What does psychosis look like

Psychoses> General

1. The most important things in a nutshell

Psychosis is a group of mental illnesses that are associated with changes in thoughts, perception, feelings and behavior. At times, the sick cannot distinguish between reality and their own ideas. They temporarily step out of reality, but often do not experience themselves as sick because their perceptions appear very real to them.

What psychotic disorders have in common is that those affected lose touch with themselves and their environment. Patients change their personality without realizing it themselves. Sick people, on the other hand, feel that it is not themselves but their environment that is changing.

2. Forms of psychotic disorders

A distinction is made between the following forms of psychotic disorders (psychoses):

  • Organic psychoses
    There is an organic cause, e.g. brain damage from dementia, epilepsy, multiple sclerosis, Parkinson's or a brain tumor.
  • Psychoses from the schizophrenic circle of forms
    Very different appearances with an emphasis on cognitive disorders in perception and thinking. A schizophrenia lies no split personality, as the meaning of the word ("schizo" = I split, "phren" = spirit) suggests.
  • Affective psychoses
    Changes in the processing of reality in connection with more affective disorders of mood and drive towards depression or mania or in both directions (= bipolar disorder).
  • Schizoaffective psychosis
    Alternation of symptoms of schizophrenia, depression and / or mania.

3. Occurrence and course

Psychotic disorders are relatively common. About 2% of the population get it once in a lifetime - about 1% from schizophrenic psychoses and about 1% in connection with depression and mania. The first outbreak of the disease usually takes place between the ages of 15 and 35. The course of psychotic disorders is very different and depends not only on the form of the disorder diagnosed but also on the person affected, his environment and the therapeutic measures.

Psychoses run in phases. In the acute phase, the symptoms are very pronounced, the patients are then cared for as closely as possible and often as inpatients. In the stabilization phase that follows, many patients need rest and time to recover. In the third phase, the remission phase, the symptoms decrease sharply or disappear completely.

Some of those affected only go through a single acute phase, often in connection with a life crisis. Some have recurrent psychotic episodes in stressful situations, but they can lead relatively normal lives between the acute phases. Other patients, however, are permanently impaired and have psychotic symptoms even between the acute episodes.

4. Causes

With the exception of organic psychoses, the causes are largely unknown. On the one hand, disorders of the brain metabolism and, on the other hand, genetic factors in connection with external psychological stress are suspected.

The Vulnerability-Stress Model is currently the best accepted causal model for the development of psychoses and takes neurological, psychological and social factors into account. It assumes that those affected have a genetic susceptibility (Vulnerability) for the development of a psychotic illness is present. If there are insufficient coping options available in stressful situations (e.g. moving out of the parental home, separation from a partner or death of a relative), psychotic symptoms can develop.

However, if you are genetically predisposed, the disease is not inevitable. There are some protective factors, such as good social inclusion and a variety of coping options, that can prevent the onset of psychosis.

As neurological causes disorders of the messenger substances in the brain, which influence information processing in the brain, are suspected. The neurotransmitter dopamine in particular is increased in schizophrenia.

Regular consumption of Drugs like cannabis or LSD is one of the risk factors. It is unclear whether the psychotic symptoms were present beforehand or whether they were caused by drug use. In any case, drugs negatively affect the course of a psychosis.

5. Symptoms

The appearance of a psychosis is diverse and individually different. The first signs of the disease are often noticed by friends or family members. You notice that the person concerned is “no longer the same” and appears to be externally controlled. As a result, they can help ensure that the disease is detected as early as possible.

The following is a description of the symptoms of a psychotic disorder using the example of schizophrenia. The core symptoms are roughly divided into 3 categories:

  • Positive symptoms (so-called plus symptoms)
  • Negative symptoms (so-called minus symptoms) and
  • Catatonic symptoms (so-called psychomotor disorders)

5.1. Plus symptoms

The plus symptoms include:

  • Delusion
    An uncorrectable, "wrong" assessment of reality. Most often, those affected suffer from paranoia and relationship delusions, megalomania and delusions of guilt. For example, paranoid patients feel persecuted by aliens or believe that other people want to harm them. In delusional relationships, those affected relate general events to themselves or interpret certain objects or people as a threat. For example, they believe that radio announcers are delivering secret messages to them. Patients with megalomania are convinced that they are a famous personality, an unrecognized genius or something similar. In delusional guilt, patients think they are responsible for the misfortune or suffering of others, although objectively there is no reason for it.
  • Hallucinations
    A sensory perception is felt that is not based on a real sensory stimulus. This delusion can affect all sense organs, the most common of which is auditory hallucinations. The sick hear voices that, for example, comment on their behavior or give them orders. Usually these voices are perceived as threatening. But optical (e.g. seeing objects, people, colors), olfactory (smells) or sensory (e.g. touch) hallucinations can occur.
  • Ego disorders
    The boundary between oneself and the environment is perceived as permeable. Body, thoughts and / or feelings are experienced as alien. Sufferers believe that others can hear their thoughts, that others withdraw their thoughts, or that their thoughts and actions are controlled and influenced by other people.
  • Formal thinking disorders
    The flow of thoughts is disturbed. This includes distortions of the conventional thought process, confusion with erratic and illogical trains of thought or breaking off a train of thought for no apparent reason. The patient often invents new terms and word combinations or constantly repeats certain sentences or thoughts.

5.2. Minus symptoms

The negative symptoms include

  • social withdrawal,
  • emotional impoverishment or flattening,
  • Lack of drive,
  • Lack of language,
  • Attention deficit,
  • Sleep disorders,
  • poor personal hygiene and
  • psychomotor slowdown.

5.3. Katatonic symptoms

With more pronounced degrees of severity of the disease, so-called catatonic symptoms can appear. These are psychomotor disorders that range from strong arousal to physical numbness.

Some patients report hypersensitivity to light or colors, sounds, smells or taste sensations. The sense of time can also be disturbed. However, the intellectual abilities and the personality are not impaired.

6. Practical tip

Free download: Counselor Psychoses with information on all of the above topics and the information in the articles linked below.

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