Psychiatry-Online

What is schizophrenic psychosis?

Schizophrenic psychosis is the acute form of schizophrenia. This is a condition in which the perception of reality is disturbed. During a psychosis it can happen that sick people hear strange voices or see ghosts that are not there. There are also frequent feelings of inner restlessness and tension. The symptoms of psychosis can be very variable and vary from person to person. There are different types of schizophrenic psychosis. The best-known form is paranoid schizophrenic psychosis, in which paranoia and the feeling of being observed are in the foreground. Schizophrenia is often mistakenly associated with split personality disorder (also known as dissociative identity disorder), in which different personalities of a person can take control of the body.

What can be the signs of schizophrenic psychosis?

Psychosis can show itself in different ways and can be very diverse. However, there are some striking signs that are common.

Delusions: In the case of a delusion, reality is perceived in a distorted manner and misinterpreted. Other people cannot use rational arguments to ensure that the person concerned abandons his or her ideas. During a psychosis, people often have the feeling of being followed or listened to (paranoia) or mistakenly refer to insignificant little things to themselves and attach particular importance to them (delusional relationship). For example, the feeling can arise that the speaker is talking about the person on the radio or television even though the news is being delivered. But body-related delusions are also possible, in which the feeling of one's own body is disturbed. Another well-known delusion is the megalomania in which one perceives oneself as a “misunderstood genius” or a “prominent personality”. However, this has nothing to do with a split personality, where you have different personalities that are split off from one another and can take over the thinking and acting.
Ego disorders: Here, those affected have difficulty distinguishing between the “I” and the environment. They have the feeling that others can read their thoughts (thought spread), thoughts are stolen from their heads (thought deprivation) or inserted (thought inspiration). The feeling of external control, self-alienation or a changed perception of the environment can also arise
Hallucinations and perception disorders: Hallucinations can occur with all five senses (hearing, seeing, tasting, smelling, feeling). Hearing voices or seeing ghosts and faces in particular is not uncommon. The brain is not able to process and interpret the sensations. When hearing voices in particular, it is important to note whether the voices are talking to each other or talking to the person concerned. In many cases, the voices are commanding or offensive and can also prompt suicide. In this case, it is important to seek professional help so as not to give in to the voices. It is difficult when the voices forbid the victim from talking about the voices asking him to commit suicide.
Formal thought disorders: As a rule, a slowdown in thinking, thought jumps or a tear-off of thoughts are noticeable here. Those affected often ignore the actual topic (bypassing), invent new words (neologisms) or show a lack of thought that creates illogical sentences with confused sentence fragments.

Also read our article: What can be signs of impending schizophrenia?

Accompanying symptoms of schizophrenic psychosis

A distinction is made between positive symptoms and negative symptoms, although the terms can sound very ambiguous. Positive symptoms are, for example, delusions or hallucinations that “expand” thought processes and sensations beyond the normal, that is, they tend to be additionally present.

Negative symptoms lead to a reduction in normal, regular actions and thought processes. Examples of this can be social withdrawal, lack of strength, lack of motivation or joylessness. But cognitive problems such as concentration and memory can also be impaired. The negative symptoms often appear before the actual outbreak of the disease. They also lead to a significant handicap for the patient and should not be underestimated!

People with psychoses often suffer from a variety of impairments in perception, thinking, speaking and acting, so-called basic disorders. Basic disturbances lead e.g. to problems with concentration, communicating with other people, making decisions. Even very simple everyday activities, e.g. Personal hygiene and dressing can therefore become a problem for those affected. The patients find it more difficult situations and e.g. include other people's emotions in the overall context. All of this leads to the fact that patients lose an average of 10 IQ points (compared to the norm) due to their illness.

For more information, also read: Symptoms of schizophrenia

Diagnosis of schizophrenic psychosis

First of all, physical causes of psychosis should be ruled out. These include diseases of the thyroid gland, various infectious diseases and other psychiatric illnesses as well as drug use. For this purpose, blood tests, nerve water punctures, physical examinations as well as imaging such as MRI and X-ray examinations or EKG and EEG are made.

Then there are various criteria that must be met for a diagnosis to be made. According to ICD-10, the international classification of diseases that is used in this context, one of the following criteria must be covered for at least one month:

I disorder (thought input, thought withdrawal, thought spreading, ...)
Delusional phenomenon with realistic content (delusions of persecution, delusions of intoxication, ...)
Delusional phenomenon with unrealistic content (conviction of having superpowers, ...)
Hearing voices (acoustic hallucination)

Or at least two of the following symptoms for at least a month:

Hallucinations of all sensory organs (e.g. seeing ghosts)
Formal thought disorders (word creation, tearing off thoughts, lost thoughts, ...)
Catatonia (immobility, falling silent, repeating, acting contrary to what is actually wanted, ...)
Negative symptoms (apathy, speech impoverishment, social withdrawal, ...)
Behavior changes

Is there a test to diagnose schizophrenic psychosis?

Psychologists and psychiatrists have various tests with which they can diagnose schizophrenia or schizophrenic psychosis. The diagnosis should therefore always be made professionally by a doctor or psychotherapist. Self-tests from the Internet are not a reliable method for diagnosing schizophrenia or acute psychosis, but can help those affected and their relatives to find their way to a psychiatrist.

Also Read: How Can You Test For Schizophrenia?

If you have the feeling that you or someone close to you could suffer from schizophrenia, take our test:

Treatment and therapy

After the diagnosis of schizophrenic psychosis has been confirmed, treatment should be started as soon as possible. On the one hand, supportive measures but also medication are used here.

Antipsychotics are given pharmacologically. There are typical and atypical antipsychotics that differ only slightly from their sites of action. As a rule, attempts are made to use atypical antipsychotics such as quetiapine, olanzapine or risperidone. If this does not help, clozapine can also be tried. Clozapine is a very effective drug, but in 1% of the cases it can seriously worsen the immune system, so that close blood tests must be carried out here.

The typical antipsychotics are used less often nowadays and agents such as haloperidol are only used in acute treatment. Due to their drowsy and calming effect, low-dose medications can also be used against restlessness, anxiety or insomnia.

Alternatively, you can also use benzodiazepines such as Lorazepam, which can also help against anxiety and restlessness.

Since depressive symptoms often accompany psychotic symptoms, antidepressants are used to stop depression.

In addition to drug therapy, however, other measures also play an important role.

In psychoeducation, the sick person is trained about their illness and should become an expert in their illness themselves. With a better understanding, behavior patterns can be adapted or early symptoms can be better recognized before the next acute psychosis.

Behavioral therapy or family therapy as well as professional reintegration can help to cope better with the illness and to keep the risk of relapse less.

For more detailed information on this topic, please also read: Therapy for schizophrenia or schizophrenia - These drugs can help

Forms of schizophrenic psychosis

There are different sub-forms of how a schizophrenic psychosis can develop. Paranoid schizophrenia is the most common, which is why most people think of schizophrenia with the typical symptoms of paranoid schizophrenia, such as delusions or hallucinations.

In hebephrenic schizophrenia, however, hallucinations are less common. The focus here is on inappropriate emotions and statements as well as ridiculous behavior. Mostly these are artists or very spiritual people who deal a lot with religion or philosophy. Not infrequently, these issues are also part of the psychosis.

Another form is catatonic schizophrenia, in which either excessive or decreased psychomotor functions are present. This means that those affected have speech impoverishment or a reduced ability to move, in the worst case they remain completely silent or rigid for a while. Mannerisms, i.e. unnatural movements such as constant twitching of the face, are often encountered. But the opposite can also be the case with catatonic schizophrenia. This can lead to aggressive or uncontrolled movements. Sometimes movement stereotypes exist, which means that movements are senselessly repeated over and over.

How is the process?

At the beginning of schizophrenia there is the so-called prodromal phase in which for about 5 years there are rather unspecific negative symptoms and can be viewed as a “warning”. They tend to gain strength over time.
Then comes the psychotic phase with more and more positive symptoms such as hallucinations or perceptual disorders that go beyond normal sensory perception. The hospital is usually only visited about a year after the onset of the first manifest psychosis. The longer this phase lasts until therapy, the worse the prognosis is usually. In the worst case, a chronic psychosis develops, in which there are more and more psychotic episodes that cannot be controlled without medication. If the schizophrenia is well controlled, new episodes can still occur, but many sick people or their relatives know about it and go to hospital. In the worst case, those affected are taken to psychiatry by the police because either criminal offenses, suicidality or other behaviors make the police officers prick up their ears.

Anyone who has been struggling with the disease for a long time or often has acute episodes and is overwhelmed by themselves can also be supported by a supervisor who either has complete or selected control rights or can only provide support when dealing with authorities and the like, as this is often very stressful and confusing is.

The more common the acute psychosis, the more difficult it is for those affected to cope with a regular everyday life without help. If therapy is started at an early stage, such severe courses can usually be contained. However, the course is individually different and depends on the conditions and insight into the disease.

Duration

The duration of a schizophrenic episode can vary greatly depending on how many previous episodes have preceded it, how quickly treatment is given, and what the trigger was. Furthermore, one must also take into account that the patient must be open to the therapy and thus an insight into the disease should be available. An often underestimated aspect is the positive influence on the success of the therapy through a supportive social environment made up of friends and family.

Symptoms must last at least 1 month for a diagnosis of schizophrenia to be made. Hallucinations, delusions and other phenomena can either fluctuate for a few hours to days or occur continuously during an acute phase. Without timely treatment, it can even happen that no improvement occurs and the psychosis becomes chronic.

So it is not possible to make a general statement about the duration of a schizophrenic psychosis. Sometimes a remnant of the negative symptoms remains after the psychosis, which is also called a schzophrenic residue.

root cause

A schizophrenic psychosis can occur with a known or as yet unknown schizophrenia and can be caused by various triggers that do not always have to be obvious. Basically there are people who are more prone to a psychiatric illness and others who do not have this characteristic. Hereditary predispositions or drug consumption often play a role in the development or “outbreak” of the disease. A wrong upbringing as a trigger could not be proven so far and is considered rather unlikely.

One approach to explaining the cause of illness is the vulnerability-stress-coping model. The name alludes to the course of the various phases. At the beginning there is a certain vulnerability or susceptibility to schizophrenia due to genetic, neuropsychological reasons or illness. If there is a stress-inducing factor within the body or through the environment, there is a possible trigger for an outbreak. These include hormonal changes as well as drug use. If the stressful situation is not brought under adequate control (coping), the stress is sufficient to cause the disease to break out.

also read: Is Schizophrenia Hereditary? or causes of schizophrenia

Is schizophrenic psychosis curable?

The goal of treatment for schizophrenic psychosis is to combat the acute psychosis and reduce its frequency. However, there is currently no cure for schizophrenia. The success of the therapy is also difficult to predict and depends on various factors. With the right medication and other measures, however, it is possible to lead a symptom-free life.

What is the difference between psychosis and schizophrenia?

Psychosis and schizophrenia are two different terms that are not synonymous. Psychosis is a psychological syndrome with various symptoms in which reality is perceived in a distorted manner. The word “psychosis” is a generic term that includes various diseases whose symptoms are similar to one another but which have different causes. Not only schizophrenia but also other diseases can express themselves as psychosis. Psychosis is conceivable as a side effect of medication such as steroids or drugs. Other causes are infections, brain tumors, metabolic disorders, or other causes that affect the structure of the brain. Schizophrenia, on the other hand, is an illness that manifests itself in the form of psychoses.

Also read our main articles: Schizophrenia and psychosis