Psychotic Episode: What is it, causes, awareness and more

A psychotic episode is an incident in which reality judgment is severely affected. It not only appears in the course of a serious illness, such as schizophrenia but also as a consequence of emotional episodes that surpass us. Discover how to detect if we are facing a psychotic episode and how to act in this article.

 What is a psychotic episode?

Persons suffering from psychosis are unable to distinguish the subjective personal experience of reality from the outside world. Let’s say it’s a loss of contact with reality.

They experience hallucinations and/or delusional ideas that they believe are real. They may behave and communicate inappropriately or incoherently. Psychosis or a psychotic episode may appear as a symptom of a large number of mental disorders, such as mood and personality disorder. It is also a defining criterion of schizophrenia.

Psychotic episode
What is a Psychotic Episode?

What are the causes of a psychotic episode?

There is no single factor for a psychotic episode to take place. It can occur due to biological and/or psychosocial factors.

  • Biological factors: such as genetic abnormalities, brain damage from substance abuse, such as marijuana use. Psychosocial factors, for
  • Psychosocial factors, for example, migration. It is believed that the stress of moving to a different country influences the susceptibility to psychotic disorders. The need to adjust to a different rhythm of life and social inequalities provoke stress. If it is not handled well it can lead to all kinds of pathologies.

Symptoms of a psychotic episode

Psychosis is characterized by the following symptoms.

  • Delusions are thoughts about situations or facts that the person perceives as real but are clearly false.
  • Hallucinations: consists of seeing, hearing, smelling, tasting or feeling things that are not there. The most typical are the auditory kind, and less frequent, the visual kind. In some cases, hallucinations may involve several senses.
  • Disorganized thinking and discourse: psychotic people, especially those with schizophrenia, often present incoherent and meaningless speech. They tend to jump from one subject to another without any relation between them. Their thinking is incoherent.
  • Disorganized or catatonic behavior: catatonic patients react inappropriately to their environment. This way of relating can be, either staying rigid and immovable or with excessive motor activity. This behavior is often inappropriate or unpredictable.
  • Low motivation and apathy. Some patients may feel apathetic and remain in a lethargic state.

In what disorders does psychotic episode appear?

Outbreaks or psychotic episodes may occur in the following disorders: Brief psychotic disorder Schizophreniform Disorder, Schizophrenia, Schizoaffective Disorder Delirious disorder Psychotic disorder due to a medical condition Substance-induced or drug-induced psychotic disorder Bipolar disorder

  • Brief Psychotic Disorder
  • Schizophreniform Disorder
  • Schizophrenia
  • Schizoaffective Disorder 
  • Delirious Disorder
  • Psychotic Disorder due to a medical condition
  • Substance-induced or drug-induced psychotic disorder
  • Bipolar disorder

1. Schizophrenia, schizophreniform disorder, schizoaffective disorder and psychotic episodes

All of these disorders are similar to schizophrenia and are often long-lasting disorders that severely affect the daily lives of those who have them. The signs of these disorders are very diverse, which is why they are considered spectrum disorders of schizophrenia. However, they have common characteristics. In a psychotic episode, there can be delusions, hallucinations, loss of motivation, interest and social skills, an absence of emotional expression, motor disorders such as hyperactivity, aggressiveness or immobility.

Schizoaffective disorder shares schizophrenia and bipolar characteristics. Discover here how to reduce schizophrenia symptoms.

Causes: It is believed that in these disorders the cause is related to certain abnormalities in the chemical structure of the brain and related to genetics. However, the course and severity of these disorders depend heavily on psychosocial factors, such as stress and lack of family support.

2. Delusional disorder and psychotic episodes

Delusional ideas are the main characteristic of this disorder and in many cases the only one. It is usually based on a single delusional idea, resistant to any logical argument. It is therefore very difficult to convince them that they need psychological treatment.

Causes: The exact causes of this disorder are not consensual, but it may have a hereditary component. It also has to do with neurological abnormalities and changes in brain chemistry. Some studies point to abnormalities in the limbic system of the brain, an area related to regulation and emotional expression.

It is more likely to be found in isolated individuals, people with language difficulties or cultural differences.

3. Brief psychotic episode disorder

Trauma and stress can cause short-term (less than one month) psychotic episodes. Events that involve a life change such as the death of a family member or a natural disaster may favor the onset of these disorders in patients who don’t have a history of mental disorders.

4. Psychotic episode or disorder due to a medical condition

Sometimes the psychotic episode can be detonated by an organic cause, such as neurological conditions (epilepsy or cerebrovascular disorders), metabolic or endocrine problems, renal failure, electrolyte imbalance or autoimmune disorders.

5. Substance-induced psychotic disorder

It is known that psychosis can be a side effect of the use and abuse of certain drugs, such as hallucinogens, amphetamines, cocaine, marijuana and even alcohol. Some medications, such as steroids, chemotherapy drugs, drugs for Parkinson’s disorder, can induce psychotic symptoms, as well as, toxic substances such as carbon monoxide.

6. Shared psychotic episode or disorder

The known psychotic disorder is a rather uncommon delusional disorder. It involves two or more people with strong emotional ties. In Western countries, it usually involves two brothers or husband and wife. While in Japan it usually involves a parent and his son or daughter. It may also involve the entire nuclear family.

7. Bipolar disorder and psychotic episode

People with bipolar disorder usually move between two cyclic phases, the manic phase (characterized by a great euphoria) and the depressive phase (characterized by negative feelings of uselessness, hopelessness, sadness). Psychotic symptoms may appear in both phases of the disorder. Women with bipolar disorder may also present the so-called postpartum psychosis, a poorly understood and poorly treated mental condition that may endanger the mother-child bond.

How to detect a psychotic episode in adolescents?

It is estimated that 3% of people experience psychosis at least once in their lifetime. If the episode happens during adolescence, it can be difficult for parents, caregivers, and teachers to detect it. Adolescence is a time of emotional ups and downs. Adolescents are generally expected to have some erratic, strange, and senseless behavior. However, certain signs may indicate that there is a psychotic episode or mental health problem:

  • Sudden and unexplained academic problems
  • Suspects towards others without logical reasons
  • A decline in personal hygiene
  • Lack of feelings of emotional expression
  • Intense and sudden emotional explosions for no apparent reason
  • Listen to voices that are not there or think that noises are really voices
  • Sudden obsession with new ideas

Some of these isolated signs are nothing to worry about. However, if there are several it is a possible indicator of mental health problems and you have to contact a professional as soon as possible.

Psychologist or psychiatrist? Which one do we go to? Check it out here.

Can a psychotic episode be prevented?

A research group from the University of Adelaide in Australia have created a new way of predicting the risk of a psychotic episode with 70% accuracy. This new model combines medical history, the latest clinical headline assessment, and fatty acid biomarkers to determine a patient’s risk of experiencing a psychotic episode.

According to the researchers, fatty acids (such as omega-3s and nerve acids) are essential for the normal functioning of the brain. In addition, low levels of these substances have been associated with an increased risk of developing psychosis in high-risk groups.

According to another study, prevention can be done by evaluating three markers or “biotypes”. One related to visual attention and with another brain noise (random brain activity with no purpose or no function)

How to treat a psychotic episode?

Treatments for psychosis are usually a combination of:

  • Antipsychotic medication, which usually alleviates psychosis symptoms, mostly act very effectively against delusions and hallucinations.
  • Psychological therapies, such as individual cognitive behavioral therapies, have been shown to be effective in patients with schizophrenia. In some cases, family therapy may also be useful since it can be effective in reducing the need for hospital treatment and reducing relapse.
  • Social support, they need support for education, employment, and housing, and having a support network of family and friends is essential in improving the prognosis of any type of mental disorder.

Depending on which disorder we are talking about, the prognosis will be better or worse. For example, patients with brief psychotic episodes usually recover in a short time. However, patients with severe schizophrenia and recurrent psychotic episodes have a much worse prognosis. Therefore, an early diagnosis is essential to improve the evolution and recovery of these people.

What if a family member is going through a psychotic episode?

With all this information it will be easier to detect a psychotic episode. But now the question is what do I do if a close friend or relative is going through one? How can I help you?

Depending on the severity of the disorder, the person may not be able to carry out a coherent conversation. And if there are delusions or hallucinations, it is very likely that he does not recognize that what he is saying and thinking is not true. Therefore, in these severe cases, it is better not to discuss and seek professional help immediately. Especially if there is a risk of harm to someone or himself.

If the contact with reality is not so damaged and the person is able to maintain a more or less logical speech, we can try to redirect their thoughts into a calm discussion. It is very important not to confront them directly, but to offer our opinion lightly. Telling them that they are wrong can strengthen delusions, as well as just going with the flow. Therefore, we have to find a middle ground to communicate without it upsetting them.

Be aware to not make them feel ashamed about their mental disorder and understand that psychotic episodes happen always because of a reason (lack of sleep, abrupt change in emotions, mistrust, etc.)

 During a crisis, the person is stressed and very scared. Voices or hallucinations can become terrible and may even drive you to act accordingly, hurting themselves or others.

What do we do?

  • Don’t argue or confront their delusions or hallucinations.
  • If there is a moment of lucidity, try to give your opinion subtly.
  • Don’t scream or threaten them.
Psychotic episode
Helping someone with a Psychotic Episode
  • Keep calm.
  • Don’t criticize or scold them
  • Avoid direct and continuous eye contact with this person.
  • Avoid touching them as well, this may upset them more.
  • If they ask you for something, as long as it is not dangerous, give it to them.
  • If you think it necessary, remove any dangerous or potentially dangerous objects (sharp objects, glass, cutlery, etc.)
  • Avoid ultimatums to force them into hospitalization.
  • Empathize, try to understand the situation and show them by saying “I can imagine how bad you are feeling… this must be very difficult”. 
  • It is important that you don’t take anything personally during an episode.
  • If the psychotic episode is acute and there is a high risk of injury, it’s important that you call 911 for the person’s safety. However, don’t try to force anyone to get help or judge them. 
  • Hope you found this article helpful. Feel free to leave a message below.

    This article is originally in Spanish written by Andrea García Cerdán, translated by Alejandra Salazar.

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