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Mind games: Understanding the effects of psychosis

June 13, 2017 | By NewYork-Presbyterian Hospital

What do the following people have in common: artist Vincent Van Gogh, mathematician John Nash, and first lady Mary Todd Lincoln? Answer: They were all known to suffer from some form of psychosis.

Of all the mental conditions that can afflict an individual, psychosis is perhaps one of the most disturbing — and it’s more common than people think. New research estimates that one in 13 people will experience a psychotic episode by the time they are 75.  Most often it will happen during adolescence or young adulthood. However, for about one quarter of people it occurs after the age of 40.

“Simply put, psychosis is a break from, or loss of contact with, reality,” explains Dr. Babatunde Asemota, a psychiatrist at NewYork-Presbyterian Westchester Division in White Plains. “The condition essentially disrupts a person’s normal thinking pattern, making it difficult for him or her to distinguish between what’s real and what isn’t. Typical symptoms of psychosis include illogical thinking, bizarre associations, disordered speech, delusional beliefs, paranoia and hallucinations. While each person’s psychosis is unique, most agree that it could be frightening and confusing not only to the patient, but to the people in his or her life.”

What creates that first break with reality?

Early or first-episode psychosis (FEP) refers to the time a person starts showing initial signs of losing contact with reality. FEP rarely comes suddenly. Usually, a person has gradual, non-specific changes in thoughts and perceptions, but doesn’t understand what’s going on. According to Dr. Asemota, “Early warning signs typically precede the condition and can last months or even years. They are oftentimes subtle, and easy to miss by family, friends or the patient themselves — such as a decreased attention span, depression, newfound social difficulties, sleep disturbances, and disorganized thoughts and behaviors.”

In most cases, it is difficult to pinpoint the cause of psychosis, but current theory suggests a combination of biological, genetic and environmental factors. While actual triggers are not clear, for example family history, those born with certain obstetric complications, increased stress or traumatic events, substance abuse, and infections can all make an individual more vulnerable. Research also points to a number of brain chemicals, including dopamine and serotonin that may play a role in how psychosis develops.

Says Dr. Asemota, “The cause of first episode psychosis may be particularly unclear, which is why it is important for the individual to have a thorough medical assessment to rule out any physical illness as the cause. This involves medical tests as well as a detailed assessment by a mental health professional.”

Team approach is key to successful treatment

The mainstay of treatment of psychosis is multi-faceted and includes antipsychotic drugs in addition to individual, family, and group psychotherapy, case management, and support from social services.

Individuals dealing with first episode psychosis should take an active role in their own treatment and recovery, such as learning about the illness and how they are affected by it. Says Dr. Asemota, “Patient education is so important, and treatment will be more successful when individuals can learn to help themselves — by recognizing their unique warning signs or symptoms, managing stress, building a support network and engaging in activities they find rewarding.”

The road to recovery from FEP varies from person to person. Some may be able to resume a normal life quickly, while others may need weeks or months to recover. “Family involvement is particularly critical to the treatment process,” emphasizes Dr. Asemota. “They can help by teaching communication and problem-solving skills, and generally act as valuable allies during the road to recovery, helping the patient cope better. Quick action that connects a person with the right treatment during FEP can make all the difference. It’s important to remember that psychosis is treatable and many people will make an excellent recovery.”

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