Breaking from Reality—The Complexity of Psychotic Disorders

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. Click To Tweet

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. Click To Tweet

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.

5. Brief Psychotic Disorder

A person with this condition has psychotic symptoms that last one month or less. Although the onset can be anytime in life, first episodes are more common during the mid-30s. If a person has one brief psychotic episode, it’s very possible they’ll have more during their lifetime.

6. Substance-Induced Psychotic Disorder

As the name implies, this is diagnosed when a person has delusions and hallucinations that occur during or after intoxication from a drug (i.e. alcohol, marijuana, opiates, benzodiazepines, cocaine, LSD, and amphetamines) or during withdrawal from the substance(s).

Because of the recurrent thought disturbances and breaks from reality, psychotic disorders are among the most challenging mental health conditions to have. Fortunately, treatment with antipsychotic medications (and other meds), along with the support of psychotherapy and case management, is possible for someone who suffers from one of these conditions to keep their symptoms in check.

Psychotic symptoms and other mental health issues can’t wait. At Amen Clinics, we’re here for you. We offer in-clinic brain scanning and appointments, as well as mental telehealth, remote clinical evaluations, and video therapy for adults, children, and couples. Find out more by speaking to a specialist today at 888-288-9834 or visit our contact page here.

18 Comments

  1. I had Covid last year in June. My only symptoms were loss of taste and smell. To this date I can only smell a few things and things still taste off. I did have a mild panic attack about 3 months ago because I could not stop thinking about the long term effects of this. Even my doctors have no clue if or when it will return to normal. Out of the 10 of us in our family only 1 of us got it really bad like a flu and he would hardly drink any water. In regards to the mental issues I feel like some of it comes from watching too much shocking news. Once I stopped watching it and stopped talking about it around the kids a lot of it calmed down. I think grownups forget our kids need a break from CONSTANT talking about everything bad in the world. So many parents let their kids watch what they should not be watching. I remember when I was a kid, we were KIDS. Our parents discussed some world news, but we were not exposed to it 24/7 or had access to it. This in turn makes kids worry all the time. We also need to be responsible enough to turn it off and spend time with our families, play board games, go outside, walk in the woods. This in turn will lead to a healthier mind. You should also try finding a positive news story to end your day on. They are hard to find since positive news does not sell as well. Sunny Skyz is a good one or just search for positive news.

    Comment by Renee — August 18, 2021 @ 4:09 AM

  2. Very interesting article. Thank you.

    Comment by Timothy Lee — August 18, 2021 @ 4:19 AM

  3. Add heavy metals. A lot of contrast mri being used for the heart stuff. Gadolinium toxicity had me able to qualify for several disorders…….mania, schiaffective, etc. No, gadolinium poisoning was the issue…..vaccine and the virus both may mess with the blood brain barrier.

    Comment by Margaret Millar — August 18, 2021 @ 4:57 AM

  4. This happened to me, hardest several months of my life but I am happy to report I am fully healed and back to my cheerful self.

    Comment by Natalie — August 18, 2021 @ 5:16 AM

  5. Thank you for addressing this condition in relation to Covid. Reading this describes exactly what happened to me this march. I never had psychosis before. This happened suddenly. What made the psychosis even more traumatic is that I did not realise that I got Covid until someone told me all my symptoms matched the infection with Covid and a cytokine storm. I attributed my symptoms to all sorts of other things, allergies to paint and foods. I got tested for all sorts of biomarkers after complaining to my doctor I lacked energy. Neither my Dr, the 3 nurses, the psychiatrist and the urgentist that tested me in the hospital, clinics and emergency psychiatric care thought about asking me for Covid symptoms. They did test me 2 months after the onset symptoms but when they finally did it was after my first shot of vaccine and it came back negative. I had delusions of being watched through my Google Home, thought I had a hacker in my wi-fi and computer, that my condo association was poisoning me through the ventilation system and my tap water. The recurring theme was feeling persecuted by things around me (the external world) while I was fighting this virus inside me and trying to recuperate from the trauma and following depression this huge energetic effort required from my body. I lost 20 pounds in less than 2 months. And every time I reached out to someone about feeling attacked, they rejected me adding to my traumas. Finally, my Dr prescribed antipsychotics and antidepressants to treat the psychosis but he is very sceptical what happened to me was related to Covid. He attributed the depression to the stress of Covid, being more isolated during lockdown, etc. But I KNOW, it was not the trigger of my illness. Maybe living alone was a factor contributing to the length of time it took me to understand I had Covid and express clearly my symptoms but it was not the cause of them. Having a partner to observe me and make me notice the symptoms could have reduced the time to seek help but even my friends to who I told about how I flet did not make the connection and just thought I was being a bit crazy and over imaginative. So hopefully an article like your will sensitize people to be more attentive those psychotic symptoms in their loved ones and get them faster and more appropriate care. Thank you.

    Comment by Melanie Roy — August 18, 2021 @ 6:14 AM

  6. My husband with Parkinson with mild dementia has had brief psychotic episodes the two times that he was hospitalized. It was brought on by the hospital protocol (not his personal protocol ) for deliver of his meds. Last week the hospital compounded the encounter by giving him morphine to lower his very high blood pressure. They refused to receive the technique for lower his blood pressure…stand him up. He has nOH (Neurogenic Orthostatic Hypertension). The combination was a disaster and the only reason they released him to me is that they wanted his hospital bed.

    Comment by Sylvia Ackley — August 18, 2021 @ 8:17 AM

  7. A common issue is when our loved one who battles mental illness, bi polar, schizophrenia is they frequently stop their medications.

    Comment by Jesnne PHIN — August 18, 2021 @ 9:40 AM

  8. I am Magine turmeric would help the situation with brain inflammation I’ve been on turmeric for the last year and a half not only has it helped with anxiety and panic but it’s helped with pain and joint issues as well I feel like it helps prevent Covid and can help with symptoms of Covid and since they don’t give you any idea of what to do here I’m just gonna throw that out:)

    Comment by Jessica Kern — August 18, 2021 @ 11:19 AM

  9. What we have witnessed since Trump became a candidate, in 2016, is a leftist narrative that Trump is evil, thus fitting the category of ‘Persecutory’ type of Delusional disorder: “Persecutory type believes that others are after them in some way through spying, harassment, following, trying to poison, etc.”
    To see the truth through a very sane and logical presentation of events, read the introduction and at least the first 25 pages of ‘Resistance (At All Costs) How Trump Haters Are Breaking America’ by Kimberley Strassel.

    Comment by Matthew Hanson — August 18, 2021 @ 11:40 AM

  10. Thank you so much for this disturbing information. i may have a client who is affect by this. He is in his 30’s and suddenly had a sudden severe psychotic break with a dramatic and disabling suicide attempt. I was treating him for an adjustment disorder dealing with a divorce, no psychosis during or before. He was unvaccinated and had COVID not long ago. Currently he’s been hospitalized for the past month . I sure hope his doctor and all doctors are made aware that this can happen.

    Comment by Sarah Edwards — August 18, 2021 @ 12:36 PM

  11. I’m just a year out from having a heart attack and multiple small strokes. When they put me in the ambulance they gave me morphine. After that I don’t remember anything for about a week. My chart says I had acute psychosis. But no one will tell me what I was doing that made them chart me that way. After I was sort of recovered, they sent me to rehab. I remember being really agitated and running through the hallways trying to find a way to escape. I did that at least 2 nights. It took 2 or 3 days to figure out how to answer the phone. And that’s my experience with psychosis.

    Comment by Linda — August 18, 2021 @ 1:04 PM

  12. Could they be having a reaction to steroids or some other drug or treatment used for treating COVID? Maybe being on a respirator or getting poisoned if it’s not sterile. I’ve read a story about how employees dosed an Alzheimer’s patient with psychedelics.

    Comment by bajones — August 18, 2021 @ 2:05 PM

  13. Thank you for this article , it is very enlightening. These lockdowns are over the top , I’m alone all day, my husband is an essential worker, so he is gone all day. I try not to watch too much of the news, it does get one down, I have no drive at the moment, I also hate all the little things, different opinions on vaccines can cause irritability with people, people that just pop over to your home, and we are asked to tell on them , it’s insane! We will end up with no friends , I miss my adult children. Both essential workers, pretty hard to. Not worry about them. Anyway thank you Dr Amen.

    Kind regards
    Helen

    Comment by Helen — August 18, 2021 @ 2:29 PM

  14. THANK-YOU!! Important topic for providing additional insight and details. I am sincerely surprised that nutritional aspects and causes have been omitted!! Perhaps include at a later date?

    Comment by Lesley — August 18, 2021 @ 6:23 PM

  15. Can you kindly give suggestions on how one can reduce brain inflammation with supplements etc.?

    Comment by Kelly — August 18, 2021 @ 8:57 PM

  16. Please tell me more about the brain scans. What can they tell you about bipolar or MDD?

    Comment by Susan — August 19, 2021 @ 5:32 PM

  17. Psychiatrists are notorious for presuming and taking for granted things that are not true, then use thrit false inferences to exchange deceit for dishonest gain at the expense of patients

    Comment by Sam Benson — August 20, 2021 @ 3:40 PM

  18. Hello Susan. For more information on SPECT imaging, please check out this link on our website: https://www.amenclinics.com/services/brain-spect/. Hope this information helps

    Comment by Amen Clinics — August 23, 2021 @ 12:16 PM

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