Breaking from Reality—The Complexity of Psychotic Disorders
When someone is experiencing a psychotic episode—seeing people who aren’t there or hearing voices that no one else can—it feels just as concrete as rational thoughts do. A person suffering in this way has lost touch with reality and cannot distinguish what is real from what is not.
The term “psychosis” is actually a multifaceted symptom, not a disorder unto itself. It can be part of a lifelong or a temporary psychiatric illness or be a once-in-a-lifetime occurrence. Approximately 3% of the U.S. population will experience a psychotic episode at some point in their lives, and each year about 100,000 young adults or teens will have their first such episode. New research shows these numbers could be increasing due to COVID-19.
Approx. 3% of the US population will experience a psychotic episode at some point in their lives, and each year about 100,000 young adults or teens will have their first such episode. These numbers could be increasing due to COVID-19.
Causes of Psychosis and Psychotic Disorders
The exact causes of psychosis are not known, but there are a number of contributing factors, including:- Genetics – Having a blood relative with schizophrenia increases the risk
- Chronic insomnia
- Trauma, severe stress, or anxiety
- Hormonal changes and imbalances
- Head injuries and brain disorders such as Parkinson’s disease, dementia, brain tumors, strokes, and some forms of epilepsy
- Some medications, including stimulants and steroids as well as recreational drugs
- Infections that affect the brain, such as Lyme disease, HIV/AIDS—and now COVID-19
Cases of Psychosis in COVID-19 Patients
The effects of COVID-19 have been detrimental to many people who have survived the virus, with some struggling for months after the initial onset of symptoms. Increasingly, medical centers in the U.S. and around the world are reporting cases of new-onset psychosis in patients who were infected with COVID-19. And these are not necessarily people who had pre-existing mental health problems or were hospitalized from the illness. Medical centers in the U.S. and around the world are reporting cases of new onset psychosis in patients who were infected with COVID-19. One theory about why this could happen involves the body’s own defense system. In order to fight off COVID-19, the immune system goes into overdrive by releasing a flood of immune cells in what is called a “cytokine storm” to attack the invading virus. Unfortunately, one of the consequences of this natural process is significantly increased inflammation which can adversely affect the body and brain. A research study published in the journal, The Lancet, analyzed the medical records of more than 236,379 patients who had COVID-19. They found that 1.4%—or 3,309— of them suffered from some form of psychosis within 6 months of their recovery from the virus. Although most people who get it will not have any unusual symptoms, cases of COVID-related psychosis have been increasingly observed. Another report about 42 cases of psychosis in people stricken with the virus was published in Neuroscience Letters. The doctors who authored the report noted that in many cases, it is difficult to know if their psychotic symptoms were the result of inflammation in the brain, if a person was predisposed to developing a psychotic disorder, or if their symptoms stemmed from other contributing factors such as isolation and stress during the pandemic. Nonetheless, the relatively quick onset of new psychotic symptoms can be very concerning and confusing to the patient and their loved ones.Symptoms of Psychosis
Psychotic symptoms occur on a spectrum that ranges from mild to severe levels of impairment. These symptoms are often very distressing and can interfere with major domains of functioning, such as interpersonal relationships, work or school, and self-care. They include:- Delusions: Tightly held beliefs that are neither grounded in nor supported by objective evidence, such as a person believing the FBI planted microchips in their teeth.
- Visual or auditory hallucinations: Seeing or hearing things that aren’t there or having unusual bodily sensations.
- Disorganized thinking: Having tangential and/or loose associations with thought processes, as well as something called “word salad” which is incoherent speech that randomly mixes up words and syntax.
- Abnormal or disorganized movements: Agitation, rigid or bizarre postures, mutism, unusual facial expressions, and catatonia during which there is an absence of physical movement or verbal communication.
- Diminished emotional expression: Monotone speech and reduced eye contact and facial and hand movements while talking.
- “Negative symptoms”: A lack of self-directed initiation to engage in activities (avolition); diminished interest in speaking (alogia); decreased ability to experience pleasure (anhedonia); and disinterest in social interactions (asociality).
6 Types of Psychotic Disorders
There are several psychiatric conditions that are characterized by psychotic symptoms and these manifest in varying degrees of severity and impairment as well as lengths of time.1. Schizophrenia
This is the most common and debilitating psychotic disorder. It is a chronic psychiatric condition that is marked by recurrent episodes of delusions, hallucinations, disorganized speech and behavior, and negative psychotic symptoms. Approximately 0.3% to 0.7% of people in the U.S. are diagnosed with this disorder.2. Schizophreniform Disorder
This condition is like schizophrenia, except the course of symptoms lasts between 1 and 6 months.3. Schizoaffective Disorder
Someone with this condition will have the same symptoms of schizophrenia and concurrently have a sustained episode of major depression or bipolar.4. Delusional Disorder
A person with this condition will have delusions that last longer than one month, and there are numerous subtypes that include:- Erotomanic type believes someone is in love with her/him despite not being romantically connected.
- Grandiose type is convinced they have a wonderful—but unrecognized—talent, insight, or contribution.
- Jealous type is certain their spouse/significant other is being unfaithful.
- Persecutory type believes that others are after them in some way through spying, harassment, following, trying to poison, etc.
- Somatic type has delusions around sensations and/or functions in their body.
