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American Heritage Dictionary:

psy·cho·sis

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(sī-kō'sĭs) pronunciation
n., pl., -ses (-sēz).
A severe mental disorder, with or without organic damage, characterized by derangement of personality and loss of contact with reality and causing deterioration of normal social functioning.


Fowler's Modern English Usage:

psychosis

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has the plural form psychoses.

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Britannica Concise Encyclopedia:

psychosis

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Any of several serious mental illnesses characterized by defects in judgment and other cognitive processes and by loss of contact with reality. Psychoses can be divided into two major types: functional and organic. Functional psychoses include schizophrenia and affective disorders (also called mood disorders), such as major depressive disorder and bipolar disorder. Organic psychoses arise secondary to a preexisting medical condition such as Alzheimer disease and share important features with functional psychoses. Certain medications, including narcotics (used to treat pain) and levodopa (used to treat Parkinson disease), can cause symptoms of psychoses. The major symptoms, aside from delusions and hallucinations, are disorganized speech and behaviour, lack of emotional expression, and apathy. Treatment usually consists of medication and psychotherapy; severe cases may require permanent hospitalization. neurosis.

For more information on psychosis, visit Britannica.com.

McGraw-Hill Science & Technology Encyclopedia:

Psychosis

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Any disorder of higher mental processes of such severity that judgments pertaining to the reality of external events are significantly impaired. A wide range of conditions can bring about a psychotic state. They include schizophrenia, mania, depression, ingestion of drugs, withdrawal from drugs, liver or kidney failure, endocrine disorders, metabolic disorders, and Alzheimer's disease, epilepsy, and other neurologic dysfunctions. The dreams of normal sleep are a form of psychosis.

Psychotic alterations of beliefs are called delusions. Psychotic alterations of perception are referred to as hallucinations. Psychotic states that are due to alcoholism, metabolic diseases, or other medical conditions are frequently accompanied by general mental confusion. On the other hand, psychiatric illnesses and drugs can produce hallucinations and delusions in the absence of general confusion. Few of those symptoms are unique to a particular illness, which can make proper diagnosis difficult and challenging. Correct diagnosis, however, is critical so that appropriate treatment can be provided. See also Addictive disorders; Affective disorders; Alzheimer's disease; Neurotic disorders; Paranoia; Psychotomimetic drug; Schizophrenia.

Oxford Companion to the Body:

psychosis

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The Greek psyche (‘life’ or ‘soul’) today can be translated as ‘mind’. The suffix ‘-osis’ means ‘any illness of’.

The Oxford English Dictionary defines psychosis as:

Any kind of mental affectation or derangement; especially one which cannot be ascribed to organic lesion or neurosis. In modern use, any mental illness or disorder that is accompanied by hallucinations, delusions or mental confusion and a loss of contact with external reality, whether attributable to an organic lesion or not.


The question of how far psychosis is an organic condition of the body or brain has fascinated psychiatrists ever since the term's origins a century and a half ago.

Origin of the term

The mid-nineteenth-century Austrian poet, politician, and psychiatrist, Feuchtersleben, introduced ‘psychosis’ to denote serious mental conditions affecting the personality; it was a subcategory of (Cullen's) neuroses. Psychosis soon comprised conditions besides the insanities and mental handicap, including minor psychological conditions and major organic disorders. Feuchtersleben coined the terms ‘psychosis’ and ‘psychopathy’ as identical terms because they were ‘diseases of the personality’ — and not of the body, nor of the soul or of the mind alone.

Psychosis-neurosis debate

Neurosis was already a popular term, and psychosis and neurosis were soon viewed in conjunction. Psychosis was seen as the psychological aspect of a neurosis — hence psychoneurosis. Thus the confusing picture arose whereby, in the late nineteenth century, there were three terms — psychosis, psychoneurosis, and psychopathy — for the same condition; by the late twentieth century by contrast these terms all referred to separate conditions. The development of this process of change over the course of the century will now be outlined, along with the different types of psychosis that were described.

At the end of the nineteenth century, attempts were made to find organic/cerebral causes for mental illnesses. The trend of ‘organicization’ increased and culminated in the discovery in 1905 that general paralysis was caused by a physical agent (syphilis). However, there remained many mental disorders that had no known organic cause. The term ‘functional’ was applied to these psychoses in 1881 by the German psychiatrist Fuerstner. However, his compatriot, the anatomist Nissl, claimed that ‘in all psychoses of whatever type there are always positive cortical findings’ (i.e. anatomical evidence of pathology). A functional illness therefore meant one that was suspected of having a physical origin, which had not yet been discovered.

By the mid 1920s, in the absence of the discovery of physical causes for Kraepelin's dementia praecox (schizophrenia) or for manic-depressive insanity, Bumke, his successor as Professor of Psychiatry at the world famous Chair in Munich, unequivocally labelled these as functional as opposed to organic illnesses. An examination of the latter should be conducted in the brain, while the study of the former had to be made in the mind, according to Bumke. The highly influential psychiatrist and philosopher Jaspers listed the functional psychoses as schizophrenia, manic-depressive insanity, and epilepsy.

Today, using computerized imaging techniques, we know that functional psychoses are accompanied by organic changes in the brain. This has made the use of the term ‘functional psychosis’ unhelpful. In the nineteenth century, many mental disorders were considered to be due to degeneration, that is ‘being predisposed to a disorder which led to deterioration, either in that individual or in succeeding generations’. These disorders were termed ‘endogenous’, which could apply both to the psychoses and to disorders of personality (psychopathies).

In 1881 the German degenerationist psychiatrist, Schuele, began the process whereby psychoses were associated with the more serious, organic conditions — cerebropsychoses — and psychoneuroses with the less serious ones. Freud emphasized and popularized the ‘psychoneuroses’ at the turn of the century, and the successful treatment of otherwise healthy soldiers suffering from shellshock in World War I established the entity of the neuroses, as they were to become known.

By 1925 Bumke was writing that ‘there has been no such thing as psychoneuroses for a long time. They have been reclassified into nervous reactions (neuroses), nervous constitutional states, psychopathies and functional psychoses.’ The neuroses were further delineated from the psychoses by Jaspers because ‘they do not wholly involve the individual himself, while those which seize upon the individual as a whole are called psychoses … [and] are generally thought to open up a gulf between sickness and health.’

In the early twentieth century, various terms were used for those conditions, which were deemed psychoses but which were not manic- depressive insanity or schizophrenia, but in the main these two remained the recognized ‘mental illnesses’. Some have upheld the significance of atypical psychoses. The recent debate on these psychoses has also generated much renewed research in the unitary theory of mental illness.

Unitary psychosis

In the mid nineteenth century, the unitary psychosis theory referred to a continuum of mental conditions from health to disease and was based on the importance of symptoms. In the twentieth century, by contrast, the term ‘unitary psychosis’ was applied to the two psychoses, schizophrenia and manic-depressive insanity, with the atypical psychoses bridging these two. Contemporary British psychiatrists have split two ways in their views on this question. Some, who analysed symptoms and emphasized the genetic basis of these disorders, have favoured the concept of unitary psychosis. Others, on the basis of neuroimaging, have rejected the unitary theory in favour of three categories of psychosis: congenital dementia praecox with poor prognosis; an adult form of schizophrenia with good prognosis; and bipolar affective disorder.

‘Psychosis’ — useful or not

There are certain problems with the use of ‘psychosis’ in contemporary psychiatry. Firstly, its very definition is difficult because its defining criteria are not specific (Oxford Textbook of Psychiatry). ‘Lack of insight’ is difficult to define. If ‘severity of illness’ is used as a criterion, the problem then arises that conditions falling into the psychosis category can occur in mild as well as severe forms. Moreover, non-psychotic conditions such as obsessional-compulsive disorder can also be very severe. ‘Impaired contact with reality, as evidenced by delusions and hallucinations’ has been considered difficult to apply. Secondly, conditions to which the term refers appear to have little in common, especially from an aetiological viewpoint. For example, some psychoses can be caused by known organic factors, while others represent a severe depressive illness. Thirdly, it may be better to classify an individual condition like schizophrenia as such, rather than as a member of an umbrella term like psychosis. So, recent classifications have renamed paranoid psychosis as paranoid disorder and affective psychosis as bipolar affective disorder. Fourthly, the tenth International Classification of Diseases (ICD 10) no longer distinguishes between psychosis and neurosis.

The arguments for retaining the term are as follows. Firstly, the psychoses are recognizable — as the ICD 10 proposes — by the presence of delusions and hallucinations without the patient having insight into their morbid nature. Secondly, on a purely practical level, psychosis has carried with it less stigma than the alternative term of ‘insanity’. Thirdly, it is very difficult always to use the term ‘disorder’ as an alternative for psychosis. For example, when it comes to the atypical psychoses the term ‘atypical disorder’ or ‘atypical insanity’ is unsatisfactory. Fourthly, the adjectival use of psychosis is a helpful shorthand term. This can be as in ‘psychotic symptom’ (delusion or hallucination) or ‘antipsychotic’ medication. To use ‘severe unipolar depression with delusions, hallucinations, and loss of insight’ as a replacement for ‘psychotic depression’ is cumbersome.

The contemporary British professor of psychiatry, Tyrer, has written that ‘classification stands or falls by its usefulness.’ In the last two decades the psychiatric profession has made many improvements in the sphere of reliability, but it has been said that there has not been comparable progress in the validity of psychiatric diseases. Therefore, there is a continuing need for the ‘umbrella’ categories such as psychosis and neurosis. The danger with an unquestioning use, and one which does not take cognisance of its abuse and attempted reification as a disease concept earlier this century, is that the mistakes of the past are repeated and an overly organic approach is adopted at the expense of a careful consideration of other — for example psychosocial — factors.

In a clinical and pragmatic sense the combination of one of the definitions of psychosis as ‘gross impairment in reality testing’ and the evident possibility in clinical practice of differentiating psychosis from normality, make psychosis a term that is accessible and acceptable, and yet one which does not necessarily carry the longer term or immutable connotations of its fellow term ‘insane’. Thus for the clinician and the man in the street, a psychotic person differs qualitatively from normal, while someone suffering an understandable neurotic or emotional disturbance usually only differs quantitatively from normal. The psychiatric profession should continue to use the term, but its conceptual limitations should not be overlooked.

— M. Dominic Beer

Bibliography

  • Berrios, G. E. and Beer, M. D. (1995). Unitary psychosis concept. In A history of clinical psychiatry. The origin and history of psychiatric disorders, (ed.) G. E. Berrios and R. Porter. Athlone Press, London

See also psychological disorders; psychosomatic illness.

Columbia Encyclopedia:

psychosis

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psychosis (sīkō'sĭs), in psychiatry, a broad category of mental disorder encompassing the most serious emotional disturbances, often rendering the individual incapable of staying in contact with reality. Until recently, the term was used in contrast with neurosis, which denoted the "mild" mental disorders which did not interfere significantly with the ability to function normally, or severely impair the individual's conception of reality. In 1980, the American Psychiatric Association made sweeping changes in its classificatory system for psychological disorders, and the opposition between neurosis and psychosis became obsolete. The former classification included functional psychoses including schizophrenia, paranoia, bipolar disorder, and involutional psychotic reactions, where no brain change was detectable with available tools. Today, there are separate categories for schizophrenic disorders, mood disorders (which include bipolar disorder and major depression), and other serious mental disturbances such as delusional disorder. Symptoms of these disorders may include hallucinations and delusions; severe deviations of mood (depression and mania); lack of, or inappropriateness of, emotional response; and severe impairment of judgment. Another type of psychosis involves brief episodes, characterized by an acute onset lasting no longer than a month, usually resulting from situational circumstances such as an earthquake or flood. Nonspecified psychotic disorders include psychotic symptoms, e.g., delusions, hallucinations, or disorganized behavior, that cannot be classified in any other disorder. Drug therapy and electroconvulsive therapy have been successful in the treatment of many patients with serious psychological disorders. Organic psychoses, so called because of the structural deterioration of the brain, include senile dementia and Alzheimer's disease. Occurring in middle to old age, these disorders involve progressive, nonreversible brain damage. Organic brain damage may also result from toxic reactions to such substances as alcohol, PCP, amphetamines, and crack cocaine. In criminal law, the term insanity can be applied to most forms of psychoses, although defenses based on insanity have been relatively rare.

Oxford Companion to the Mind:

psychosis

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The word 'psychosis' seems to have been coined in the mid-19th century and to have meant originally any kind of mental disturbance arising from whatever cause. But after the turn of the century its meaning was restricted by excluding both the mental consequences of familiar physical illnesses (such as delirium associated with fever) and the neuroses. In contemporary psychiatric terminology, 'psychosis' is a classificatory and descriptive term, referring to a specific range of illnesses and symptoms, the illnesses being those in which the patient's basic competence as a person is called into question, the symptoms being those which seem to indicate some gross disorder of perception and thought (such as hallucinations and delusions). A psychosis is, therefore, any mental illness which is liable to render its victim non compos mentis, and unfit to plead in a court of law; and a symptom is 'psychotic' if it betrays misapprehension and misinterpretation of the nature of reality.

If, for instance, someone asserts that he is Napoleon, or emperor of Canada, or has had sexual intercourse with God, he is psychotic, since such assertions are by common consent untrue and anyone making them seriously must be misapprehending the nature of reality and failing to distinguish between his fantasies and the facts of the case. In contrast, if someone asserts that he spends time imagining that he is Napoleon, or day dreaming that he has established an empire in Canada, or that he has dreamt he was emperor of Canada or has had intercourse with God, he is not psychotic, for he has correctly distinguished between his own imaginings and the nature of the external world. Similarly, if someone asserts that he has committed terrible crimes (when he has not) and deserves lifelong imprisonment for having done so, he is psychotic, but someone who complains of feeling irrationally guilty is not; nor is a religious person who has a lively sense of original sin.

The International Classification of Diseases (see classification of psychiatric disorders), published by the World Health Organization and used by the National Health Service in Britain, lists eight specific psychoses. Four of these, the so-called organic psychoses (senile, pre-senile, arteriosclerotic, and alcoholic), are generally agreed to be the result of degenerative changes in the brain. They excite little interest within the psychiatric profession and practically none at all with the general public. The other four, the so-called functional psychoses — schizophrenia, manic–depressive psychosis (see depression), involutional melancholia, and paranoia — arouse considerable controversy within the profession and great interest with the general public, partly because their symptoms are dramatic, but more importantly because research has (as yet) failed to discover any convincing, as opposed to plausible, causes for them — and in the absence of any specifiable physical causes it is possible and legitimate to question even whether the medical model is the appropriate one to apply to psychosis.

However, the majority of psychiatrists do seem to believe that the functional psychoses are true medical diseases and that, one day, physical causes will be found for them — and that as a result, rational, effective treatments will become available. If they are right, not only will an enormous amount of suffering be relieved, but the claims of the medical profession to be the appropriate people to care for and treat the mentally disturbed will finally be vindicated. In fact, the advent of effective drugs for the treatment of schizophrenia and manic–depressive psychoses has given considerable support to the possibility that biochemical rather than structural changes in thezbrain could be causes of these diseases. The medical model therefore gains some plausibility from these discoveries.

But, it must be stressed, at least two non-organic, non-medical conceptions of psychosis are also in circulation. One, held by some but not all psychoanalysts, argues that the functional psychoses are not in principle all that different from the neuroses; it is merely that the fixation points are earlier, the regressions deeper, the infantile traumas more massive, the defence mechanisms more primitive. If the analysts who hold this view are right, the functional psychoses are psychogenic, not organic, illnesses, and their symptoms require interpretation in terms of their concealed meanings, not explanations in terms of cerebral dysfunction.

The other, non-organic conception, held by anti-psychiatrists, 'family process' therapists, and the post-Laingian counter-culture generally, explains the functional psychosis of any single individual as the end result of complex and skew interactions within his family that have driven him into bizarre and incomprehensible behaviour, which is then 'disauthenticated' by being labelled 'mad' or 'psychotic'. This theory exists in more than one form. In one the psychotic patient is the victim of a villainous schizophrenogenic parent, usually the mother; in another he is the overt casualty of a deeply concealed family tragedy. This last is a socio-political theory which locates pathology not in the body or the mind of the individual patient but in the power politics of society and the family.

(Published 1987)

— Charles Rycroft

    Bibliography
  • Bateson, G. (1956). 'Towards a theory of schizophrenia'. In Steps to an Ecology of Mind.
  • Fairbairn, W. R. D. (1952). 'A revised psychopathology of the psychoses and psychoneuroses'. In Psychoanalytic Studies of the Personality.
  • Laing, R. D. (1971). The Politics of the Family.
  • — —  and Esterson, A. (1964). Sanity, Madness and the Family.

Word Tutor:

psychosis

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pronunciation

IN BRIEF: A mental illness in which contact with reality is impaired.

pronunciation A true psychosis must be treated seriously by a qualified mental health professional.

LearnThatWord.com is a free vocabulary and spelling program where you only pay for results!

Dictionary of Cultural Literacy: Science:

psychosis

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(seye-koh-sis)

A severe mental disorder, more serious than neurosis, characterized by disorganized thought processes, disorientation in time and space, hallucinations, and delusions. Paranoia, manic depression, megalomania, and schizophrenia are all psychoses. One who suffers from psychosis is psychotic.

Saunders Veterinary Dictionary:

psychosis

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Pl. psychoses; any major mental disorder of organic or emotional origin, marked by derangement of the personality and loss of contact with reality, often with delusions, hallucinations or illusions.
There is no scientific study of animal psychiatry and no specific psychoses but some well-identified and traumatic vices, e.g. crib-biting, weaving, tail chasing and flank sucking in dogs, are often classified as such. farrowing hysteria in sows seems to be the animal disease with the closest approximation to a derangement of personality.

  • parturient p. of sows — see farrowing hysteria.
Mosby's Dental Dictionary:

psychosis

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(sī-kō′sis)
n

A functional or organic kind of mental derangement marked by a severe disturbance of personality involving autistic thinking, loss of contact with reality, delusions or hallucinations.

Random House Word Menu:

categories related to 'psychosis'

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Random House Word Menu by Stephen Glazier
For a list of words related to psychosis, see:
  • Syndromes, Disorders, and Conditions - psychosis: severe mental illness, such as manic depression, paranoia, or schizophrenia, involving loss of contact with reality and breakdown of comprehensible behavior, speech, and thought
  • Insanity - psychosis: major, severe form of mental disorder

Bradford's Crossword Solver's Dictionary:

psychosis

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  See crossword solutions for the clue Psychosis.
Wikipedia on Answers.com:

Psychosis

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This article may be too technical for most readers to understand. Please help improve this article to make it understandable to non-experts, without removing the technical details. The talk page may contain suggestions. (May 2012)
Not to be confused with Psychopathy.
For other uses, see Psychosis (disambiguation).
Psychosis
Classification and external resources
ICD-10 F20- F29[1]
ICD-9 290-299
OMIM 603342 608923 603175 192430
MedlinePlus 001553
MeSH F03.700.675

Psychosis (from the Ancient Greek ψυχή "psyche", for mind/soul, and -ωσις "-osis", for abnormal condition or derangement) means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality". People suffering from psychosis are described as psychotic. Psychosis is given to the more severe forms of psychiatric disorder, during which hallucinations and delusions and impaired insight may occur.[2] Some professionals say that the term psychosis is not sufficient as some illnesses grouped under the term "psychosis" have nothing in common (Gelder, Mayou & Geddes 2005). Indeed, a complex constellation of neurological and psychological factors can result in the altered signalling observed in psychosis. In otherwise normal individuals, exogenous ligands can produce psychotic symptoms. NMDA receptor antagonists, such as ethanol and ketamine, can replicate a similar psychosis to that experienced in schizophrenia.[3]

Prolonged or high dose use of psychostimulants will alter of function like the manic phase of bipolar disorder.[4] NMDA antagonists replicate some of the so called "negative" symptoms e.g., thought disorder in subanasthetic doses, and catatonia in high doses. Psychostimulants, especially in one already prone to psychotic thinking, can cause some "positive" symptoms, such as delusional beliefs, particularly those persecutory in nature. However, some positive symptoms lack a simple neurotransmitter-based explanation, specifically, the auditory hallucinations observed in schizophrenia. These have a much more complex genesis, involving abnormal synaptic plasticity, and the formation of a "parallel process" within the brain. Of specific interest is the entorhinal cortex, which has much less (indirect) connections to the tertiary auditory cortex, as well as direct connections to the hippocampus, the most active region of neurogenesis in the adult brain.

The absence of layer IV in this portion of the temporal lobe means much less interneuronal "buffering" is present. As such, there are many more connections between the large pyramidal neurons of layer V and the relatively small pyramidal neurons of layer III. As such, the unique structure of this area allows its cortiocortical efferents, specifically layer III to layer I of the prefrontal cortex, to exert much excitatory, to the globally modulatory frontal lobes.

This gain in transmission allows the hippocampus, through the entorhinal cortex, to create a global network after much long-term potentiation throughout infancy and childhood. LTP allows certain circuits to become dominant, and when neurons do not receive input, they atrophy and die. After this network is established (through the representation of language), some unknown plastic process occurs, during adolescence, commonly, or less often in adulthood.

In a schizophrenic's brain, an independent circuit within the entorhinal cortex/basal ganglic complex has formed. Through layer III/I transmission to the greater area of the medial temporal lobe. This then results in the auditory hallucinations observed in schizophrenia.[5] The specific mechanisms of LTP are unknown at the moment, but NMDA receptors crucial for the burst firing required, and dopamine plays a very important role in medating basal ganglic, thus hippocampal and memory activity(which is much more complex, involving neurogenesis and LTD as well). Thus, the neurochemical alterations which induce psychosis in otherwise healthy people are indicative that the root of the symptoms altered thalamocortical and hippocamalcortical transmission, and corresponding layer 5/thalamus axis function, altering the crucial ordered cortiocortical layer 3/1 and 2/3 transmission necessary for rational language self-expression.

The terms psychosis and psychotic are very broad and can mean anything from relatively normal aberrant experiences through to the florid and catatonic expressions of schizophrenia and bipolar type 1 disorder [6] Despite this, psychosis is a term generally given to noticeable deficits in normal behavior (known as deficit or negative signs) or more commonly to the florid experiences of hallucinations or delusional beliefs. People experiencing psychosis may exhibit personality changes and thought disorder. Depending on its severity, this may be accompanied by unusual or bizarre behavior, as well as difficulty with social interaction and impairment in carrying out daily life activities. It is also important to note that psychosis usually refers to negative expressions, that is paranoia, stereotypy etc. rather than ecstatic experience such as religious ecstasy, though with such a broad term, there are no hard and fast rules.

A wide variety of central nervous system diseases, from both external poisons and internal physiologic illness, can produce symptoms of psychosis.

Contents

Signs and symptoms

People with psychosis may have one or more of the following: hallucinations, delusions, catatonia, or a thought disorder, as described below.

Hallucinations

A hallucination is defined as sensory perception in the absence of external stimuli. Hallucinations are different from illusions, or perceptual distortions, which are the misperception of external stimuli.[7] Hallucinations may occur in any of the five senses and take on almost any form, which may include simple sensations (such as lights, colors, tastes, and smells) to experiences such as seeing and interacting with fully formed animals and people, hearing voices, and having complex tactile sensations.

Auditory hallucinations, particularly experiences of hearing voices, are a common and often prominent feature of psychosis. Hallucinated voices may talk about, or to, the person, and may involve several speakers with distinct personas. Auditory hallucinations tend to be particularly distressing when they are derogatory, commanding or preoccupying. However, the experience of hearing voices need not always be a negative one. One research study has shown that the majority of people who hear voices are not in need of psychiatric help.[8] The Hearing Voices Movement has subsequently been created to support voice hearers, regardless of whether they are considered to have a mental illness or not.

Delusions

Psychosis may involve delusional beliefs, some of which are paranoid in nature. Karl Jaspers has classified psychotic delusions into primary and secondary types. Primary delusions are defined as arising suddenly and not being comprehensible in terms of normal mental processes, whereas secondary delusions may be understood as being influenced by the person's background or current situation (e.g., ethnicity, religious beliefs, superstitious belief).[9]

Catatonia

Catatonia describes a profoundly agitated state in which the experience of reality is generally considered to be impaired. There are two primary manifestations of catatonic behavior. The classic presentation is a person who does not move or interact with the world in any way while awake. This type of catatonia presents with waxy flexibility. Waxy flexibility is when someone physically moves part of a catatonic person's body and the person stays in the position even if it is bizarre and otherwise nonfunctional (such as moving a person's arm straight up in the air and the arm stays there). The other type of catatonia is more of an outward presentation of the profoundly agitated state described above. It involves excessive and purposeless motor behavior as well as extreme mental preoccupation which prevents intact experience of reality. An example would be someone walking very fast in circles to the exclusion of anything else with a level of mental preoccupation (meaning not focused on anything relevant to the situation) that was not typical of the person prior to the symptom onset. In both types of catatonia there is generally no reaction to anything that happens outside of them. It is important to distinguish catatonic agitation from severe bipolar mania although someone could have both.

Thought disorder

Thought disorder describes an underlying disturbance to conscious thought and is classified largely by its effects on speech and writing. Affected persons show loosening of associations, that is, a disconnection and disorganization of the semantic content of speech and writing. In the severe form speech becomes incomprehensible and it is known as "word-salad".

Psychiatric disorders

From a diagnostic standpoint, organic disorders were those held to be caused by physical illness affecting the brain (that is, psychiatric disorders secondary to other conditions), while functional disorders were considered to be disorders of the functioning of the mind in the absence of physical disorders (that is, primary psychological or psychiatric disorders). The materialistic view of the mind-body problem holds that mental disorders arise from physical processes; in this view, the distinction between brain and mind, and therefore between organic and functional disease, is an artificial one. Subtle physical abnormalities have been found in illnesses traditionally considered functional, such as schizophrenia. The DSM-IV-TR avoids the functional/organic distinction, and instead lists traditional psychotic illnesses, psychosis due to general medical conditions, and substance-induced psychosis.

Primary psychiatric causes of psychosis include the following:[10][11][12]

Psychotic symptoms may also be seen in[12]

Stress is known to contribute to and trigger psychotic states. A history of psychologically traumatic events, and the recent experience of a stressful event, can both contribute to the development of psychosis. Short-lived psychosis triggered by stress is known as brief reactive psychosis, and patients may spontaneously recover normal functioning within two weeks.[13] In some rare cases, individuals may remain in a state of full-blown psychosis for many years, or perhaps have attenuated psychotic symptoms (such as low intensity hallucinations) present at most times.

Normal states

Brief hallucinations are not uncommon in those without any psychiatric disease. Causes or triggers include[12]

Medical conditions

A very large number of medical conditions can cause psychosis, sometimes called secondary psychosis.[12] Examples include:

Psychosis can even be caused by familiar ailments such as flu[50][51] or mumps.[52]

Recreational drugs

Main article: Substance-induced psychosis

Various psychoactive substances (both legal and illegal) have been implicated in causing, exacerbating, and/or precipitating psychotic states and/or disorders in users. This may be upon intoxication, for a more prolonged period after use, or upon withdrawal. Drugs that can induce psychotic symptoms include amphetamine, caffeine (which can worsen psychotic symptoms in schizophrenia and produce olfactory hallucinations at very high doses in normal volunteers), cannabis, cocaine, desoxypipradrol, dimethyltryptamine, alcohol (ethanol), inhalants, gammahydroxybutyric acid (and its precursors gammabutyrolactone and 1,4-butanediol), ketamine, LSD, mephedrone and methcathinone, mescaline and other phenethylamine hallucinogens, methamphetamine, MDMA (very rarely, likely due to different phethylamines that are sometimes sold as MDMA, or even piperazine derivatives sold as "extacy"), opiates such as heroin, phencyclidine, piperazine-based drugs, psilocybin, and anabolic steroids at high doses.[12]

Frequent users of cannabis have twice the likelihood of developing both psychosis and schizophrenia.[53] Older studies indicate that certain strains containing large proportions of tetrahydrocannabinol and low proportions of cannabidiol[54][55] merely lowers the threshold for psychosis, and thus helps to trigger full-blown psychosis in some people.[56] On the other hand, cannabis use has increased dramatically over the past few decades but declined in the last decade, whereas the rate of psychosis has not increased. This suggests cannabis generally only hastens the onset of psychosis in those who would otherwise only become psychotic at a later date.[57]

Another interpretation of these results is that maladaptive coping mechanisms are a root cause of schizoform disorders, and psychological disorders in general. These may be a "normal" response to the altered reelin, 5-HT, DA, and other plasticity-regulating neurotransmitters. Given the poorly understood nature of the endocannabinoid system, it will take many more generations of progress to even scratch the surface of the extraordinarily complex mechanisms that control neurological development/degeneration.[citation needed]

Medication

Administration, or sometimes withdrawal, of a large number of medications may provoke psychotic symptoms.[12] Drugs that can induce psychosis experimentally and/or in a significant proportion of patients include amphetamine and other sympathomimetics, dopamine agonists, ketamine, corticosteroids (often with mood changes in addition), and some anticonvulsants such as vigabatrin.[12][58]

Pathophysiology

The first brain image of an individual with psychosis was completed as far back as 1935 using a technique called pneumoencephalography[59] (a painful and now obsolete procedure where cerebrospinal fluid is drained from around the brain and replaced with air to allow the structure of the brain to show up more clearly on an X-ray picture).

The purpose of the brain is to collect information from the body (pain, hunger, etc.), and from the outside world, interpret it to a coherent world view, and produce a meaningful response. The information from the senses enter the brain in the primary sensory areas. They process the information and send it to the secondary areas where the information is interpreted. Spontaneous activity in the primary sensory areas may produce hallucinations which are misinterpreted by the secondary areas as information from the real world.

For example, a PET or fMRI scan of a person who claims to be hearing voices may show activation in the primary auditory cortex, or parts of the brain involved in the perception and understanding of speech.[60]

Tertiary brain cortex collects the interpretations from the secondary cortexes and creates a coherent world view of it. A study investigating structural changes in the brains of people with psychosis showed there was significant grey matter reduction in the right medial temporal, lateral temporal, and inferior frontal gyrus, and in the cingulate cortex bilaterally of people before and after they became psychotic.[61] Findings such as these have led to debate about whether psychosis itself causes excitotoxic brain damage and whether potentially damaging changes to the brain are related to the length of psychotic episode. Recent research has suggested that this is not the case[62] although further investigation is still ongoing.

Studies with sensory deprivation have shown that the brain is dependent on signals from the outer world to function properly. If the spontaneous activity in the brain is not counterbalanced with information from the senses, loss from reality and psychosis may occur after some hours. A similar phenomenon is paranoia in the elderly when poor eyesight, hearing and memory causes the person to be abnormally suspicious of the environment.

On the other hand, loss from reality may also occur if the spontaneous cortical activity is increased so that it is no longer counterbalanced with information from the senses. The 5-HT2A receptor seems to be important for this, since psychedelic drugs which activate them produce hallucinations.

However, the main feature of psychosis is not hallucinations, but the inability to distinguish between internal and external stimuli. Close relatives to psychotic patients may hear voices, but since they are aware that they are unreal they can ignore them, so that the hallucinations do not affect their reality perception. Hence they are not considered to be psychotic.

Psychosis has been traditionally linked to the neurotransmitter dopamine. In particular, the dopamine hypothesis of psychosis has been influential and states that psychosis results from an overactivity of dopamine function in the brain, particularly in the mesolimbic pathway. The two major sources of evidence given to support this theory are that dopamine receptor D2 blocking drugs (i.e., antipsychotics) tend to reduce the intensity of psychotic symptoms, and that drugs which boost dopamine activity (such as amphetamines and cocaine) can trigger psychosis in some people (see amphetamine psychosis).[63] However, increasing evidence in recent times has pointed to a possible dysfunction of the excitory neurotransmitter glutamate, in particular, with the activity of the NMDA receptor. This theory is reinforced by the fact that dissociative NMDA receptor antagonists such as ketamine, PCP and dextromethorphan/dextrorphan (at large overdoses) induce a psychotic state more readily than dopinergic stimulants, even at "normal" recreational doses. The symptoms of dissociative intoxication are also considered to mirror the symptoms of schizophrenia, including negative psychotic symptoms, more closely than amphetamine psychosis. Dissociative induced psychosis happens on a more reliable and predictable basis than amphetamine psychosis, which usually only occurs in cases of overdose, prolonged use or with sleep deprivation, which can independently produce psychosis. New antipsychotic drugs which act on glutamate and its receptors are currently undergoing clinical trials.

The connection between dopamine and psychosis is generally believed to be complex. While dopamine receptor D2 suppresses adenylate cyclase activity, the D1 receptor increases it. If D2-blocking drugs are administered the blocked dopamine spills over to the D1 receptors. The increased adenylate cyclase activity affects genetic expression in the nerve cell, a process which takes time. Hence antipsychotic drugs take a week or two to reduce the symptoms of psychosis. Moreover, newer and equally effective antipsychotic drugs actually block slightly less dopamine in the brain than older drugs whilst also blocking 5-HT2A receptors, suggesting the 'dopamine hypothesis' may be oversimplified.[64] Soyka and colleagues found no evidence of dopaminergic dysfunction in people with alcohol-induced psychosis[65] and Zoldan et al. reported moderately successful use of ondansetron, a 5-HT3 receptor antagonist, in the treatment of levodopa psychosis in Parkinson's disease patients.[66]

Psychiatrist David Healy has criticised pharmaceutical companies for promoting simplified biological theories of mental illness that seem to imply the primacy of pharmaceutical treatments while ignoring social and developmental factors which are known to be important influences in the aetiology of psychosis.[67]

Some theories regard many psychotic symptoms to be a problem with the perception of ownership of internally generated thoughts and experiences.[68] For example, the experience of hearing voices may arise from internally generated speech that is mislabeled by the psychotic person as coming from an external source.

It has been suggested that persons with bipolar disorder may have increased activity of the left hemisphere compared to the right hemisphere of the brain, while persons with schizophrenia have increased activity in the right hemisphere.[69]

Increased level of right hemisphere activation has also been found in people who have high levels of paranormal beliefs[70] and in people who report mystical experiences.[71] It also seems to be the case that people who are more creative are also more likely to show a similar pattern of brain activation.[72] Some researchers have been quick to point out that this in no way suggests that paranormal, mystical or creative experiences are in any way by themselves a symptom of mental illness, as it is still not clear what makes some such experiences beneficial and others distressing.

Diagnosis

Diagnosing the presence and/or extent of psychosis may be distinguished from diagnosing the cause of psychosis.[12]

The presence of psychosis is typically diagnosed by clinical interview, incorporating mental state examination.[10][11] Its extent may be established by formal rating scales. The Brief Psychiatric Rating Scale (BPRS)[73] assesses the level of 18 symptom constructs of psychosis such as hostility, suspicion, hallucination, and grandiosity. It is based on the clinician's interview with the patient and observations of the patient's behavior over the previous 2–3 days. The patient's family can also provide the behavior report. During the initial assessment and the follow-up, both positive and negative symptoms of psychosis can be assessed using the 30 item Positive and Negative Symptom Scale (PANSS).[74]

Establishing the cause of psychosis requires clinical examination, and sometimes special investigations, to diagnose or exclude secondary causes of psychosis; if these are excluded, a primary psychiatric diagnosis can be established.[12]

Treatment

The treatment of psychosis depends on the cause or diagnosis or diagnoses (such as schizophrenia, bipolar disorder and/ or substance intoxication). The first line treatment for many psychotic disorders is antipsychotic medication (oral or intramuscular injection), and sometimes hospitalization is needed. There is growing evidence that cognitive behavior therapy[75] and family therapy[76] can be effective in managing psychotic symptoms. When other treatments for psychosis are ineffective, electroconvulsive therapy or ECT (also known as shock treatment) is sometimes applied to relieve the underlying symptoms of psychosis due to depression. There is also increasing research suggesting that animal-assisted therapy can contribute to the improvement in general well-being of people with schizophrenia.[77]

Early intervention

Main article: Early intervention in psychosis

Early intervention in psychosis is a relatively new concept based on the observation that identifying and treating someone in the early stages of a psychosis can significantly improve their longer term outcome.[78] This approach advocates the use of an intensive multi-disciplinary approach during what is known as the critical period, where intervention is the most effective, and prevents the long term morbidity associated with chronic psychotic illness.

Newer research into the effectiveness of cognitive behavioural therapy during the early pre-cursory stages of psychosis (also known as the "prodrome" or "at risk mental state") suggests that such input can prevent or delay the onset of psychosis.[79]

History

The word psychosis was introduced to the psychiatric literature in 1841 by Karl Friedrich Canstatt in his work Handbuch der Medizinischen Klinik. He used it as a short-hand for 'psychic neurosis'. At that time neurosis meant any disease of the nervous system, and Canstatt was thus referring to what was thought to be a psychological manifestation of brain disease.[80] Ernst von Feuchtersleben is also widely credited as introducing the term in 1845,[81] as an alternative to insanity and mania.

The term stems from the Greek ψύχωσις (psychosis), "a giving soul or life to, animating, quickening" and that from ψυχή (psyche), "soul" and the suffix -ωσις (-osis), in this case "abnormal condition".[82][83]

The word was also used to distinguish disorders which were thought to be disorders of the mind, as opposed to "neurosis", which was thought to be a disorder of the nervous system.[84] The psychoses thus became the modern equivalent of the old notion of madness, and hence there was much debate on whether there was only one (unitary) or many forms of the new disease.[85] One type of broad usage would later be narrowed down by Koch in 1891 to the 'psychopathic inferiorities' - later renamed abnormal personalities by Schneider.[80]

The division of the major psychoses into manic depressive illness (now called bipolar disorder) and dementia praecox (now called schizophrenia) was made by Emil Kraepelin, who attempted to create a synthesis of the various mental disorders identified by 19th century psychiatrists, by grouping diseases together based on classification of common symptoms. Kraepelin used the term 'manic depressive insanity' to describe the whole spectrum of mood disorders, in a far wider sense than it is usually used today. In Kraepelin's classification this would include 'unipolar' clinical depression, as well as bipolar disorder and other mood disorders such as cyclothymia. These are characterised by problems with mood control and the psychotic episodes appear associated with disturbances in mood, and patients will often have periods of normal functioning between psychotic episodes even without medication. Schizophrenia is characterized by psychotic episodes which appear to be unrelated to disturbances in mood, and most non-medicated patients will show signs of disturbance between psychotic episodes.

During the 1960s and 1970s, psychosis was of particular interest to counterculture critics of mainstream psychiatric practice, who argued that it may simply be another way of constructing reality and is not necessarily a sign of illness. For example, R. D. Laing argued that psychosis is a symbolic way of expressing concerns in situations where such views may be unwelcome or uncomfortable to the recipients. He went on to say that psychosis could be also seen as a transcendental experience with healing and spiritual aspects. Arthur J. Deikman suggested use of the term "mystical psychosis" to characterize first-person accounts of psychotic experiences that are similar to reports of mystical experiences. Thomas Szasz focused on the social implications of labeling people as psychotic, a label he argues unjustly medicalises different views of reality so such unorthodox people can be controlled by society. Psychoanalysis has a detailed account of psychosis which differs markedly from that of psychiatry. Freud and Lacan outlined their perspective on the structure of psychosis in a number of works.

Since the 1970s, the introduction of a recovery approach to mental health, which has been driven mainly by people who have experienced psychosis (or whatever name is used to describe their experiences), has led to a greater awareness that mental illness is not a lifelong disability, and that there is an expectation that recovery is possible, and probable with effective support.

Subtypes

Subtypes of psychosis include:

Cycloid psychosis

Cycloid psychosis is psychosis that progresses from normal to full-blown usually within a few hours, not related to drug intake or brain injury.[86] In addition, diagnostic criteria include at least four of the following symptoms:[86]

  • Confusion
  • Mood-incongruent delusions
  • Hallucinations
  • Pan-anxiety, a severe anxiety not bound to particular situations or circumstances
  • Happiness or ecstasy of high degree
  • Motility disturbances of akinetic or hyperkinetic type
  • Concern with death
  • Mood swings to some degree, but less than what is needed for diagnosis of an affective disorders

Cycloid psychosis occurs in people of generally 15–50 years of age.[86]

See also

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Further reading

  • Sims, A. (2002) Symptoms in the mind: An introduction to descriptive psychopathology (3rd edition). Edinburgh: Elsevier Science Ltd. ISBN 0-7020-2627-1

Personal accounts

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American Board of Psychiatry and Neurology · American Psychiatric Association · American Neuropsychiatric Association · Brazilian Association of Psychiatry · Canadian Psychiatric Association · Chinese Society of Psychiatry · Democratic Psychiatry · German Society of Psychiatry, Psychotherapy and Neurology · Hong Kong College of Psychiatrists · Independent Psychiatric Association of Russia · Indian Psychiatric Society · Irish College of Psychiatrists · Israeli Psychiatric Association · Italian Psychiatric Society · Japanese Society of Psychiatry & Neurology · Korean Neuropsychiatric Association · Maryland Psychiatric Society · National Institute of Mental Health · Pakistan Psychiatric Society · Royal Australian and New Zealand College of Psychiatrists · Royal College of Psychiatrists · Singapore Psychiatric Association · South African Society of Psychiatrists · World Psychiatric Association
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M: PSO/PSI

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proc(eval/thrp), drug(N5A/5B/5C/6A/6B/6D)
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M: PSO/PSI

dsrd (o, p, m, p, a, d, s), sysi/epon, spvo

proc(eval/thrp), drug(N5A/5B/5C/6A/6B/6D)

This entry is from Wikipedia, the leading user-contributed encyclopedia. It may not have been reviewed by professional editors (see full disclaimer)

Translations:

Psychosis

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Home > Library > Literature & Language > Translations

Dansk (Danish)
n. - psykose

Nederlands (Dutch)
psychose

Français (French)
n. - psychose

Deutsch (German)
n. - Psychose

Ελληνική (Greek)
n. - (ψυχολ.) ψύχωση

Italiano (Italian)
psicosi

Português (Portuguese)
n. - psicose (f)

Русский (Russian)
психоз

Español (Spanish)
n. - psicosis

Svenska (Swedish)
n. - psykos

中文（简体）(Chinese (Simplified))
精神病, 精神状态, 精神不正常

中文（繁體）(Chinese (Traditional))
n. - 精神病, 精神狀態, 精神不正常

한국어 (Korean)
n. - 정신병, 정신이상

日本語 (Japanese)
n. - 精神病, 精神異常

العربيه (Arabic)
‏(الاسم) اضطراب عقلي حاد, ذهان‏

עברית (Hebrew)
n. - ‮הפרעה נפשית חמורה המביאה להזיות ואובדן הקשר עם המציאות, פסיכוזה‬

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