What Are Psychotic Breaks?

Understanding Psychosis

Understanding psychosis is the first step in recognizing and addressing a psychotic break. This section will shed light on the definition, causes, and symptoms of psychosis.

Definition of Psychosis

Psychosis is a term used to describe a set of psychological symptoms that result in a loss of contact with reality. According to the NCBI Bookshelf, although only 1.5 to 3.5 percent of people will meet the diagnostic criteria for a psychotic disorder, a significantly larger variable number will experience at least one psychotic symptom in their lifetime. The NIMH further explains that during an episode of psychosis, a person's thoughts and perceptions are disrupted, leading to difficulty discerning what is real and what is not.

Causes of Psychosis

Psychosis can be triggered by a variety of factors. It is a common feature of many psychiatric, neuropsychiatric, neurologic, neurodevelopmental, and medical conditions, serving as the hallmark feature of schizophrenia spectrum and other psychotic disorders, according to the NCBI Bookshelf. The NHS adds that psychosis can also be caused by certain mental conditions, general medical conditions, or misuse of alcohol or drugs.

Symptoms of Psychosis

The main symptoms of psychosis are characterized by hallucinations, delusions, and confused and disturbed thoughts. Hallucinations involve sensing things that do not exist, while delusions are unshakeable beliefs in something untrue. Confused and disturbed thoughts are manifested as disrupted patterns of thought, as explained by the NHS.

In summary, understanding the definition, causes, and symptoms of psychosis is crucial in navigating and managing psychotic breaks. Recognizing these signs and seeking early intervention can significantly improve the prognosis and recovery process.

Types of Psychotic Disorders

Psychosis, characterized by confused thinking, delusions, hallucinations, changes in feelings and behavior, is not a specific disorder but a condition seen across various disorders [1]. It acts as a common feature of many psychiatric, neuropsychiatric, neurologic, neurodevelopmental, and medical conditions, often manifesting as a hallmark feature of schizophrenia spectrum and other psychotic disorders. For a better understanding of "what are psychotic breaks?", it's pivotal to distinguish between primary and secondary psychotic disorders.

Primary Psychotic Disorders

Primary psychotic disorders are considered neurodevelopmental abnormalities and believed to develop in utero, although many times the manifestation of psychotic symptoms and full-blown illness correlate with epigenetic or environmental factors such as substance abuse, stress, immigration, infection, postpartum period, or other medical causes [2]. There is significant evidence for genetic risk factors in the pathogenesis of these disorders.

Recognizing these disorders can be challenging, particularly in their early stages, which may manifest with nonspecific changes often mistaken for normal teenage behavior. This is a critical issue as these symptoms can lead to isolation, impaired social relationships, difficulties in school and work performance, and secondary issues like substance use problems, depression, self-harm, suicide, and illegal behavior.

Secondary Psychotic Disorders

Secondary psychotic disorders, on the other hand, are conditions where psychosis is secondary to other medical or psychiatric conditions. These can include mood disorders, substance use disorders, and various neurologic conditions.

It's important to note that distinguishing between primary and secondary psychotic disorders can be challenging, especially in first-episode psychosis where distinguishing between disorders is difficult due to overlapping symptoms. In fact, around 30-40% of diagnoses related to disorders that produce psychotic symptoms are changed within three months.

The complexity of psychotic disorders underlines the importance of professional diagnosis and treatment. Understanding the distinction between primary and secondary disorders is a key part of effectively managing symptoms and working towards recovery.

Risk Factors for Psychosis

Understanding the risk factors for psychosis is key in recognizing and preventing the onset of psychotic breaks. These risk factors can be divided into two major categories: biological factors and environmental factors.

Biological Factors

Biological factors play a significant role in the development of psychosis. Research suggests that changes in the brain, particularly increased activity of neurotransmitters like dopamine, may be linked to triggering symptoms of psychosis. Medicines that reduce dopamine effects in the brain also tend to reduce psychotic symptoms.

Primary psychotic disorders are considered neurodevelopmental abnormalities and are believed to develop in utero, although many times the manifestation of psychotic symptoms and full-blown illness correlate with epigenetic or environmental factors such as substance abuse, stress, immigration, infection, postpartum period, or other medical causes [2]. There is significant evidence for genetic risk factors in the pathogenesis of psychotic disorders.

Furthermore, in older age, psychosis may be a symptom of a neurological disorder such as Alzheimer’s disease or dementia.

Environmental Factors

The environment in which an individual lives and interacts can significantly influence the risk of developing psychosis. The risk factors for developing schizophrenia, a type of psychotic disorder, encompass an interplay between biological, psychological, and social factors at individual and ecological levels that interact over time. These risk factors do not operate independently but rather in conjunction with each other [5].

Certain environmental triggers can contribute to the onset of psychosis. These include underlying mental health conditions, physical illness, trauma, sleep deprivation, prescription medication, or substance abuse. Each of these factors can increase the likelihood of experiencing a psychotic break, particularly when combined with biological predispositions.

It's important to note that psychosis can be caused by a mental (psychological) condition, a general medical condition, or alcohol or drug misuse [3]. Therefore, addressing these factors can be instrumental in preventing the onset of psychosis and managing the condition effectively.

In conclusion, understanding and addressing both biological and environmental risk factors can significantly reduce the likelihood of experiencing a psychotic break. Early intervention, awareness, and appropriate treatment are key in managing psychosis and promoting recovery.

Treatment for Psychosis

Understanding how to manage and treat psychosis is crucial in helping those experiencing psychotic breaks. This usually involves a combination of medication and therapeutic approaches aimed at managing symptoms and supporting the individual's wellbeing.

Medication Options

Medication is often the first line of treatment for psychosis. Antipsychotic medicines work by blocking neurotransmitters like dopamine in the brain, which can help manage and reduce psychotic symptoms. It's important to note that side effects vary among individuals, making close monitoring crucial, especially for those with conditions like epilepsy and cardiovascular disease.

In severe cases, if a person poses a significant risk to themselves or others during a psychotic episode, they may be compulsorily admitted to a hospital under the Mental Health Act. This ensures that appropriate treatment is provided for their condition, which may involve physical restraint or administration of tranquillizers in extreme circumstances.

Therapeutic Approaches

Alongside medication, therapy plays a significant role in the treatment of psychosis. Talking therapies such as Cognitive Behavioral Therapy (CBT) and family intervention can help reduce the intensity and anxiety caused by psychosis. They provide support and coping strategies for individuals and their families, aiding in the management of symptoms and the navigation of daily life.

Rehabilitation is another key aspect of treatment, aiming to build confidence and skills for independence. This may involve a multidisciplinary team including a rehabilitation psychiatrist, mental health nurse, occupational therapist, and social worker. The process of rehabilitation can be repeated depending on the individual's needs, ensuring they receive the necessary support at different stages of their journey.

Overall, the treatment for psychosis is multifaceted, involving both medical and therapeutic approaches. It is tailored to the individual's needs and circumstances, ensuring they receive the best possible care and support. It's essential to remember that each person's experience with psychosis is unique, and what works for one person may not work for another. Therefore, treatment plans should be flexible and adaptable, allowing for changes as necessary.

Recovery from Psychosis

Navigating through the world of psychosis can be challenging. However, understanding the prognosis after a psychotic break and the factors that influence recovery can provide hope and direction for individuals and their loved ones.

Prognosis after Psychotic Episode

Recovery from psychosis varies among individuals, with most people recovering well from the initial psychotic episode. While some recover quickly with minimal intervention, others may require longer-term support. Proper treatment and support from family and friends enhance the likelihood of good recovery.

Following recovery from a first episode of psychosis, close to 20% of individuals may never experience a second episode (relapse) of psychosis. The risk of relapse increases if medication and treatments are discontinued prematurely, and there is no reliable method to predict which individuals will not experience a second episode.

Factors Influencing Recovery

There are several factors that can influence the recovery from a psychotic break.

• Early Intervention: Early intervention in the first onset of schizophrenia has been linked to improved long-term prognosis. First-episode services have been developed in many high-income countries with the aim of treating early to increase the likelihood of recovery.
• Treatment during Prodrome Stage: Trials of treating individuals in the prodrome stage of schizophrenia have shown some emerging evidence that this approach improves outcomes.
• Avoiding Untreated Psychosis: Untreated psychosis has been suggested to be biologically toxic to the brain, leading to changes in neuronal structures and functions. The inability to regulate specific brain functions due to untreated psychosis may result in individuals being refractory to treatment.

Understanding these factors can help individuals, their families, and their healthcare providers make informed decisions about the best approach to treatment and recovery. It's important to remember that everyone's journey with psychosis is unique, and recovery may look different for each person.

Importance of Early Intervention

When dealing with psychotic breaks, early intervention is crucial. Recognizing the early signs of psychosis and seeking appropriate treatment as soon as possible can help prevent serious complications and improve long-term prognosis.

Early Signs of Psychosis

The early signs of psychosis may vary for different individuals, but generally include:

• Persistent feelings of suspicion
• Hallucinations, such as hearing voices or seeing things that aren't there
• Delusions, or beliefs that don't change despite evidence to the contrary
• Disorganized thinking, evidenced by illogical or nonsensical speech
• Withdrawal from family, friends, and social activities
• Sudden decline in self-care or personal hygiene
• Difficulties with concentration, memory, or logical thought
• Unusual or exaggerated beliefs about personal powers or identity
• Persistent and excessive anxiety

If these symptoms are recognized and addressed early, the individual may have a better chance of managing their psychosis and reducing the risk of a full-blown psychotic episode.

Benefits of Timely Treatment

Timely treatment of psychosis has several benefits, most importantly, it can help minimize the harmful effects of untreated psychosis on the brain. Untreated psychosis can lead to changes in neuronal structures and functions, making illnesses more complex and difficult to treat.

Moreover, similar to chronic diseases like diabetes, delayed treatment can lead to end-organ damage and complications across the body. The sooner treatment begins, the less damage occurs [5].

Treatment usually includes antipsychotic medication and coordinated specialty care, a multi-element, recovery-oriented team approach. People experience better outcomes from coordinated specialty care if they begin treatment as soon as possible after psychotic symptoms emerge [7].

Moreover, early intervention in the first onset of schizophrenia has been linked to improved long-term prognosis. First-episode services aim to treat early to increase the likelihood of recovery.

In conclusion, recognizing the early signs of psychosis and seeking timely treatment is crucial. It not only helps to manage the symptoms better but also reduces the risk of severe complications and improves the overall prognosis.

References

[1]: https://www.earlypsychosis.ca/diagnosis-of-psychosis/

‍[2]: https://www.ncbi.nlm.nih.gov/books/NBK546579/

‍[3]: https://www.nhs.uk/mental-health/conditions/psychosis/causes/

‍[4]: https://www.forbes.com/health/mind/psychotic-break/

‍[5]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4197783/

‍[6]: https://www.nhs.uk/mental-health/conditions/psychosis/treatment/

‍[7]: https://www.nimh.nih.gov/health/publications/understanding-psychosis