The signs may be quite subtle at first. A friend or loved one may seem “off” recently, with an unkempt appearance that is not their norm at all. A coworker may have let their quality of work slip, becoming incrementally substandard over time. Maybe you are plagued with an unsettling sense that someone is watching you, or have become increasingly suspicious of others.
These early signs of a potential psychotic break from reality may not seem worrisome when seen in isolation, but when a cluster of unusual symptoms begin to gather steam it may indicate that you or someone you care about is experiencing the sense of losing touch with reality.
Psychosis—including such features as hallucinations and delusional thinking—is the symptom of an underlying mental health disorder, not an illness itself. According to the National Alliance on Mental Health, an estimated 100,000 Americans experience psychoses annually. Early intervention is key, so do not ignore the symptoms. These will center on difficulty recognizing what is real and tangible versus a figment of their imagination. Behaviors and thoughts will be unusual, not the norm for the afflicted person.
When you notice that you or a loved one seems to be losing touch with reality it is important to seek professional help. It may be that the symptoms are related to a physical or neurological condition that needs attention. If it is indeed the early signs of a psychotic disorder, receiving timely, proactive care is essential in containing the effects of the psychosis.
What are Psychotic Disorders?
Psychotic disorders represent the types of mental illnesses that feature around losing touch with reality symptoms. These disorders are characterized by odd behaviors, feelings, thoughts, and emotions, including seeing or hearing things that are not really there. When a mental health condition has psychosis as a primary symptom, it will be classified as a psychotic disorder.
According to an article published in JAMA Psychiatry, about 3.5% of the U.S. adult population will experience psychosis at some point. Psychotic features can be associated with severe anxiety, severe depression, and bipolar disorder, as well as identified as its own standalone mental health disorder.
The cause of psychotic disorders is still mainly unknown, although there are some theories exists to explain the cause. These include neurological malfunctioning, certain viral infections, extreme trauma or prolonged excessive stress, certain drugs of abuse, and genetics.
Treatment for this complex mental health disorder will rely on a comprehensive approach of multiple elements for the best recovery results. Generally, an individual with a psychotic disorder can learn to manage many of the symptoms associated with the disorder.
Different Types of Psychotic Disorders
Psychotic disorders emerge in varying ways and with differing features, while sharing core characteristics. The different types of psychotic disorders include:
- Schizophrenia. Schizophrenia is the most common type of psychotic disorder. Symptoms of a schizophrenic episode embody the sensation of losing touch with reality, with audible and/or visual hallucinations, delusional thoughts, angry, erratic behavior, and extreme moodiness. Schizophrenia is diagnosed when the behavioral changes and psychotic features persist for more than six months.
- Schizoaffective disorder. Schizoaffective disorder combines features of schizophrenia with a mood disorder involving depressive or manic episodes. This equates to someone with schizophrenia having extreme and unpredictable mood shifts between manic and depressive episodes, further complicating treatment protocol.
- Brief psychotic disorder. Brief psychotic disorder is a short-lived disorder that is sometimes triggered by a traumatic event, such as the death of a loved one, a natural disaster, or a serious accident that lasts less than a month. Brief psychotic disorder is characterized as a burst or short, sudden episode rather than a persistent state.
- Schizophreniform disorder. Schizophreniform is similar to schizophrenia but tends to affect young adults and teens, and lasts 1-6 months in duration. About one individual out of 1000 will develop this form of psychotic disorder. Schizophreniform occurs equally between men and women, but in men it may emerge at a younger age.
- Shared psychotic disorder. Shared psychotic disorder, or shared delusional disorder, is a rare form of psychosis that involves two people who both believe in a delusional situation, such as a husband and wife who both believe the same delusion. The two individuals will transfer the delusional beliefs back and forth to each other.
- Delusional disorder. Delusional disorder features false and often suspicious beliefs that the individual believes are true, such as thinking someone is out to murder you or your spouse is having an affair. The types of delusions involve real-life situations that could actually be true, with features of paranoia. Most delusional disorders last for one month or longer.
- Substance induced psychotic disorder. Substance-induced psychotic disorder is the presence of hallucinations or delusions occurring as a withdrawal symptom for several drugs, including alcohol, LSD, methamphetamine, cocaine, benzodiazepines, and PCP. The intense psychosis experienced during the withdrawal phase reflects the impact of these substances on the brain structures.
What Are the Symptoms of Psychosis?
Generally, psychosis comes on gradually, with signs that indicate a developing mental illness. Those might include inappropriate emotions, a decline in personal hygiene, difficulty thinking straight or concentrating, a decline in job or academic performance, emotional detachment or intense inappropriate emotions, isolating behaviors, and acting highly suspicious of others. These are psychotic features, early symptoms of a possibly emerging psychotic disorder.
The primary feature of psychosis is losing contact with reality. While the different types of psychotic disorders will have unique features, there are some general symptoms that can indicate the onset of a psychotic disorder. The common symptoms of psychotic disorder include:
- Insomnia. Individuals will have difficulty falling asleep or staying asleep.
- Persistent feelings of being watched. Individuals feel certain that they are being observed or followed.
- Increasingly disorganized thinking. Disorganized and disordered thought patterns increase in number and intensity.
- Mental confusion. Individuals may not recognize their surroundings or those around them, even if these are usually familiar to them.
- Auditory and visual hallucinations. Hallucinations involving things that are heard and things that are seen, but which in reality do not exist.
- Delusional thoughts. Delusional thoughts involve the false belief that certain events or objects have a grandiose quality, or some special personal meaning attributed only to them.
- Strange or disorganized speech or writing. Along with the mental confusion and disorganized thinking, the individual struggles to articulate their thoughts in spoken or written formats. They speech may come across as gibberish or nonsensical.
- Inappropriate behavior. The individual may lose the ability to control their behaviors to align with social norms, and begin to exhibit behaviors that are socially inappropriate, such as removing their clothing or urinating in public.
- Avoidance of social situations. When someone has a psychotic disorder they are unable to function appropriately at a social function or event. They may be ostracized or removed from an event, leading them to begin to avoid social situations altogether.
- Decline in academic or work performance. As the disorder worsens, there will be a marked decline in functioning at work or at school. The individual may be repeatedly absent, may be unable to keep up with projects or assignments, and may be terminated as a result.
- Unusual body positioning or movement. Unusual postures or uncontrollable muscle movements are sometimes caused by the medications the individual is one, or from an active psychotic episode when they are experiencing a break from reality. They may also exhibit spasms or pacing back and forth.
- Suspicious or paranoid behavior. The symptoms of paranoia or suspicion may be a response to perceived delusions, in which they feel they are being targeted for harm.
- Unusual preoccupation. The psychotic disorder may lead to a type of tunnel vision, where the individual becomes highly focused on or fearful about a particular person or situation.
- Irrational or angry behaviors. Angry outbursts or impulsive irrational behaviors are often a result of the person’s decreasing ability to communicate effectively.
- Inability to concentrate. Disordered and confused thinking contribute to an increasing inability to focus and concentrate.
- Loss of interest in appearance and hygiene. A common sign of severe mental illness is the loss of interest in maintaining personal hygiene habits. The person may become disheveled and do not bathe or practice dental hygiene, and may discontinue laundering their clothing.
- Personality changes. One of the first signs of psychotic disorder is a distinct change in personality. Someone who was formerly kind and caring may become distant, withdrawn, and cold. In some forms of psychosis, the individual may acquire more than one personality.
The earlier the emergence of losing touch with reality symptoms are recognized, and being proactive in getting the loved one professional help from a psychiatric practitioner, the better the clinical outcome.
Treatment for Psychotic Disorders
Generally, a residential setting provides a more intensive and tailored treatment approach in a setting that is safe and offers 24-hour monitoring and support. However, if the individual is displaying signs of a psychiatric break or has become a danger to themselves or others, they should be admitted to a psychiatric hospital for stabilization.
Treatment of psychotic disorders relies primarily on psychotherapy and psychotropic drug therapy will likely involve an integrated approach, including:
Psychotherapy: While in a residential treatment the individual will be involved in various types of psychotherapy. The focus for therapy involves helping the individual recognize irrational thoughts and behaviors and to replace those with healthy thought-behavior patterns. Individual therapy, group therapy, and family therapy are all provided in a residential program as part of the psychotherapy piece of treatment for psychosis.
The individual cognitive behavioral therapy sessions allow the therapist to help the individual identify irrational thoughts and fears and maladaptive emotional responses.
Group therapy: Group sessions provide opportunities for small groups to discuss and share their mental health issues while being facilitate by a therapist who guides the topics. These intimate group settings provide a safe environment for sharing and foster peer support in the process.
Psychosocial interventions: An important component of treatment is assisting the individual in improving their ability to get along with others. These interventions can offer new communication skills, conflict resolution techniques, and vocational rehabilitation.
Medication: Medication will be prescribed depending on the specific diagnosis. In many cases medication will include antipsychotics, benzodiazepines, antidepressants, and mood stabilizers. For some individuals with a psychotic disorder, these medications will necessary to help manage the disorder on a daily basis, and will likely be prescribed for a lifetime.
Adjunctive therapies: Electroconvulsive therapy (ECT) is reserved for the most severe forms of psychosis in individuals who are not responsive to the medications.
Holistic therapies: Increasingly, holistic therapies, most of which are derivative of Eastern practices, are utilized for the treatment of psychosis or other mental health disorders with psychotic features. Activities such as yoga, mindfulness training, guided meditation, acupuncture, and massage therapy are helpful in controlling stress and promoting relaxation. Patients can learn how to initiate mindfulness exercises on their own at any time of day, which is helpful when sudden symptoms emerge.
Transitional housing. In some instances, it may be beneficial for the individual to reside in a transitional housing environment following residential treatment. This type of housing provides a safe, supportive home environment that allows the patient to gradually readapt to regular daily life, while having the therapeutic support available at all times.
When Does a Psychotic Break Require Hospitalization?
When someone experiences a psychotic break, or the sense that they are no longer tracking with reality, it may be appropriate to consider hospitalization. This might be a psychiatric hospital or a psychiatric wing within a general hospital. This level of care is distinct from residential care, in that the hospital environment is equipped to manage a psychiatric emergency. In the hospital setting the individual will likely be segregated from other patients and may be need to be restrained to avoid the risk of self harm or harm to others.
In the hospital settling, the individual will receive very close observation. Medications will be reviewed and adjusted, and the emphasis will be on acute stabilization measures. This process of stabilizing the individual may take a couple of days, before they can step down to a residential mental health treatment center.
When Severe Depression Causes Psychosis
In some severe cases of depression, the emotional anguish may cause an individual to exhibit a break from reality with symptoms of hallucinations or delusions. The actual diagnosis may be coined depression with psychotic features or psychotic depression. In the case of depression that is so profound that it sparks feelings of losing touch with reality, there may be a co-occurring medical condition or substance use disorder that is contributing to the symptoms.
Psychotic depression features the following symptoms:
- Sleep disturbances
- Experiencing hallucinations, voices or visions, telling them they are worthless or evil
- Delusional thoughts
- Suicidal ideation
- Difficulty concentrating
- Falsely thinking they have another disease or illness
In the case of major depression with psychotic features the risk for suicide is heightened. Extra attention must be paid to identify the warning signs of suicide, such as the individual talking about taking his or her life, acquiring the means by which to commit the act of suicide, giving away their prized possessions, commenting that they are a burden to loved ones, isolating behaviors, or increased substance abuse.
When Severe Anxiety Causes Psychosis
Can severe anxiety cause psychosis? Research suggests that symptoms of psychosis may be preceded by an extreme even, such as a panic attack or trauma. The intense emotional distress suffered as a result of anxiety can trigger psychotic symptoms. According to a study published in the Journal of Clinical Psychiatry, anxiety disorders, such as panic disorder, OCD, or PTSD can result in psychotic symptomology. These symptoms resolved with treatment involving both benzodiazepines and antidepressants.
When this condition occurs it may be referred to as a psychotic break or a nervous breakdown. The symptoms are clearly related to the anxiety disorder, rather than a psychotic disorder such as schizophrenia. Stabilizing the individual should be the first step in care, followed by enhanced treatment for the core anxiety disorder.
Co-Occurring Psychotic Disorder and Substance Abuse
There is still not a coherent causal relationship between psychotic disorder and co-occurring substance use disorder. However, there is a high prevalence of these two disorders coexisting. Whether the substance abuse is in response to the unsettling effects of a severe mental health disorder or if the symptoms of psychosis are drug-induced are two valid examples of how the psychotic disorder and substance use disorder become intertwined.
In addition, the treatment picture can become muddied when the patient is using drugs or alcohol. According the authors of a study on this type of dual diagnosis, entitled Substance abuse and schizophrenia: Pharmacotherapeutic intervention [Green, M.D. et.al.], “The typical antipsychotic medications are effective for the treatment of psychosis but may have only limited efficacy in patients with these co-occurring disorders because patients continue to use substances while taking them.” The study examines the benefits of MAT for co-occurring alcoholism in this population, showing that naltrexone has shown positive benefits in an integrated treatment plan.
When treating an individual for dual diagnosis, success is dependent on the individual receiving individual psychotherapy to address the thought patterns and self-talk that may perpetuate the cycle of substance abuse. A comprehensive rehabilitation program will provide specialized dual diagnosis programming that includes both one-on-one psychotherapy, peer-based therapy, 12-step programming, and continuing care services.
Elevation Behavioral Health Leading Residential Mental Health Center in Los Angeles
Elevation Behavioral Health is a luxury residential mental health program featuring an intimate, home-like environment. Elevation Behavioral treats all forms of mental health disorders, including psychotic disorders, using a proven integrated approach. If you are feeling you’re out of touch with reality, contact our compassionate team at Elevation Behavioral today at (888) 561-0868.