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INSIDE MY CRAZY MIND! (My Current Struggles With Depression, Obsession, & Anxiety)
A cat lady is crazy. That homeless guy on the street is crazy. Your ex girlfriend is crazy or at least she has a personality disorder. However, there is a much more interesting, much more dangerous form of crazy — psychosis. When someone is psychotic it means they are experiencing one or more of the following symptoms: A delusion is a firmly held, fixed, and false belief. Delusions can be nonbizarre, meaning that the belief is unlikely, but within the realm of possibility, such as thinking the CIA is following you. Or they can be bizarre, meaning that the belief is totally impossible, such as thinking aliens implanted a microchip in your brain this type of delusion is characteristic of schizophrenia. Disordered thought is a hallmark of schizophrenia. Psychosis is not caused by stress although stress can bring out underlying symptoms. It is usually an indication of a serious mental or physical illness. Or an indication that you just did some LSD. It often requires treatment with heavy-duty antipsychotic medications. Substance-induced psychosis Probably the most common cause of psychosis is the use of illicit drugs, such as marijuana, hallucinogens LSD, acid, schrooms , or amphetamines meth, cocaine. I see patients who are psychotic after taking drugs at the VA all the time. I had a patient who, after snorting bath salts a new synthetic amphetamine derivative that is can be purchased at head shops , abruptly left the hotel room where he was staying because he became paranoid that people were trying to break in and kill him. However, for people with lingering symptoms off drugs, a psychiatrist may prescribe antipsychotic medication as treatment. Major Depressive Disorder with Psychotic Features When people get really, really depressed, they can become psychotic. This is extremely common in older adults. I had a patient at UCLA last year who was a woman in her 80s. Over a period of months prior to her hospitalization she became increasingly depressed. She thought the devil had bugged her house and was listening in on all of her conversations. They may have delusional beliefs about people trying to punish them. Psychotic symptoms indicate severe depression. A psychiatrist would use both an antidepressant to treat the mood symptoms and an antipsychotic to treat the psychotic symptoms. Bipolar Disorder in a Manic Episode Bipolar Disorder is characterized by alternating periods of depression and mania. When people are manic, they often become psychotic. People who are manic will have mood congruent, grandiose delusions. Schizophrenia or Schizoaffective Disorder Schizophrenia or Schizoaffective Disorder, which is Schizophrenia plus a prominent mood disorder, such as Depression or Bipolar Disorder is a primary psychotic disorder. This means that the psychotic symptoms are a primary feature of the disorder and are not resulting from mood symptoms. Schizophrenia is characterized by: Hallucinations usually auditory hallucinations of voices Delusions Disordered speech or behavior Negative symptoms, such as blunted affect, poverty of speech, and decreased motivation Certain psychotic symptoms are so characteristic of schizophrenia that they are diagnostic of the disorder. Auditory hallucinations or two voices arguing with each other. Auditory hallucinations of a single voice making a running commentary on the person. Schizophrenia is a serious, lifelong mental illness that requires ongoing treatment with antipsychotic medications. Delusional Disorder Delusional Disorder is uncommon and difficult to treat. It is diagnosed when a person who is otherwise normal has a fixed, nonbizarre delusion that they continue to believe even in the face of evidence to the contrary. For example, a woman who becomes absolutely fixated on the idea that her husband is cheating on her, which no evidence to support it, may have delusional disorder. Psychosis Secondary to a General Medical Condition Sometimes a person has psychotic symptoms because of a physical, rather than mental illness. For example, a brain tumor pushing on the visual cortex might lead to visual hallucinations. When a patient with no past psychiatric history comes into the hospital with new-onset psychotic symptoms, we often do head imaging such as a CT or MRI to ensure there is not a tumor. Delirium is a condition very common in medical ill people such as patients with infections, metabolic abnormalities, or who recently had surgery that results in confusion, disorientation, and often hallucinations or delusions. Just last week I had a patient who was in the hospital with a subdural hematoma from a ground-level fall. In the ICU she became confused, thinking she was in her house and accusing nursing staff of being intruders who had misplaced her furniture. After a few days her mental status cleared and she was able to go home. Often we use short-term low-dose antipsychotics — most often haldol — to treat delirium. Psychosis Read more of my writing Sign up for my newsletter Get essays like this sent to your inbox as soon as I write them.
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