Delusion; where the patient has beliefs which are false and usually in contrast to what they have been taught during upbringing and from their background. This belief isn’t affected by any form of reasoned argument.
Hallucination; where the patient makes false perceptions of their surroundings without an external stimulation.
Psychotic disorders affect a person’s ability to think clearly, possibly affecting their ability to make judgements, produce an emotional response, communicate, and in more severe cases, their understanding of reality. They distort a person’s senses causing confusion as to what is real. Psychotic disorders affect a significant number of people all over the men and women equally, often striking in their late teens, the world, and early 20’s.
In milder forms, a person may block out a certain feeling for a certain person. In more serious forms, a person might block out all feelings (also rare). The 4th and final level is the multiple personality disorder that became popularized by the film, Three Faces of Eve. In this Dissociative Disorder, a person includes more than one personality. These personalities alternately take over complete control, with no conscious awareness of another part or parts. DID Treatment In the healing process for all levels, each of the splits&mdash ;or parts that are &ldquo ;not acceptable&rdquo ;— will need attention. There is a story behind each one of a person who has gone through any level of splitting. Those stories need to be told— along with the associated feelings. Although it sounds easy, it is a major business. At levels three and four, professional expertise is essential. Any counselor who chooses to be involved will need to be in continual prayer for wisdom and guidance because of the complexity of the therapeutic process, and the numerous dangers to the client. Establishing trust is a constant challenge throughout treatment of DID. Trust has been shattered as a result of the extreme and often repetitive trauma experienced.
How Could You Know…
It is estimated that about 3 people in every one hundred experience a psychotic episode in their life; this ratio makes psychosis more common than diabetes. However, most people do make a full recovery, although early assessment, treatment, and education are needed and greatly improve the outcomes for the individuals and their families.
Psychosis is a serious mental illness which can be the product of a physical health problem or disease, such as UTI’s and chest infections in older adults, and brain diseases which include Parkinson ‘s, epilepsy, and dementia. The exact causes of psychotic disorders aren’t completely understood; however certain of the disorders are known to run in families, some have been linked to certain environmental factors such as stress and drug abuse; others seem to occur, owing to a chemical imbalance in the brain which affects the brain’s response to certain stimuli.
To understand the momentum of trauma and post-traumatic stress disorder one has to understand why the three brains and the body work. The Cerebrum and Prefrontal Cortex are the human portion of the brain and operate by rational thought. This brain is linear and causal and therefore if something is explained to this area of the brain and a person agrees then they’ll follow those directions voluntarily. It is the conscious portion of our brain. This is the side of our brain that traditional psychotherapy or talk therapy is aimed at. The Limbic system is an older portion of the brain that is comparable to all mammals’ brains. It is made up mostly of chemicals called Neurotransmitters that help us think and feel. However, not necessarily on a logical basis.
All the cells in the main body are connected and are able of body memory and are thus all minute brains. Candice Pert, the discoverer of Endorphins and the Enkephalin System, postulates that our feelings are in a certain way yet to be understood, involved with the Enkephalin System that is found in every cell of our body. She believes that this web of endorphins/feelings constitute a highly evolved, yet intricate brain system. In a real sense each cell is made up of a primary primitive brain. Often these brains work quicker than the others that I have mentioned.
It is very important that we clearly understand what can potentially cause psychosis if we hope to, in the future, prevent it before the occurrence of the first episode. Factors which contribute towards the development of psychosis can be genetic or environmental.
Possible environmental factors of psychosis being investigated include the deficiency of vitamin D which plays a role in brain development. It has been noted that schizophrenics with psychotic symptoms have low levels of vitamin D; this can be tackled by administering vitamin D S supplements. The functionality of mitochondria is also being investigated, as it is the organelle which provides energy to cells, including those in the brain. Without the right amount of energy, the cells would not function as they usually would; this could be potentially avoided by the intake of several vitamins and minerals. People with schizophrenia as well as those with bipolar disorder have been discovered to have malfunctioning mitochondria.
Numerous studies have demonstrated a correlation between the occurrence of psychotic disorders and other factors. For example, complications at birth as well as grown up in a large city seem to take a role in the development of schizophrenia, while trauma during childhood and stressful events play a role in the development of both schizophrenia and bipolar disorder. Unfortunately there is not much we can do to prevent these things from happening in an individual’s life. There are many other potentially contributing factors which we’re still unaware of.
There have been hundreds of studies conducted to examine whether and to what extent psychosis can be passed on genetically. So far, researchers find that the disorder isn’t entirely ‘genetically distinct ;’ this meant that there are not any specific genes which cause it, however there are people which increase the chances of it developing if the disorder was to be triggered by another factor. Scientists believe that it is the mix of genes and life experiences which determine which illness is most likely to develop in an individual; this means that theoretically, psychosis can be completely avoided if the individual has the correct lifestyle.
One factor that appears to be most directly related to the occurrence of psychosis is the level of dopamine in the brain. Dopamine is one of several neurotransmitters-chemicals that pass information from one neuron (brain cell) to another. It plays an important role in memory, attention, problem solving, and the monitoring of movement. Dopamine is normally published in the brain as a consequence of rewarding experiences; it is likewise found in most illegal drugs.
Research has shown a clear correlation between high levels of dopamine and hallucinations, delusions, and disordered thoughts. The level of dopamine is commonly at its highest just before first episode psychosis. Its levels can usually be controlled by taking dopaminergic drugs to increase its quantities in the brain or by taking dopamine antagonists to reduce its quantities.
The level of dopamine is returned to as ‘the final common pathway’ to psychosis. This means that it’s what links events in an individual’s life to the actual development of psychosis. The exact mechanism whereby the rise in dopamine levels is caused, as well as how the rise causes psychosis, is still unknown. It is possible that by regulating the levels of dopamine, one can avoid the occurrence of psychosis without having to alter their lifestyle.
Stress is one of the most important factors which are related to the development of psychosis. Psychotics tend to find dealing with stress very challenging. When an individual experiences stress, cortisol, a hormone, is manufactured by the adrenal glands. The production of the stress hormone is monitored by the hypothalamic pituitary adrenal (HPA) axis, a system which is composed of the pituitary glands, the hypothalamus, and the adrenal glands; these are given in the diagram on the right. Abnormally high levels of cortisol are normally detected in people experiencing first episode psychosis, suggesting the existence of a relationship between the two. It has been found that the higher the levels of the hormone, the more extreme the symptoms as the existence of high levels of cortisol is known to increase the output of dopamine which causes the mental illness. Therefore, reducing stress levels should theoretically reduce the risk of developing psychosis as well other health complications.
Continuous high levels of cortisol have adverse effect on the hippocampus. This is the portion of the brain responsible mainly for short and longer term memory as well as spatial awareness. This theory is supported as it is clear from brain imaging that the amount of the hippocampus in a schizophrenic individual is lower than that in a non-schizophrenic individual. It has been observed that blood relatives of people who experience psychosis are also more susceptible to stress than the average individual, as they too have an overactive HPA axis which causes an overabundance of the neurotransmitter dopamine. Research has been carried out to investigate this however there isn’t sufficient evidence to confirm that the hyperactivity of the HPA axis is genetic.
In the last few years, several studies have been made to investigate the relationship between childhood adversity and the occurrence of psychosis in an individual. A team of scientists from the Institute of Psychiatry published a study in February 2010 in which they collected and analysed information from a large number of people who had experienced first episode psychosis; over 12 per cent of individuals reported to have suffered from physical abuse by their mothers before the minimum age of 12. A sample of people who didn’t have psychosis was also surveyed of which only 4% reported the same form of abuse.
A research team analysed information from 7353 people in the Adult Psychiatric Morbidity Survey in England in 2007 to find that sexual abuse before the 16 years of age is strongly correlated with the development of psychosis in later life.
Another team examined results obtained from 36 different studies recently carried out. These studies involved about 80, 000 people; after analysis, they noted that individuals who had experienced abuse and trauma as children are about three times more likely to develop psychotic symptoms in their life than those who hadn’t experienced it.
There is a strong correlation between the two however it isn’t still the case; as mentioned earlier, there are many factors which can cause these symptoms. The cases of abuse or trauma merely affect the brain’s methods of coping with the stresses of everyday life which itself may give rise to psychotic symptoms.
Neurologic examination is an important process in diagnosing patients with psychiatric disorders. They consist of different complex and challenging components. Conducting such tests requires many skills which can only be mastered by the recurrent use of the necessary techniques on people with, as well as without neurologic diseases. Many cases go undiagnosed; it is important that we change this in order to avoid potential future episodes.
Most clinicians begin the process with an assessment of the patients’ mental status followed by their cranial nerves, their motor system, their sensory system, their coordination, and finally, their gait. A patient’s mental status is examined by observing their communication abilities (I.e. Speech), memory, level, and direction of consciousness. Their cranial nerves are assessed by checking the fundi, pupil size, visual fields, and extra ocular and facial movements. The clinician would look for muscle atrophy, for the motor system. To examine the sensory system, the patient is asked whether they can feel a light cool touch on their skin. The patient’s ability to perform rapid movements is tested, for the assessment of the patient’s coordination. Finally, for a patient’s gait, observations are made while the patient is walking normally, along a straight line, and on heels and toes.
Detecting abnormalities is difficult as we cannot do biopsies of different parts of the brain as we normally do with other organs.
Urine sampling and blood tests provide no room for disagreement amongst physicians when diagnosing patients with disorders such as diabetes. However, before these tests were used, there was a lot of uncertainty as to which diagnosis is most suitable. It is this stage which we’re at now with the diagnosis of psychiatric disorders.
Having an MRI can turn out to be very intimidating for patients; about 5 percent of the population would experience claustrophobia in the context in which MRI scans are conducted. Some patients are sedated, before the process, for this reason.
MRI’s are entirely safe however ferromagnetic implants may torque, causing damage to vessels and may even be fatal. This is why all healthcare personnel as well as patients have to be screened and thoroughly educated to prevent these disastrous incidents as the magnet is always switched ‘on’.
The only other negative point about MRI scans is that they require more patient cooperation than CT scans apart from that risk.
CT scans are best used in the assessment of any acute changes in mental status, acute trauma to the spine and brain, focal neurologic feelings, suspected subarachnoid hemorrhage, as well as conductive hearing loss.
CT scans are very safe, fast, and reliable. However, the radiation exposure does have to be decreased when it is used on children.
Research involving these scans has shown substantial differences among the brains of people who later went on to develop psychotic symptoms and the people who didn’t.
Those who went on to develop psychosis had less grey matter, specifically in the right temporal and the frontal lobe. These are the fields of the brain which are closely linked with memory, emotions, attention, and social behaviour.
Scientists have suggested that such differences, as well as others discovered in this study, may indicate an individual’s vulnerability to the development of psychosis.
Physical methods have been utilized for the treatment of psychiatric disorders for a long time. The first major advance was when as with most scientific advances, convulsive therapy, also known as electroplexy, was accidentally discovered in 1933. It involved the death of an electrical discharge through the central nervous system (CNS). In 1938, this process was made less extreme when two men, Cerletti and Bini, found that introducing a small electric current across the forehead of the patient (modern electro-convulsive therapy; ECT) was just as effective.
It was a revolutionary discovery in psychiatry, as about 40 years ago, psychiatric illnesses were as dreaded as cancer is to us today. Cases and symptoms were immensely more severe because there was no way to maintain the symptoms at bay; most cases went untreated and deteriorated.
It was only several years after it was presented that anaesthetics and muscle relaxants were provided to the patients. This made the treatment much more pleasant for the people who desperately needed it. It soon became a very safe and effective treatment for psychotic illnesses, where the only side-effects are headaches and muscle stiffness; it came to the extent that patients did not have to be hospitalised, with a view to receive the treatment.
It was noted that electroplexy was most successful in cases where the patient had depressive psychosis. It was also very effective on schizophrenics where there are extreme cases of hallucinations and delusions and other such symptoms. The quickest improvement after the use of this treatment was observed in patients with acute manic psychoses, however this was only when it was used early in the development of the illness.
Research has demonstrated that this treatment has given significantly better results that drug therapy alone.
The same effect of ECT (the electrical discharge) can be obtained with insulin coma therapy. This has received a lot less criticism.
Other physical methods of treatment which have been utilized in psychiatry include leucotomy (also known as lobotomy). This is a form of psychosurgery where the connections to and from the prefrontal cortex, the anterior portion of the frontal lobes of the brain responsible for complex behaviour and personality expression, are severed. It became very popular about 30-40 years ago, however it is rarely used now.
Patients who’re unable to care for themselves are usually hospitalized. Recovery is possible however those with severe psychotic episodes may need to be medicated indefinitely, usually in lower doses, to control the symptoms.
Antipsychotics are employed in the treatment and the prevention of psychosis. They work by dampening the impact of the dopamine system in order to reduce the symptoms which appear in an individual. However, they don’t always work; this may be explained by the possible contribution of other neurotransmitters to the occurrence of psychosis. They include gamma amino butyric acid (GABA) and glutamate. Glutamate stimulates the brain; it plays a role in memory, thought, as well as learning. Its levels in the nervous system are influenced by stress levels and the use of drugs such as cannabis. Abnormalities in its activity are thought to have an effect on dopamine levels. GABA has the opposite effect as it slows down brain activity and also affects dopamine levels.
Psychotherapy is used a lot as a treatment in modern psychiatry; it is also being incorporated into psychosis prevention programs. It ranges from superficial psychotherapeutic counselling, where the therapists simply allows the patient to speak about their problems, to deep psychotherapy, where these problems are analysed at a further level. More recently, new methods have been introduced where the behaviour and not to the thoughts of a patient are being addressed; these are called behaviour therapies.
Cognitive Behavioural Therapy (CBT) is most commonly used. Its purpose is to enable patients to face their problems and reflect on them in a manner that would cause them less emotional/mental distress. It also teaches people how to deal with these problems. Studies have been carried out in recent years, and showed a significant decrease in psychotic experiences in patients who’ve received the treatment, especially in the early months of the treatment.
Evidence has shown that CBT, when given for longer durations (6 to 12 months), is more effective at reducing the impact of psychotic symptoms and helping with recovery (as well as prevention) than when provided for shorter periods of time (less than three months).
CBT seems to become a reasonable choice for a method of prevention because the majority of people who’re at risk of developing psychosis would have had distressing or disturbing experiences which would have given rise to the disorder. CBT would give individuals the ability to find explanation for these experiences and it would help them manage them so that they don’t cause enough distress in their lives to trigger the development of psychosis.
Research is being conducted to refine and develop CBT to reduce the risk of triggering psychosis and other psychiatric disorders in susceptible individuals. There are also many clinical trials underway testing the degree to which CBT contributes to the prevention of psychosis, with as well as without low doses of antipsychotic drugs. The results so far have shown that there exists a considerable backlog in the occurrence of the disorder among those who receive those treatments.
There is no known way to actually prevent psychosis however early treatment of first-episode psychosis-the first time that psychotic symptoms are experienced by an individual to which they would seem unfamiliar and frightening causing confusion and even distress-seems to reduce the disruption a disorder can cause in a person’s life.
This theory was upheld by a reduced response shown by psychotic patients who were treated later in their illness in the 10-year follow-up of the early Treatment and Intervention in Psychosis (TIPS) study in Denmark and Norway. A higher proportion of the patients who were treated at an early stage recovered prior to the end of the 10 year period.
The study was very selective, only severely impaired patients were used as they were thought to produce better and clearer results than patients who were not as badly affected by the disorder.
Patients who were treated at an earlier stage were more likely to have fully recovered prior to the end of the 10-year period.
Although it is possible that the results of this experience were due to chance, the correlation is strong and it is quite likely that the time of intervention is linked to the rate of recovery.
In order to prevent psychosis altogether, one would have to be able to determine those who’re at a higher risk of developing the disorder. There have been major developments in this ability over the past 15 to 20 years.
There are many methods by which we can theoretically prevent the development of the disorder, most of whom are the different treatments which are submitted to those who’ve psychosis.
A recent analysis showed that the number of individuals with psychosis would decrease by 33% if childhood adversity was completely eliminated from the population. This means that supporting projects against child adversity in turn helps with the prevention of psychosis. This method of prevention could potentially be used for the majority of the environmental factors which are related to the development of psychosis.
The recent study ‘Early detection and intervention evaluation for people at risk of psychosis,’ also investigated the concept of preventing psychosis in adults who’re more susceptible to it.
Two years into after the commencement of the treatment, 2% fewer individuals who received it went on to be diagnosed with psychosis than those who didn’t receive any form of treatment.
According to Robin Murray, professor of Psychiatric Research at the Institute of Psychiatry, King’s College London, it isn’t yet possible to prevent psychosis. However, if everybody in UK stopped smoking cannabis we could prevent about 15 percent of the number of cases of psychosis (R. Murray, personal communication, March 23, 2013).
The results of all these studies and research are promising with respect to the future of the prevention of the disorder. However, it will likely be many years before we’re able to completely prevent the occurrence of psychosis in susceptible individuals as a lot more funding and research needs to be carried out to better understand its causes of the disorder, how to better detect those who’re likely to develop it, and which methods of prevention are most likely to stop it from ever occurring.