What is it about ?
Acute psychosis is a mental state in which a person completely or partially loses normal contact with reality. The symptoms can be diverse and varied. The adjective “acute” means that the symptoms appear suddenly.
A psychosis may only occur once, but it can also be repeated.
Sometimes it is part of schizophrenia. It is a disease that usually begins at a young age.
The risk factors that can trigger the onset of a psychotic state are very diverse:
- Certain diseases such as brain tumor or epilepsy which can interfere with the functioning of the brain so much that a psychotic state occurs;
- Psychiatric pictures (such as depression, bipolar disorder, mania …) can also lead to psychosis;
- People with certain psychiatric disorders, such as schizophrenia, go through psychotic episodes repeatedly and / or for a long time;
- Taking certain substances (cannabis, LSD, etc.) or certain drugs can also cause a psychotic crisis;
- Excessive fatigue or stress can lead to psychosis in people who are predisposed to it.
The main ones psychotic symptoms can occur individually or simultaneously.
Delusions
The delusions are stubborn thoughts or ideas, about yourself or those around you, which do not correspond to reality. The person with psychosis does not question these delusions; she is not able to tell the difference between what is real and what is not. There are different types of delusions, such as:
- The delusion of persecution, when the person thinks he is being followed constantly or being the object of a conspiracy;
- Delirium of grandeur (or delusional megalomania), when the person thinks they are an important religious figure (Christ, for example) or a famous person (Napoleon, for example).
Hallucinations
The person can also perceive (hear, see, smell, feel …) things that are not there. This is what we call hallucinations. The most common auditory hallucinations (the person hears voices) and visual (the person sees imaginary people).
Confusion
A third characteristic symptom of psychosis is the confusion : the person is not able to hold a coherent speech or suddenly forgets what he was doing.
What is its frequency?
Acute psychosis affects up to 1 in 100 older people. Among people with dementia, 1 in 3 to 1 in 2 have psychotic symptoms.
How to recognize it?
The person with psychosis has no hold on reality. She experiences reality as strange, sometimes overwhelming and frightening. Indeed, it is difficult to distinguish between what is real and what only she can see. It is the consequence of a disturbance of the functioning of the brain at the time of a psychosis.
With psychosis, both positive and negative symptoms are possible. Sometimes people with psychosis have experiences and notice strange things (positive symptoms). They then suffer from hallucinations and delusions, or are confused. They can also have less energy, be passive (negative symptoms).
In schizophrenia, psychotic symptoms are long lasting. They are mainly characterized by delusions and auditory hallucinations.
In depression with psychotic characteristics, unrealistic thoughts and feelings of guilt are typical.
In mania with psychotic features, the person is often irritable or exhibits agitated behavior.
Dementia with psychotic features often gives rise to delusions (theft) and visual hallucinations. The symptoms are then generally transient.
How is the diagnosis made?
It is important that the doctor can assess the situation objectively. He will listen to the story of the person and his entourage. Environmental factors can also be the starting point for a future management strategy. For example, is help necessary, or is there a need for a safe place to live?
The doctor will also perform a clinical examination of the psychotic person and check whether the psychotic state is due to the use of drugs or substances. Based on all this information, the doctor will assess the severity and possible physical causes that will determine the management strategy.
What can you do ?
If you think you recognize any psychotic features, it is important to talk to a doctor. In people who have had psychosis in the past, it is best to watch out for symptoms that may indicate a relapse.
It is essential to follow the prescribed treatments and to take the medications correctly.
What can the doctor do?
In an acute situation (when the person represents a danger to himself or to those around him), the doctor may decide to hospitalize quickly. This is also the case when the psychosis is caused by an illness requiring urgent treatment.
In the long term, good supervision is important to reduce mental suffering as much as possible. Doctors and caregivers who accompany people during a psychotic phase do so with the necessary respect in order to create a relationship of trust. It can also be done at home with the participation of the doctor, nurses and home help. However, partial or full admission to a nursing home or psychiatric facility may be indicated. Often the doctor will also support the family. Because, to avoid relapses, it is important that the treatment is followed completely.
Drug treatment varies from person to person and depends on what other illnesses the person may have as well as the medications they are taking. The drugs of first choice are usually antipsychotics (risperidone, quetiapine, olanzapine and haloperidol).
For older people, the dose is usually much lower than for younger people. The doctor will regularly assess whether the drugs should be continued.
Want to know more?
- Risperidone – CBIP – Belgian Center for Pharmacotherapeutic Information
- Quetiapine – CBIP – Belgian Center for Pharmacotherapeutic Information
- Olanzapine – CBIP – Belgian Center for Pharmacotherapeutic Information
- Haloperidol – CBIP – Belgian Center for Pharmacotherapeutic Information
Source
Foreign clinical practice guide ‘Psychosis of the elderly’ (2000), updated on 03.08.2017 and adapted to the Belgian context on 18.06.2019 – ebpracticenet