Symptoms experienced by patients are:

• Delusions: These are unusual and unshakable beliefs held by the individual which are believed to be absurd or false by others around them. Beliefs like “The anchor in the TV show is talking about me and giving me signals” or “I can make it rain on my wish”. The patient has full belief in them and holds the belief even when sufficient evidence to the contrary is presented to them.

• Hallucinations: It is an experience of sensation like sound, smell, taste, vision, touch felt by a person without having any source to cause it e.g. being able to hear someone shouting one’s name despite no one being around.

• Thought disorder: This involves a problem in constant flow of thoughts or being able to properly organise one’s own thought. Patient may appear to jumble words/sentences or say words without any meaning.

• Catatonia: In this there is an impaired ability of the patient to move or speak in a normal manner. The patient may appear to be in an uncomfortable postures for a long time or may repeat words or actions repeatedly. However few patient paradoxically may even become excited and agitated.

Is having paranoia normal?

What are the causes of psychosis?

1. Drug induced psychosis: It has been classified in the International classification of diseases – 10 under the under the category of Psychotic Disorder due to Psychoactive Substance use F1x.5 (where “x” varies with type of substance). Psychosis may occur in intoxication phase, or in withdrawal phase.

The drugs that may lead to psychosis during acute intoxication are – cannabis, cocaine, LSD, methamphetamine, mescaline, psilocybin, ecstasy, MDMA etc. Withdrawal of certain substances such as alcohol, sedative and hypnotic drugs may also lead to symptoms of psychosis. It may also be seen as an adverse reaction to prescription drugs such as steroids and bupropion, ketamine, drugs used in parkinsonism, etc. If the individual is having pre-existing mental illness then there might be a worsening of symptoms after using these substances.

In order to distinguish drug-induced psychosis from schizophrenia experts observe a relation of substance with the symptoms, generally psychosis due to drug use occurs during or immediately after drug use or sudden increase in dose (usually within 48 hours). Similarly it should decrease with a decrease in dose and usually subside after stopping the drug sometimes up to a month of use. These symptoms reappear after reinitiating the substance.

2. Schizophrenia: Psychotic symptoms are at the core of schizophrenic illness. The distinguishing features of psychosis in a patient suffering from Schizophrenia are that they are chronic, longer lasting, stable (i.e. symptoms don’t change frequently). It may also be that they are more bizarre and associated with incongruent moods, and are more disabling than other type of psychosis. Thus, it is important to rule out other possibilities before making a diagnosis of Schizophrenia.

3. Mood disorders and Psychosis: Extreme mood states like severe depression and mania are also associated with psychotic symptoms. While few patients with other illnesses like Borderline personality disorder may experience short lasting elation or euphoria in which they may experience ill-formed psychotic symptoms. This may be different from psychotic symptoms experienced in Mania (drastic shift in mood to irritable or euphoric mood which is disabling) or Hypomania (a less drastic shift in mood to irritable or euphoric mood which is less disabling). The psychotic symptoms associated with mood symptoms usually develop after the onset of mood symptoms and in the context of mood state e.g. in a depressed individual there may be delusion that they are getting poor even when they have enough resources; on the contrary a manic individual may have a delusion that they are a billionaire and make plans accordingly opposite to contrary. Treating the underlying mood episode and short-term use of antipsychotics is helpful.

4. Schizoaffective disorder: these are the disorders where one sees a combination of psychotic symptoms as well as mood symptoms. The distinguishing feature of schizoaffective disorders from the above two categories is that the mood symptoms and the psychotic symptoms exist independent of each other if we look at the long-term pattern of the illness. And there are periods of overlap between them.

5. Medical disorders and Psychosis: Medical issues like stroke, dementia, chemical changes in body salt like sodium/ potassium etc. may give rise to psychotic symptoms. The underlying changes vary from disease to disease but overall it is seen that the improvement in the underlying condition also improves the psychotics symptoms. In case there are any residual symptoms or the underlying medical problem is less likely to improve then a trial of antipsychotics may be given.

6. Stress and psychosis: Psychosis may occur within the context of lack of sleep, stress, extreme trauma etc. which is sometimes referred to as “psychotic breakdown”. This type of psychosis is shorter, lasting typically less than a month and rarely up to three months. Apart from psychotic symptoms a mixture of other symptoms may be seen e.g. emotional turmoil, anxiety, mood swings, irritability etc. These symptoms fluctuate in severity and nature from time to time throughout the course. Many individuals may also have these symptoms even without a stressor. In either case treatment should be taken at the earliest and any progression of symptoms beyond three months should be taken seriously.

The unconscious origin of psychosis.

Is psychosis a genetic disorder?