there is increased likelihood of a discreet episode of psychosis becoming chronic or recurring. Prognosis is much better for people who are treated at the earliest possible stages.[1]

The Latest Medical Information on Psychosis Threads

Morbidity Rate

Psychosis on its own is not fatal, however it can lead to dangerous behaviours that would not otherwise be demonstrated and that could be potentially fatal.

References

  1. ^ a b cpsychosis. (n.d.). Retrieved from https://medical-dictionary.thefreedictionary.com/psychosis
  2. ^ a b c d eCarlson, N. R. (2017). Physiology of behavior (12th ed.). Boston, MA: Allyn and Bacon.
  3. ^Fibiger, H. C. (1991). The dopamine hypothesis of schizophrenia and mood disorders: Contraindications and speculations. In P. Willner & J. Scheel-Kruger (Eds.), The mesolimbic dopamine system: From motivation to action.
  4. ^ a b cBurton, L., Westen, D., & Kowalski, R. (2015). Psychology: Australian and New Zealand edition (4th ed.). Milton, Australia: John Wiley & Sons.
  5. ^Schubart, C., Sommer, I., Fusar-Poli, P., De Witte, L., Kahn, R., & Boks, M. (2014). Cannabidiol as a potential treatment for psychosis. European Neuropsychopharmacology, 24(1), 51-64. doi:10.1016/j.euroneuro.2013.11.002
  6. ^Arseneault, L. (2004). Causal association between cannabis and psychosis: examination of the evidence. The British Journal of Psychiatry, 184(2), 110-117. doi:10.1192/bjp.184.2.110
  7. ^Andréasson, S., Engström, A., Allebeck, P., & Rydberg, U. (1987). CANNABIS AND SCHIZOPHRENIA A Longitudinal Study of Swedish Conscripts. The Lancet, 330(8574), 1483-1486. doi:10.1016/s0140-6736(87)92620-1
  8. ^Gouzoulis-Mayfrank, E., König, S., Koebke, S., Schnell, T., Schmitz-Buhl, M., & Daumann, J. (2015). Trans-Sector Integrated Treatment in Psychosis and Addiction: A Randomized Controlled Study of a Motivational, Cognitive Behavioral Therapy Program Under Standard Hospital Treatment Conditions. Deutsches Ärzteblatt International, 112(41), 683–691. http://doi.org/10.3238/arztebl.2015.0683
  9. ^Piskulic, D., Barbato, M., Liu, L., & Addington, J. (2015). Pilot study of cognitive remediation therapy on cognition in young people at clinical high risk of psychosis. Psychiatry Research, 225(1-2), 93-98. doi:10.1016/j.psychres.2014.10.021
  10. ^Hutton, P., Morrison, A. P., Wardle, M., & Wells, A. (2013). Metacognitive Therapy in Treatment-Resistant Psychosis: A Multiple-Baseline Study. Behavioural and Cognitive Psychotherapy, 42(02), 166-185. doi:10.1017/s1352465812001026
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