May 26, 2020 By Julie Rael, LCSW, CCO Valley Behavioral Health This blog concludes the May Mental Health Awareness blog series. During the past four weeks this blog series has explored grief and loss, mood disorders, and anxiety. This last week we are exploring psychosis and what the associated symptoms look like for individuals experiencing a psychotic disorder. The word “psychotic” has been used inappropriately in non-clinical settings, as well as in a derogatory manner when describing someone. This language is not only inaccurate and harmful, but it also continues to stigmatize the most vulnerable people who struggle with psychotic symptoms. This stigma can change the way others view or accept someone with psychosis, but also had that person views and accepts themselves. I have met individuals with this disorder that express that they delayed seeking treatment as they did not want to be judged or treated differently by others. The word psychosis in clinical terms means that the individual has experienced a state of mind where their thoughts and perceptions impacted their experience with reality. I also what to clarify common misconceptions about mental health and psychotic disorders that the media and Hollywood often portray these individuals as violent and dangerous. I have yet to watch a film that portrays mental health disorders in an accurate manner. During my last fifteen years in the mental health field, I have personally met and interacted with numerous individuals with a psychotic disorder who have never become violent or aggressive towards anyone. The heart of the matter is that most of the information that is out there is inaccurate and harmful, and if we continue to communicate reliable information and provide education around mental health issues, while also dismissing the inaccurate, the general public will no longer fear what they have yet to learn. Psychotic disorders are categorized and diagnosed with the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013). These categories include descriptions, symptoms, and the necessary criteria for a psychotic disorder. Psychotic disorders include Schizophrenia, Schizoaffective Disorder, and Delusional Disorder. The five main symptoms of a psychotic disorder include seeing things that are not real (visual hallucinations), hearing voices that are not real (auditory hallucinations), believing things that are not true or irrational according to one’s culture (delusions), disorganized speech, disorganized behavior or catatonia and negative symptoms. The negative symptoms include blunted affect, apathy, reduction in words spoken, reduction in goal-directed activity, lack of social drive, and reduction of inability to experience pleasure. At Valley Behavioral Health, we provide treatment for the disorders described above with evidenced-based interventions that include medication and cognitive-behavioral therapy. The medication prescribed for Schizophrenia is recommended as a long-term treatment and in most cases for the remaining of the person’s lifetime, as these medications are the first line of defense in preventing further psychotic episodes. At Valley, we also utilize case management, peer support services, family therapy, and psychoeducation to help the patient’s family learn more about their loved one’s diagnosis so that they can know what to expect in their recovery process and know what they can do to help them in being successful in treatment. Early treatment immediately after the first psychotic episode and a comprehensive treatment plan including the interventions above are essential to prevent further psychotic episodes and the cognitive decline associated with these episodes. Schizophrenia and the other psychotic disorders don’t always originate from one source, but the result of various factors including genetics, environmental, psychological trauma, and changes in one’s brain chemistry. Psychosis can also occur outside of a mental health disorder from physical injury, substance use, or medical illness. Psychotic symptoms outside of a mental health disorder are referred to as secondary psychotic symptoms. Secondary psychotic symptoms are due to changes in brain function due to a toxic substance, alcohol, or other illicit substance during intoxication or withdrawal as well as the result of medical conditions that affect nervous system functions. According to the World Psychiatric Association, the following substances can lead to psychosis, “PCP, MDMA, LSD, cannabis, alcohol Lead, mercury or arsenic poisoning” and the following medical conditions can present risk factors for secondary symptoms of psychosis, “traumatic brain injury, autoimmune disorders, Cytogenetic/congenital disorders, Iatrogenic disorders, Cerebrovascular disorders, Cerebral tumors, Metabolic disorders, Dietary disorders or vitamin deficiencies, Sepsis/infectious disorders, degenerative/demyelinating disorders, Seizure disorders, and endocrine disorders”. Research continues to look at the causes of psychosis and improve the treatments available. I am optimistic that our society will continue to learn more about mental health disorders, discontinue the use of stigmatizing language, and treat those with mental health concerns with understanding and kindness. In the same vein, I hope more individuals will learn to recognize and acknowledge their own mental health concerns, treat themselves with the same kindness, and no longer delay reaching out for help. I know that if we continue to progress as a society in how we view and treat those with mental health difficulties the better and more available help will become. I also hope for a continued increase in funding to further expand the services available, as well as see an increase in support and more allies join the cause. I often think about what our community would look like if our agency and our community partners were not around, and I quickly shift my focus to one of gratitude for the services and the providers contributing to the cause. If you or a loved one is experiencing symptoms discussed in this blog, please don’t hesitate in reaching out to us at Valley Behavioral Health to start services. In the meantime, it can help to obtain a physical from a primary care physician and request further testing if there is a history of physical injuries and medical conditions. It is also recommended that the use of alcohol and illicit substances is discontinued to provide good treatment results. We look forward to hearing from you and helping you navigate your recovery process. References American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. Keshavan, M. S, & Kaneko.Y. (2013 Feb; 12). World Psychiatry (1): 4–15. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3619167/.