Psychosis – medical revision notes

1. Definition

• Psychosis is a mental health condition where a person loses touch with reality
• This typically involves experiencing hallucinations (seeing or hearing things that aren’t there) and delusions (firm beliefs that aren’t based on reality)
• Psychosis can affect someone’s thinking, mood, and behaviour, often leading to impaired insight (i.e. patients are unaware they have it, or are unwell)
• It has several causes including schizophrenia and depression.

2. Epidemiology

• Psychosis affects roughly 2% of the population at some point in their lives. Schizophrenia, a the most well-known psychotic disorder, affects about 1%
• The onset of psychosis is most common in late adolescence to early adulthood, but it can happen at any age
• Schizophrenia tends to present in men in their late teens or early 20s, and in women, it’s more common in the late 20s to early 30s.

3. Risk factors

• Genetic: A family history of psychosis or conditions like schizophrenia increases risk
• Substance use: Drugs like cannabis, LSD, and amphetamines are known triggers for psychosis in some individuals
• Trauma: Significant life events, such as bereavement, sexual assault, or war-related trauma, can contribute
• Physical illness: Brain injuries, infections, or neurological conditions can also lead to psychosis.

4. Causes

Psychosis can result from a number of conditions, including:

• Schizophrenia
• Bipolar disorder
• Major depressive disorder (with psychotic features)
• Substance abuse (e.g. drugs or alcohol)
• Severe stress or trauma
• Medical conditions affecting the brain (e.g. brain tumours, infections, cerebral lupus).

5. Symptoms

Psychosis can be broken down into:

• Positive symptoms: Hallucinations, delusions, disorganised thinking, and abnormal motor behaviour
• Negative symptoms: These include reduced emotional expression, lack of motivation, and social withdrawal.

Early warning signs
Early signs of psychosis can include a noticeable drop in performance at work or school, difficulty concentrating, paranoia, withdrawal from social activities, and neglecting personal hygiene.

6. Diagnosis

Diagnosis is based on a full clinical assessment, including:

• A detailed history and mental state examination (MSE)
• Investigations to rule out other causes, such as blood tests and neuroimaging (CT/MRI).

Differential diagnosis

• Anxiety disorders
• Non-psychotic depression
• Personality disorders
• Acute confusional state (delirium)
• Dementia.

7. Treatment

• Antipsychotic medication: First-line treatment to control symptoms. These can be oral or depot SC preparations, depending on the patient’s needs.
• Psychotherapy: Cognitive-behavioural therapy (CBT) is often used to help patients manage symptoms and improve functioning.

8. Complications

• Substance misuse: Some patients turn to drugs or alcohol as a way to cope with their symptoms, which can worsen their condition.
• Self-harm or suicide: Psychosis significantly increases the risk of self-harm or suicide attempts, especially if untreated.

9. Prognosis

• With early intervention and the right treatment, many patients with psychosis can manage their symptoms and lead fulfilling lives
• However, untreated psychosis can lead to long-term impairment
• Stigma around psychosis often discourages individuals from seeking help, so support from family, friends, and healthcare professionals is essential for recovery.

10. Prevention

• Early detection and intervention: Identifying and supporting those at high risk of psychosis early can make a significant difference in outcomes
• Reducing risk factors: Avoiding known risk factors like cannabis use and managing stress or trauma effectively can help prevent the onset of psychosis
• Supportive interventions for children: Preventing childhood trauma and providing support for those who have experienced it may reduce long-term mental health issues
• CBT and psychological support: Psychological interventions like CBT can help manage early symptoms and reduce the likelihood of progression into full-blown psychosis.