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Your Mental Health

Psychosis

When we see news stories involving very bizarre or inexplicable behaviour, it is common to pause and think, “that person is psychotic.” I hear this comment frequently from people when talking about strange or unsettling behaviour.

The statement may indeed be correct, but there are a lot of misconceptions out there about what constitutes psychosis and what it means for someone to be psychotic.

Psychosis is actually a symptom rather than an illness in itself. Psychotic episodes are experienced in several psychiatric disorders as well as some general medical conditions and as a result of substance use.

So what does psychosis entail? It is derived from the Greek words “psyche” for mind and “osis” for abnormal condition – and that is truly what it is - an abnormal condition of the mind. It is used in connection with a disconnection with reality as with hallucinations and delusions. When people are hearing or seeing things that others around them cannot hear or see we say they are hallucinating and are psychotic.

Hallucinations involve perceiving things that are not there or are unreal. Hearing voices is one of the more commonly portrayed types of hallucinations, especially in schizophrenia. There are also olfactory hallucinations when a person smells something that is not there or tactile hallucinations when someone, feels something that is not there such as insects or parasites crawling in their skin.

Delusions are fixed beliefs that are out of keeping with those in one’s social circle. Paranoid delusions are among the most common. These may involve the belief that that another person or organization is conspiring against one.

As mentioned above, psychosis can occur as a symptom in schizophrenia. It can also occur in bipolar disorder, severe depression, post partum depression, Alzheimer’s disease, Parkinson’s, multiple sclerosis and some other medical conditions. Some prescription medications can also cause psychotic side effects and psychotic symptoms can also occur from the use of street drugs.

Psychosis is more common than you might think – affecting more than one in every 100 people. A psychotic episode can occur only once in a person’s life or as a recurring symptom.

Since psychosis is by definition an abnormal brain state involving a disconnection with reality, they can be dangerous. People sometimes act on their false beliefs and/or perceptions to the detriment of themselves and those around them.

Treatment for psychosis depends to some degree on what is causing the symptom. Often, hospital admission is necessary in the midst of a psychotic episode for the safety of the patient and others. There are a number of antipsychotic medications such as quetiapine, risperidone, olanzapine, and aripiprazole to name a few. These will provide symptomatic relief in most situations.

Psychosis is a serious symptom and a physician should always be consulted as quickly as possible if the cause and appropriate treatment are unknown.



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Schizophrenia medication

Schizophrenia is a very serious and disabling mental illness. Troubling symptoms including hallmark psychotic hallucinations and delusions tend to develop in the prime of life and can lead to detachment from reality and a near total loss of ability to function in society.

With appropriate treatment, symptoms can be managed and some degree of function restored for many patients with this condition.

Unfortunately, if prescribed treatment plans are not carefully followed or are discontinued, problems can arise. This is not an uncommon issue. For many reasons, close to 50 percent of people discontinue or fail to regularly take a prescribed anti-psychotic medication within the first year of treatment.

Sometimes, as symptoms subside with a new treatment, the patient no longer feels as though medication is needed and so discontinues or becomes irregular with it. Others may discontinue because of unpleasant side effects or if the treatment is not working as well as hoped. Unstable life situations can also play a role in irregular medication usage.

While psychiatrists have long advocated the importance of sticking to a treatment plan when it comes to serious conditions such as schizophrenia, a new study published in the American Journal of Psychiatry has shown just how important it is.

Researchers from UCLA followed outpatients taking oral anti-psychotic medications and examined their adherence to prescribed treatments as well as effects for those who chose not to reliably follow their treatment plan.

After 18 months, results showed even short periods of irregular medication use can lead to relapse of psychotic symptoms and a need for hospitalization.

Although not totally unexpected, the researchers were surprised to learn that irregular medication use even for brief periods is associated with a significant risk of relapse.

Within the study: 32 percent took their medication as prescribed; 33 percent had mild non-adherence (meaning they took only 50-75 percent of meds over a two week period); 16 percent had moderate non-adherence (taking less than 50 percent of meds during a two to four week period); and 19 percent had severe non-adherence (taking less than 50 percent of meds for more than four consecutive weeks or dropping out of treatment).

Any irregular treatment compliance – even mild – was associated with a risk of relapse. Typically, symptoms would begin to show up within a couple of months of irregularity in medication usage.

Although it’s not clear why even mild issues with medication compliance are dangerous, researchers suggest it may be due in part to the current practice of prescribing the lowest amount of medication that will improve symptoms while minimizing side effects – leaving very little room for missed doses.

Whatever the reason, this study highlights the importance of sticking to a course of treatment and working closely with a professional when managing a serious mental illness such as schizophrenia. When it comes to psychotic symptoms, a relapse is not only unpleasant, but it can also be quite dangerous.



Obesity and mental illness

We’re all aware of the rising epidemic of obesity in North America. A quarter of all Canadian adults are clinically obese as well as one in 10 Canadian children and many more are overweight.

We know obesity is associated with all sorts of health problems and can even lead to premature death – yet in spite of all of this awareness and myriad of public health initiatives aimed at preventing obesity – the epidemic continues with no signs of stopping.

Of course, its intractable nature is because obesity is complicated – and it is a state affected not only by genetics or simple lifestyle choices, but significantly and subtly connected to social, psychological and behavioural factors as well.

Perhaps not surprisingly, mental illness is often a very significant factor in obesity.

Individuals with mental illness are much more vulnerable to weight gain than the general population. When a person has both a genetic predisposition to put on weight and a psychiatric illness, it can be very difficult to prevent or treat weight gain.

For one thing, the symptoms of many common psychiatric conditions lend themselves to weight gain. Mood disorders and ADHD are some of the most difficult for weight gain with symptoms such as increased appetite, loss of motivation, reduced energy and increased impulsiveness.

Biological changes that occur within these disorders such as inflammation and hormonal dysregulation can also make weight gain more likely.

Substance abuse is much more common among those with psychiatric conditions and when this is a problem, it is very difficult to make healthy lifestyle choices surrounding nutrition and exercise.

Even those receiving treatment for their mental illness are more vulnerable to unwanted weight gain as many psychiatric medications themselves have weight gain as a side effect.

With all of these compounding factors, it is unrealistic to simply tell an individual experiencing ADHD or depression to “eat less and exercise more”. It is not surprising that this approach is often unsuccessful.

In spite of the difficulty, we do need to address this issue as obesity-related medical problems are common and not benign among those with mental illness.

There are a variety of tools being used in addition to common lifestyle recommendations.

Various forms of talk therapy have shown some promising results to date. These tend to challenge negative thinking surrounding weight loss and work on adaptive behaviours and thought patterns.

Prescription medication for weight loss is a very controversial topic and there is currently only one drug approved in Canada for obesity treatment (orlistat). It has shown some positive results but is associated with negative side effects and is not widely used.

Bariatric surgery is a method with dramatic results and has definitely been on the rise over the past decade. This can be a good option for those with significant weight problems. It serves as a kind of forced behavior modification and is only recommended after in-depth consultation with professionals. Many morbidly obese individuals with a controlled mental illness could be candidates for bariatric surgery. Although effective, bariatric surgery is not easily available and is very expensive so not accessible for many people.

As always, it is important to identify and treat any underlying mental illness. If you are having difficulty losing weight in spite of repeated efforts, speak with your doctor about what weight loss tools that may be helpful in your situation.



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Hair pulling

Have you ever been gripped by an irresistible bad habit – like children who suck their thumbs or those who can’t stop biting their nails?

Many of us have some quirky habit we can’t seem to shake. Something we do when we’re absentmindedly watching TV or when we’re nervous or deep in thought.

For some, a bad habit is really not so simple. Between one and three percent of people experience a compulsion to obsessively pull out their hair, which leaves them with bald patches, stress and feelings of distress.

Trichotillomania is a long and complicated-sounding word to describe an impulse control disorder sometimes also referred to as hair pulling disorder.

Similar to other impulse control conditions such as OCD, kleptomania, pyromania or pathological gambling, trichotillomania involves a recurrent and overwhelming urge to pull out one’s hair. Usually it is the hair on the scalp that is most affected, but other hair such as eyelashes, eyebrows or beard can also be subject to pulling with this condition.

Typically, individuals with this and other conditions like it feel an increasing sense of tension and anxiety immediately before pulling out their hair or when they are really trying to resist the habit. This anxiety dissipates somewhat while the hair is being pulled and then gradually builds up again afterward.

Far from enjoying the experience, those with trichotillomania tend to feel significant distress about their behaviour and also experience difficulties in social, work and other areas of life as a result. Many with this condition avoid intimate relationships and try to hide their hair pulling behaviour.

Although symptoms can begin at any age, trichotillomania usually begins near puberty. It is not understood exactly what causes this condition, but it is believed that both biological and environmental factors play a role.

Sometimes hair pulling can be triggered by a stressful event such as a change of schools, abuse, family conflict or trauma. In other cases, hormonal changes associated with puberty may trigger symptoms.

There is also thought to be a genetic component to trichotillomania as it seems to occur more commonly in those with a family history of anxiety or other psychiatric conditions.

Those experiencing trichotillomania also commonly experience other psychiatric conditions such as obsessive compulsive disorder, anxiety disorders or depression. Other impulse control problems are also common among those who pull out their hair.

Fortunately, there are some effective treatments available that can help those experiencing trichotillomania. Usually, a combination of cognitive behaviour therapy and medication offer the most relief.

In therapy, individuals learn to track their symptoms, increase their awareness of when hair pulling occurs and learn techniques to reverse the habit. These can involve getting the individual to engage in behaviour that is incompatible with hair pulling at times when the pulling is more likely to occur.

Medications that are helpful in treating anxiety and obsessive compulsive disorder also seem to help those with trichotillomania – and combining these with the skills learned in a structured course of therapy can help to manage the condition.

If you or a loved one experience an overwhelming urge to pull out your hair – speak with your doctor about it and get referred to a mental health professional. You don’t need to let this continue to disrupt your life.



Read more Mental Health articles

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About the author...

Paul Latimer has over 25 years experience in clinical practice, research and administration. After obtaining his medical degree from Queen's University in Kingston, Ontario, he did psychiatric training at Queen's, Oxford and Temple Universities. After his residency he did a doctorate in medical science at McMaster University where he was also a Medical Research Council of Canada Scholar. Since 1983 he has been practicing psychiatry in Kelowna, BC where he has held many administrative positions and has done numerous clinical trials. He has published many scientific papers and one book on the psychophysiology of the functional bowel disorders. He is an avid photographer, skier and outdoorsman.

 

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The views expressed are strictly those of the author and not necessarily those of Castanet. Castanet presents its columns "as is" and does not warrant the contents.


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