What is psychosis?
Psychosis is a mental health condition characterized by a disconnect from reality. The main symptoms are hallucinations, such as hearing or seeing things that aren’t there, and delusions, which are false beliefs that the person holds despite lack of evidence. Other symptoms can include disorganized thinking and speech, and extremely disorganized or abnormal motor behavior.
Psychosis is often associated with conditions like schizophrenia, bipolar disorder, and severe depression. However, it can also occur temporarily as a result of substance use, lack of sleep, extreme stress, or a physical condition like a brain tumor or dementia. If the psychotic symptoms last for more than a month, it is considered an ongoing psychotic disorder. If the symptoms last less than a month and then go away, it is known as a brief psychotic disorder.
What causes recurring psychosis?
There are several potential causes for recurrent or persistent psychotic episodes:
– An underlying psychiatric disorder – Schizophrenia and other chronic psychotic disorders can cause repeated episodes of psychosis during periods of illness exacerbation. This may happen when the individual is noncompliant with medication or during times of high stress.
– Substance abuse – Chronic use of drugs like methamphetamine, cocaine, hallucinogens, and even marijuana can trigger recurring psychotic symptoms that mimic disorders like schizophrenia. The psychosis may abate with sobriety but reemerge with subsequent drug use.
– Medical conditions – Some medical problems like seizures, dementia, tumors, and autoimmune disorders can prompt episodes of psychosis. Treatment of the underlying condition may help, but there may still be psychiatric medication needed to control symptoms.
– Medication changes – Changes in medications, doses, or abrupt discontinuation can precipitate psychotic relapse in those with chronic psychotic disorders. This highlights the importance of careful monitoring and controlled titration when making medication adjustments.
– Stress and sleep deprivation – High stress and lack of sleep are common triggers for psychotic relapse. Stress management, therapy, and sleep hygiene may help mitigate symptoms.
– Postpartum psychosis – Psychosis with delusions, hallucinations, and disorganized thinking can occur following childbirth, likely related to dramatic hormone changes. Medication and hospitalization are often needed to stabilize symptoms.
Why does psychosis keep recurring?
There are several reasons why someone may suffer recurring bouts of psychosis rather than an isolated psychotic episode:
– An underlying chronic psychotic disorder like schizophrenia or schizoaffective disorder. These conditions involve biological vulnerabilities and chemical imbalances in the brain that make the person prone to psychotic relapse when not properly treated and managed.
– Continued substance use can repeatedly trigger psychosis through effects on brain chemistry. This may occur even when drug use is intermittent. Each psychotic episode can further disrupt normal brain function.
– Poor adherence to prescribed psychiatric medications. Stopping medication abruptly or missing many doses can allow psychotic symptoms to return. This highlights the importance of medication compliance.
– Extreme, uncontrolled stress. High stress can repeatedly trigger psychotic episodes in vulnerable individuals by elevating hormones like cortisol and affecting neurotransmitters.
– Deficits in coping skills. Those who lack resiliency, social support, and healthy coping mechanisms are more prone to decompensation under stress. Therapy can help here.
– Toxic home or work environment. Chronically stressful or abusive environments can contribute to recurrent psychotic breaks. Removing the individual from the toxic situation may help.
– Undiagnosed medical illness. An untreated medical condition affecting the brain can result in ongoing psychosis. A full medical workup is warranted.
– Genetic predisposition. Gene variants linked to dopamine and other neurotransmitters can create a susceptibility to recurrent psychosis. While not causal alone, genetics play a role.
What are the stages of psychosis?
Psychosis typically develops through various stages:
Prodrome phase
This early stage may involve subtle changes in thoughts, feelings, and behaviors including:
– Social withdrawal and isolation
– Depressed mood
– Sleep disturbances
– Irritability
– Difficulty concentrating
– Suspiciousness
– Deterioration in hygiene
Many people seek help during this stage as they notice something is not right. Early intervention here may prevent progression to full psychosis.
Acute psychotic episode
This stage is characterized by onset of overt psychotic symptoms like:
– Auditory hallucinations – hearing voices or sounds
– Visual hallucinations – seeing things others cannot
– Delusions – fixed, false beliefs
– Disorganized speech and behavior
– Catatonia – lack of movement, mutism
Symptoms are severe enough to impair function. Hospitalization may be required for safety.
Residual phase
Here, florid symptoms of hallucinations and delusions improve with treatment, but residual symptoms may persist:
– Difficulty concentrating, organizing thoughts
– Foggy thinking
– Lack of motivation, energy
– Blunted emotions
– Social withdrawal
– Suspiciousness
– Sleep disturbances
Ongoing treatment helps control residual symptoms and prevent relapse.
Recovery phase
Many people with psychosis can achieve full recovery with proper treatment and support. Key markers include:
– Resolution of all psychotic symptoms
– Normal thought processes
– Return to premorbid level of social and occupational function
– Ability to self-manage symptoms and medication
– Resiliency and strong coping skills
With recovery, risk of recurrence can be dramatically lowered. Long-term remission is possible.
Risk factors for recurring psychosis
Several risk factors make some people more prone to experiencing repeated episodes of psychosis:
| Risk Factor | Description |
|---|---|
| Genetic predisposition | Family history of psychotic disorders |
| Chronic mental illness | Disorders like schizophrenia and schizoaffective disorder |
| Substance abuse | Chronic use of stimulants, hallucinogens, marijuana, and other drugs |
| Severe stress | High levels of emotional stress |
| Sleep deprivation | Lack of sleep disrupts normal brain function |
| Social isolation | Lack of interpersonal connections and support |
| Trauma | PTSD and severe traumatic experiences |
| Medical conditions | Seizures, infections, brain injuries, tumors, autoimmune disorders |
| Noncompliance with treatment | Not taking prescribed psychiatric medications |
Those with multiple risk factors are most vulnerable to recurring psychotic episodes. Mitigating these risk factors is key to prevention.
Warning signs of impending psychotic relapse
For those with chronic psychotic disorders, being attuned to subtle changes can help catch early warning signs of impending relapse. Warning signs include:
– Sleep disturbances – insomnia or excessive sleep
– Social withdrawal and isolation
– Decline in self-care and hygiene
– Irritability and agitation
– Depressed mood
– Anxiety or panic symptoms
– Problems concentrating and thinking clearly
– Increased sensitivity to sights/sounds
– Growing suspicion or paranoid thoughts
– Subtle changes in beliefs and thinking
When these indicators are caught early, interventions can sometimes prevent full-blown psychosis from developing. Warning signs warrant contacting the treatment team immediately.
How to prevent recurrent psychosis
Preventing further episodes of psychosis involves a multifaceted approach:
Medication adherence
Antipsychotics and mood stabilizers help correct chemical imbalances in the brain underlying psychosis. Missing doses frequently can allow relapse, so taking medication consistently is key. Long-acting injectable antipsychotics can help if taking daily pills is difficult.
Psychotherapy
Cognitive behavioral therapy builds resilience, coping strategies, and thought awareness to manage stress and prevent relapse. Group or individual therapy provides support.
Avoid substance use
Psychoactive drugs and alcohol can trigger psychosis, so maintaining sobriety is important. Securing stable housing away from drug use can help.
Stress management
Techniques like meditation, yoga, art therapy, music therapy, and journaling help manage stress levels. Lowering stress makes relapse less likely.
Social support network
Close relationships with family, friends, and peer support groups help reduce isolation and provide accountability, crisis intervention, and encouragement.
Self-care and routine
Eating nutritious foods, exercising, getting good sleep, and keeping a consistent daily routine help maintain stability.
Early intervention
Being attuned to subtle symptom changes and getting help quickly at warning signs can prevent progression to full psychosis.
Treatment of underlying illness
If a medical condition like seizure disorder contributes to psychosis, ongoing treatment of that primary illness is important.
Psychosocial rehabilitation
Programs promoting recovery skills, employment, education, health, and housing help establish stable foundations.
When to seek emergency help
It is crucial to seek immediate emergency assistance if:
– Suicidal thoughts or plans emerge
– Signs of violent behavior directed at self or others
– Psychosis with mania/excitement – inability to be calmed
– Catatonia – lack of speech, movement or response
– Food/fluid refusal
– Medical conditions requiring urgent care
– Behavior jeopardizing safety – wandering outdoors in severe weather
Emergency intervention may involve hospitalization to ensure safety and intensive treatment until the crisis stabilizes.
Conclusion
Recurring psychosis can arise from varied causes, including underlying psychiatric disorders, substance abuse, stress, and medical illnesses. While challenging to treat, psychotic relapse can often be prevented through medication compliance, lowering stress, avoiding substances, establishing support systems, and early intervention at warning signs. Recovery is very possible with a personalized, multimodal treatment approach.
