Definition

Psychotic disorders are a group of serious mental disorders that affect a person's thinking. This disorder causes patients to have abnormal thoughts and perceptions. Individuals with psychotic disorders have difficulty thinking clearly, making the right decisions, responding emotionally, communicating effectively, assessing reality, and behaving appropriately.

When a psychotic episode is occurring, individuals can be disconnected from reality so they cannot differentiate between what is real and what is not real and are often unable to carry out daily life.

Approximately 1% of the population suffers from psychotic disorders, the most common age being late adolescence to early third decade of life.

Causes

The mechanism underlying psychotic disorders is hyperactivity (excessive activity) of the chemical substance in the brain, namely glutamate, in several specific parts of the brain. As a result, problems occur in thought processes, perception and motivation.

Psychotic episodes can also be caused by an underlying medical condition, for example:

• Use of alcohol or certain drugs
• Brain tumor
• Brain infection
• Strokes
• Dementia (decline in memory and thinking skills)

Risk Factor

There are several factors that can increase the occurrence of psychotic disorders, namely:

• The presence of other mental disorders, often bipolar disorder. Some individuals with bipolar disorder also experience psychotic symptoms
• Presence of genetic susceptibility or family history of psychotic disorders
• History of fetal or childhood brain injury
• There are big changes in life

Symptoms

The main symptoms of psychosis are delusions, hallucinations, and disturbed thinking.

• Delusions: false beliefs about something even though it has been shown or proven that it is wrong. Examples include believing that someone is planning to harm you, or believing that someone talking on TV is sending you a secret message, or believing that your food has been poisoned even though this has been proven untrue. One of the types is delusion of grandeur, which occurs when someone believes that their life is more special than reality, for example the belief that they are God. Another example is delusion of persecution where a person believes that other people are conspiring to harm, punish, or injure him.
• Hallucinations: false internal sensory perceptions, for example hearing, seeing, tasting, and smelling things that are not actually there. For example, a person can see things that are not there, hear sounds, smell smells, taste something strange in their mouth, or feel strange sensations on their skin even though no one is touching them.

Even though these hallucinations and delusions seem strange to other people, to people with psychosis they feel very real.

Other symptoms that are also frequently encountered are:

• Disorganized conversation
• Incoherent (illogical) speech
• Confused thinking
• Strange behavior, sometimes it can be dangerous
• Slow or strange body movements
• Neglecting self-care
• Loss of interest in activities
• Problems at school or work, as well as in relationships with other people
• Cold and indifferent attitude
• Unable to express emotions
• Mood swings or other mood symptoms such as depression or mania

People with psychotic disorders can have varying symptoms and these symptoms can change over time.

Diagnosis

If someone experiences symptoms of a psychotic disorder, the doctor will check the medical history and perform a physical examination to rule out medical conditions that could cause this disorder.

After that, the doctor will determine the type of psychotic disorder being experienced. There are several types of psychotic disorders, including:

• Schizophrenia: is the most common type. Individuals with this disorder experience changes in behavior, delusions and hallucinations that last more than six months. Usually this condition will cause a decline in social function, learning and work.
• Schizoaffective disorder: characterized by symptoms of schizophrenia and mood disorders such as depression, mania, or bipolar disorder.
• Schizophreniform disorder: symptoms of schizophrenia that have lasted for one to six months so that they cannot be diagnosed as schizophrenia.
• Brief/acute psychotic disorder: brief and sudden psychotic behavior. This is usually a response to a difficult situation such as the death of someone close to you and usually lasts less than one month. Healing usually takes place quickly and in most cases can heal in less than one month.
• Delusional disorder: the individual has persistent and false beliefs about a situation that could have happened, but in fact did not happen. An example is believing that he is sick or that someone else wants to harm him. This disorder is diagnosed if it has lasted more than one month.
• Shared psychotic disorder or folie à deux: occurs when someone in a group adopts or experiences the same delusions as other people in the group.
• Drug-induced psychotic disorders: usually caused by substance abuse or withdrawal states such as hallucinogens and cocaine which can cause hallucinations, delusions and slurred speech.
• Psychotic disorders due to other medical conditions: symptoms of hallucinations, delusions, etc. caused by diseases that affect brain function, such as brain tumors or head injuries.
• Paraphrenia: this condition has symptoms similar to schizophrenia, but occurs in elderly people.

Management

Management of psychotic disorders depends on the cause. The existing treatment options are drugs to control symptoms and psychotherapy. Severe psychosis in general can also be treated well.

• Psychotherapy: includes individual sessions, family and group support
• Medication: the main drugs used to treat psychotic disorders are antipsychotic drugs. Although it is not a cure, it can control the most disturbing symptoms such as hallucinations, delusions and thinking problems. Examples of antipsychotic drugs are haloperidol, chlorpromazine, risperidone, aripripazole, clozapine, olanzapine, quetiapine, and others. The number of drugs or combination of drugs used will be determined by the doctor, depending on the severity and side effects of each individual.

In severe and serious cases where a person can endanger the safety of themselves and others, then hospitalization is the best option.

A person's response to therapy can vary. Some people show a rapid response to therapy, while some take weeks or even months for symptoms to disappear. People who have experienced several severe psychotic episodes may need lifelong medication.

With appropriate therapy, many people with psychotic disorders can lead productive lives and return to normal functioning.

Complications

Psychotic disorders that are not treated appropriately will cause a decline in social, learning and work functions so that they cannot live their daily lives.

Some people cannot completely recover from psychotic disorders and will need lifelong therapy, especially people who were diagnosed with psychosis at a very young age, have a family history of psychotic disorders, and do not have a good support system.

Prevention

Psychotic disorders cannot be prevented, but their bad effects can be controlled and prevented with therapy as early as possible. For people at high risk of developing psychotic disorders, such as brain injury, it can be prevented by always using safety (helmet) when driving. For toddlers, do not shake the baby's head while playing to prevent brain injury. Avoiding drugs such as marijuana and alcohol can help prevent or slow the onset of this disorder.

When to See a Doctor?

If you or someone close to you shows psychotic symptoms, you should consult a doctor as early as possible to get therapy quickly and appropriately. Early treatment can improve the patient's quality of life and prevent serious complications.

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