Mental Disorders

III

Psychoses

Psychosis is a serious mental illness, in which the patient develops a distorted view of reality. The two main types of psychosis are schizophrenia and affective psychosis (sometimes called manic-depressive psychosis). Both tend to develop quite suddenly, often when the person is under stress. Schizophrenia can occur at any age, but commonly begins in late teens or early twenties. Manic depressive psychosis tends to develop rather later in life.

A

Schizophrenia

Typically, schizophrenia begins with a distortion of perception. Sometimes, this simply can be that colours seem brighter than normal, or sounds seem louder than usual. As the illness progresses, the sufferers may start to think that they are being followed, or watched. Sometimes they begin to see or hear things that are not really there, and often this feels very frightening. Some people may even feel things touching them, or imagine that there are insects crawling over them. Some may feel that their body has changed in some way.

The most commonly reported symptoms is to “hear voices”. The sufferer does not usually think that the voices are inside their head. Often the voices will comment on the person’s life, behaviour, or thoughts, or they will tell the person to do or say things. “Magical” thinking is common, in which the sufferer may begin to think that they have special powers or are being asked to fulfil some special mission. Some patients may believe that the voices are those of God or the devil. In rare cases, this may result in offences such as murder. Most schizophrenics are not violent and are able to lead relatively normal lives, with some support for their condition from drugs. Antipsychotic drugs, which are mainly used to treat schizophrenia, act to manage its acute symptoms and prevent relapses by blocking the action of the neurotransmitter dopamine in the brain. Some drugs interact with other neuroreceptors. The main groups of drugs used include the phenothiazines, thioxanthenes, and butyrophenones.

B

Affective Psychosis (Manic-Depressive Psychosis)

Affective, or manic-depressive psychosis results in changes in mood. A sufferer may swing between being overactive, talkative, and impulsive (manic) to being morose, withdrawn, and even suicidal (depressive). Judgement is also often affected and the sufferers may say or do things that they would not normally do. A common result is that they seriously overspend, or make unrealistic plans which never get carried out. Some people may become aggressive. Sleep patterns are disturbed, and in the manic phase, sufferers may not sleep for several days at a time. Often the family are more distressed by this than the sufferer, who may feel very happy and energetic, and often fails to understand the effect that this behaviour is having on those around them.

C

Causes of Psychosis

As with personality disorder, the causes of psychosis are not fully understood. Mental illness seems to run in families, with close relatives at particular risk of developing symptoms.

However, it is also accepted that stress often triggers off the illness, and may causes relapses later on. Once again an interaction between the inherited characteristics and the environment seems likely. What appears to be inherited is a vulnerability to the disorder, but whether it actually appears or not will depend on life experiences.

Psychotic conditions are not usually fully curable, although some people will have one breakdown and never have another. Many, however, will have a series of breakdowns or relapses throughout their lives. In recent years many new drugs have become available which control the worst of the symptoms. Drug treatment is very important in controlling the symptoms of psychosis. However, once the symptoms are under control, psychotherapy to examine the underlying problems and stresses can also be helpful. Once the symptoms have settled, sufferers can usually live a reasonably normal life in the community. For those who have been ill for some years, however, rehabilitation may be needed to restore social and self-care skills.

More recently, a specific form of psychological therapy for psychosis has been developed. This is a form of cognitive behaviour therapy, which is an approach that encourages sufferers to examine the evidence for their distorted beliefs, and with the help of the therapist, to consider alternative explanations of their experiences. It aims to increase people’s understanding of their symptoms and how they arise, so that even if the symptoms persist, they may become more easily tolerated.

IV

Other Forms of Mental Disorder

It is possible to have more than one form of personality disorder at the same time, or to have a personality disorder and a mental illness together. Some types of mental illness do not fit neatly into one category or another, and it is possible for individuals to show symptoms of more than one type of illness at the same time.

Brain damage may also produce unusual behaviour and symptoms of mental illness. If the injury happens early in life, it can affect the later development of the sufferer’s personality and behaviour. It is becoming accepted that the earlier the injury occurs, the more generalized the effect will be. Some forms of brain injury produce symptoms which mimic mental illness, and people who have suffered brain injury appear to be more prone to develop mental illness afterwards.

Diseases of the brain can also produce symptoms of mental illness. Older people may suffer from destruction of the brain tissue as a result of dementia, often caused by Alzheimer’s disease, and this can result in disturbed perceptions, speech, memory, or behaviour. Epilepsy, which is a disturbance of the electrical activity of the brain, is rarely associated with severe mental disorder, even though resulting fits may appear dramatic and frightening. For most sufferers drugs can now control these for much or all of the time.

Minor forms of mental disturbance are not uncommon, and may affect anyone. Many people become depressed for a while after losing someone they love, or losing a job. Others may become anxious if threatened with redundancy, or if a loved one is seriously ill. These are common reactions in these kinds of situation. In most cases problems will disappear in a few weeks or months once the situation has been accepted or resolved. It is only when symptoms persist over months or years, and begin to affect normal life, that such reactions might begin to be considered abnormal, and require specialist treatment.