Psychosis (psychotic disorder): symptoms and treatment

By Cristiano Antonino On May 31, 2023

The term ‘psychosis’ was introduced in the 19th century with the meaning of mental illness or madness. A rescuer has to deal with patients in this state quite often, so some information on this is useful

Subsequent to the definition of pathology, the need emerged on a conceptual level to subdivide some of these illnesses under the name neurosis.

Since then, the two terms have evolved on different levels.

What is psychotic disorder

Nowadays, psychotic disorder refers to a severe psychiatric disorder characterised by detachment from one’s surroundings, severe difficulty in initiating activities and having authentic feelings towards other people.

There is thus a severe alteration of the individual’s psychic balance with impairment of the reality test and formal thought disorders.

Symptoms of psychosis

Psychotic disorders are characterised by delusions, hallucinations, disorganised thinking and behaviour and negative symptoms (DSM-5, 2013).

Psychotic symptoms can be grouped into:

– Thought form disorders: alterations in the ideational flow, up to flight of ideas and incoherence, alteration of associative links. Derailment, tangentiality may therefore occur to the extent that effective communication is impaired.

– Thought content disorders: prevailing or delusional ideation (so-called delusions); in particular, so-called paranoia is well known. The content of delusions may be of various types: persecution, reference, somatic, religious or grandiose.

– Sensory perception disorders: auditory, visual, olfactory, tactile, taste hallucinations. However, auditory hallucinations are the most common in psychotic disorders and occur in the form of voices, familiar or unfamiliar.

Characteristics and manifestations of psychosis

A person with psychotic symptoms may be unable to cope with his or her everyday problems because he or she can no longer think clearly or because he or she is convinced that something or someone is influencing his or her thoughts.

With psychosis, the person may no longer be able to work as before, as if they have lost the ability to do things they used to be able to do or as if they can no longer concentrate on making decisions.

In addition, he or she may have difficulty talking to other people or no longer take pleasure in doing so.

Onset and development of psychotic disorders

Psychotic disorders generally begin in adolescence and early adulthood and are almost always the result of organic, psychological and constitutional factors.

Prodromal symptoms may often precede the active phase and residual symptoms (hallucinations and subthreshold delusions and negative symptoms) may follow it.

Finally, social withdrawal and depressive symptoms often constitute the first signs of the disorder.

Risk factors for psychotic disorders

The causes of psychosis have not yet been clearly identified.

It is widely assumed that biological, genetic, psychological and social factors are involved.

It is likely that these factors may create a vulnerability in some people to developing psychotic disorders; this vulnerability under conditions of particularly pronounced or chronic stress may allow such disorders to develop.

The main psychotic disorders or forms of psychosis are:

Schizophrenia
Delusional disorder
Schizophreniform disorder
Schizoaffective disorder
Brief psychotic disorder

Treatment of psychosis

Drug therapy

The treatment of psychosis aims to re-establish proper biochemical functioning of the central nervous system.

Generally the treatment of psychosis, especially in the acute phase, is pharmacological (there are now many new anti-psychotic drugs), to which it is essential to associate a psychotherapeutic-rehabilitative intervention.

Cognitive-behavioural psychotherapy

Psychotherapeutic interventions focus on teaching social skills and working with the family through psycho-educational interventions on psychosis.

These help family members cope with the illness and promote their mutual support.

Specifically, cognitive-behavioural psychological interventions aim to reduce emotional dysregulation and disabilities resulting from psychotic symptoms by learning specific and more functional skills.

They also aim to increase the patient’s awareness of their disorder and promote compliance with pharmacological treatment.

This is to prevent social isolation and reduce/reduce possible psychopathological relapses.