Over the edge: Psychotic disorders take many forms

Reality checks are important for all of us— some more than others. Joan Rivers gives Hollywood fashionistas a run for their money, such as her criticisms of Cate Blanchett’s Givenchy dress at the Oscars. Some critics said it was “high fashion,” but Joan gave these dreamers a reality check. She said the dress looked like it had a bad staph infection, so everyone who hugged Cate had to take antibiotics. Amen, Joan!

What happens when our minds go over the edge?

Psychosis occurs in about 3-5 percent of the population.  It means losing touch with reality. A psychotic person might think we live on Venus, while a neurotic person knows we live on Earth– but can’t accept it. 

Psychosis means a person has a twisted view of reality, such as delusions, hallucinations, or disorganized thoughts. Since the world can seem upside down, a psychotic person can become very agitated— restless and possibly violent. These erratic behaviors can cause all sorts of harm— both self-inflicted and to others.

Hallucination means sensing something that's not there. It's not ESP, like believing a ghost is around– it's hearing voices that aren’t there (as in schizophrenia) or seeing bugs swarming across the floor (as in alcohol withdrawal).

Delusions are pretty easy to explain since so many people are delusional. Think how many folks believe they're going to patent the next best thing or, like Joaquin Phoenix, think they're going to become a rapper. 

Sure, I understand having a dream: I still dream of a starring role in a Broadway musical. But I don’t have a false belief about it. (How many Asian male stars are there? Even in the 1996 Broadway revival of The King and I, the cast had fewer Asian actors than a Chinese restaurant.) 

“Ideas of reference“ refers to the false belief that remarks, news items, lyrics, etc. are meant specifically for the sufferer of the psychosis. Murderers who go on killing sprees sometimes believe that music or the media is telling them to do it. Ideas of reference isn’t about being influenced by media; it's a false belief it's actually telling them what to do.

Thought disorganization occurs when random thoughts lead to bizarre behavior. The person can seem sane, but then suddenly do something irrational (although not necessarily aggressive).

Folks around an acutely psychotic person often run for the hills because the psychotic one is revved up from anxiety and ready to explode emotionally. Psychotic persons sometimes know they're going mad and are thus understandably highly agitated. 

Psychosis occurs in mental illness such as schizophrenia, schizoaffective disorder (kind of like a “mini” schizophrenia), and bipolar disorder. The mania of bipolar disorder can lead to delusions of grandeur (like “I’m going to write the next best-seller and paint the neighborhood all the same color"). On the flip side, severe depression can cause psychosis.

Drugs and alcohol, especially during withdrawal, can make a person psychotic. Extreme stress, such as an airplane crash or a breakup, can lead to a brief psychotic episode. Folks with a borderline personality disorder or histrionic personality disorder are more prone to a psychotic break.

Commonly, Alzheimer’s Disease can lead to visual hallucinations and delusions, especially at night (this is called sundowning). It can be difficult to control agitated behavior when the psychosis hits.

Antipsychotic medications to mood stabilizers can be very effective. Lifestyle changes and emotional support, such as from a psychologist, can also be of great use to give the person a good reality check.
Dr. Hook cracks a joke or two, but he's a renowned physician with an interesting website, drjohnhong.com. Email him with your questions.