Category: Psychosis

The Psychotic Spectrum

Auditory Hallucinations, Delusions, Mental Health, Psychosis, Schizoaffective Disorder, Schizophrenia

“Psychotic” is a term that gets tossed around a lot in American culture.

To start, psychosis represents a spectrum of disorders with many different origins. People are most familiar with the term schizophrenia, but schizophrenia is probably going to turn out to be an umbrella diagnosis for many different conditions. People can be psychotic for all kinds of reasons, in the wake of substance abuse — with hallucinogens, for example— or because of schizophrenia. People who are bipolar can become psychotic, and so can people with various degenerative disorders. The interaction between biological and genetic vulnerabilities with family and cultural factors is known to be complex.

What are the chief symptoms?

The symptoms most people are familiar with are what we call positive symptoms: hallucinations, delusions, paranoid beliefs, unusual behavioral or mood manifestations. Those are often treated acutely with medications and patients respond well to that.

Once the positive symptoms have been treated, people can enter what’s called the negative phase of a psychotic disorder: lack of motivation, lack of direction, flatness. There’s a quality of just being slowed down, and a withdrawal or social isolation. This can be debilitating. It is also much harder to identify and treat. Everyone is familiar with the worst-case psychotic disorder, which is the disheveled person in the street who makes everyone anxious. That’s the more obvious, positive symptom.

People in the negative phase don’t look so disorganized because they’re not having hallucinations or delusions, but they can be very isolated and shut down. They often don’t really know what they want to do. They may feel lost and ashamed. They’ve gotten help from medication, but they have a whole other road ahead of them. How are they going to pick up the pieces of their lives, go on and adapt?

One feature of these disorders is tremendous denial that a person is troubled, or needs treatment. It can be very hard to treat someone who other people think is impaired when that person doesn’t think so. Typically, you see problems with family members, problems in employment. These individuals see themselves in the world quite differently, and often aren’t interested in receiving any treatment. This creates a lot of frustration in attempting to offer help.

Sources: Austen Riggs Center

A Few Facts About Schizophrenia

Mental Health, Psychosis, Schizoaffective Disorder, Schizophrenia

~ It is estimated approximately 50% of patients with schizophrenia do not take their prescribed medications as directed. The most common reason is anosognosia, meaning they are unaware of their condition.

~ Lack of treatment leads to severe negative health outcomes, including a life expectancy shortened by an average of 28.5 years. 

~ Approximately half of individuals with schizophrenia have co-occurring mental or behavioral health disorders.

~ Co-occurring medical conditions such as heart disease, liver disease, and diabetes contribute to the higher premature mortality rate among individuals with schizophrenia.

~ Following illness onset, 25-50% of those living with schizophrenia attempt suicide.

~ At least 50% of people with severe psychiatric illnesses like schizophrenia smoke, compared to 23% of the general population. 

~ Smoking-related illnesses cause half of all deaths among people with psychiatric disorders. 

~ Those diagnosed with schizophrenia smoke more than half of all cigarettes produced in the United States, and they are only half as likely as other smokers to quit.

Types of Delusions

Delusions, Mental Health, Psychosis, Schizoaffective Disorder, Schizophrenia

1) Collapse delusion: A transient condition that occurs frequently in acute illnesses, coinciding with the cessation of febrile states; 

2) Reference delusion: The patient attributes a special meaning to objects, events or people close to him; 

3) Touch delusion: It consists in the excessive mania of touching certain objects; 

4) Nihilistic delusion: It is found in melancholic depressions, and is made up of an incoherent mass of negative ideas; 

5) Oneiric delusion: It consists in a disturbance of the conscience that leads to emotions similar to those present in the oneiric phase (the conscience of the disturbed person enters a phase such that it is unable to distinguish reality from the oneiric profile of itself); 

6) Professional or occupational delusion: It consists in recreating, on the patient’s part, the usual conditions and places of work; 

7) Residual delusion: Represented by the persistence of delusional representations at the level of thought, even after the perturbation has ceased; 

8) Interpretative delusion: The subject interprets random facts as facts linked to him, feeling that he is the main actor or feeling indicated as a party in the case; 

9) Persecution delusion: The patient believes he is the object of persecution (a situation often identified also with the term paranoia); 

10) Bizarre delusion: The patient adheres to a system of totally implausible beliefs (in the culture of reference); 

11) Control delusion: The patient is convinced that his thoughts or emotions are under the control of some external force; 

12) Insertion delusion: Similar to the previous one; the patient is convinced that some of his thoughts are imposed on him by an external force; 

13) Erotomanic delusion: The patient is convinced that a certain person (often a celebrity) is secretly in love with him; 

14) Jealousy delusion: The patient has the unfounded and obsessive belief that he is betrayed by his partner. Among delusions, it is the most frequent; 

15) Delusion of grandeur (megalomania): The patient has the conviction that he is extremely important, for example, that he has been chosen by God to carry out a mission of fundamental importance, or that he is the only holder of extraordinary knowledge or powers; 

16) Somatic delusion: The patient is convinced that his body has something unusual, such as a rare disease, some kind of parasite or an unpleasant smell; 

17) Religious delusion: The patient is convinced that religious forces (almost always belonging to his own religion) protect him from misfortune, or from a disease (real and existing); 

18) Identity delusion: He who is affected believes he is another person, often important people such as Kings, Princes or Presidents.

Schizoaffective Disorder: What are Hallucinations?

Auditory Hallucinations, Mental Health, Psychosis, Schizoaffective Disorder

Hallucinations are a psychotic symptom of schizoaffective disorder. People experiencing hallucinations may hear, see, smell, taste or feel things that aren’t really there, and which other people can’t hear, see, smell, taste or feel.

Auditory hallucinations are the most common type of hallucination. They are mostly experienced as voices. To a person with schizoaffective disorder, these voices sound just like people speaking to them, and people with the illness cannot differentiate between what is real – for example a friend speaking to them – and what is a hallucination.

Voices might be heard in the second person – for example someone saying “you stink”, “you’re ugly”, “they hate you”. Sometimes voices might command a person to do something – by saying, for example, “jump off the bridge”, “take an overdose”. People with schizoaffective disorder may also have third person hallucinations, which commonly take the form of two or more voices talking among themselves or commenting on the person’s behaviour. Third person hallucinations are common in both schizoaffective disorder and schizophrenia, but are seen less frequently in bipolar disorder.

In most cases the experience of auditory hallucinations in the form of voices is unpleasant. Voices are frequently accusatory, reminding the person of past misdeeds, some imaginary, and some real. However, in a minority of cases, voices can be pleasant or even helpful.

In addition to voices, auditory hallucinations can involve noises, such as buzzing, screeching and ringing. Additionally, people with schizoaffective disorder may think that their own thoughts are being broadcast, or can be heard by other people. They may also think that other people’s thoughts are being forced into their own minds, or that their thoughts have been stolen from their heads.

Hallucinations of all five senses may be experienced. In addition to auditory hallucinations, people may have tactile hallucinations – such as feeling as though you are being pushed, touched or held down – visual hallucinations – such as seeing things that aren’t there or feeling that colours are brighter than they should be – hallucinations of smell and hallucinations of taste.

Visual hallucinations occur much less frequently than auditory hallucinations, and are more common in conjunction with auditory hallucinations – for example seeing and hearing someone who no one else can see. Hallucinations of smell and taste are more unusual and tend to focus on things tasting or smelling different than usual. This can lead to people with schizoaffective disorder thinking that their family and friends are trying to poison them.

Sources: Schizoaffective Disorder Simplified

Paliperidone (Oral Route)

Medications, Mental Health, Psychosis, Schizoaffective Disorder, Schizophrenia

Brand names:

  • Invega
    • Extended-release tablet: 1.5 mg, 3 mg, 6 mg, 9 mg
  • Invega Sustenna
    • Extended-release injectable suspension: 39 mg, 78 mg, 117 mg, 156 mg, 234 mg

Generic name: paliperidone (pal ee PER i done)

Paliperidone is a medication that works in the brain to treat schizophrenia and schizoaffective disorder. It is also known as a second-generation antipsychotic (SGA) or atypical antipsychotic. Paliperidone rebalances dopamine and serotonin to improve thinking, mood, and behavior.

What Should I Discuss With My Healthcare Provider Before Taking Paliperidone?
  • Symptoms of your condition that bother you the most
  • If you have thoughts of suicide or harming yourself
  • Medications you have taken in the past for your condition, whether they were effective or caused any adverse effects
  • If you ever had muscle stiffness, shaking, tardive dyskinesia, neuroleptic malignant syndrome, or weight gain caused by a medication
  • If you experience side effects from your medications, discuss them with your provider. Some side effects may pass with time, but others may require changes in the medication.
  • Any psychiatric or medical problems you have, such as heart rhythm problems, long QT syndrome, heart attacks, diabetes, high cholesterol, or seizures
  • If you have a family history of diabetes or heart disease
  • All other medications you are currently taking (including over the counter products, herbal and nutritional supplements) and any medication allergies you have
  • Other non-medication treatment you are receiving, such as talk therapy or substance abuse treatment. Your provider can explain how these different treatments work with the medication.
  • If you are pregnant, plan to become pregnant, or are breast-feeding
  • If you smoke, drink alcohol, or use illegal drugs

Paliperidone tablets are usually taken 1 time per day with or without food.

Typically patients begin at a low dose of medicine and the dose is increased slowly over several weeks.

The dose of the tablets usually ranges from 3 mg to 12 mg. The dose of the Sustenna brand of long-acting paliperidone injection formulation usually ranges from 78 mg to 234 mg every month. The dose of the Trinza brand long-acting paliperidone injection formulation ranges from 273mg to 819mg every 3 months. Only your healthcare provider can determine the correct dose for you.

The tablets should be swallowed whole. They should not be chewed, crushed, or broken.

What Are Possible Side Effects Of Paliperidone?

Common side effects:

Tachycardia, drowsiness, extrapyramidal symptoms, restlessness, headache, increased prolactin, cholesterol abnormalities, increased glucose, vomiting, tremor.

Rare/serious side effects:

Paliperidone may increase the blood levels of a hormone called prolactin. Side effects of increased prolactin levels include females losing their period, production of breast milk and males losing their sex drive or possibly experiencing erectile problems. Long term (months or years) of elevated prolactin can lead to osteoporosis, or increased risk of bone fractures.

Some people may develop muscle related side effects while taking paliperidone. The technical terms for these are “extrapyramidal symptoms” (EPS) and “tardive dyskinesia” (TD). Symptoms of EPS include restlessness, tremor, and stiffness. TD symptoms include slow or jerky movements that one cannot control, often starting in the mouth with tongue rolling or chewing movements.

Temperature regulation: Impaired core body temperature regulation may occur; caution with strenuous exercise, heat exposure, and dehydration.

Second generation antipsychotics (SGAs) increase the risk of weight gain, high blood sugar, and high cholesterol. This is also known as metabolic syndrome. Your healthcare provider may ask you for a blood sample to check your cholesterol, blood sugar, and hemoglobin A1c (a measure of blood sugar over time) while you take this medication.

On Schizoaffective Disorder

Auditory Hallucinations, Delusions, Mental Health, Psychosis, Schizoaffective Disorder

On Schizoaffective Disorder & Hallucinations:

“I awoke, went to drink a glass of water and walked back toward my room. I stopped dead in my tracks. My room was red and four cloaked figures floated above my bed with fire circling around them. Inside of the cloaks was a black abyss and I knew they had come for me. As long as I stayed out of my room they wouldn’t see me. I stared at them for what seemed like an hour before they went away. I slept on the couch that night.”

~ Thomas Wallingford, The Mighty Contributor

#MentalHealth #SchizoaffectiveDisorder #Hallucinations #EndStigma

Postpartum Depression: Symptoms

Depression, Mental Health, Psychosis

The birth of a baby can trigger a jumble of powerful emotions, from excitement and joy to fear and anxiety. But it can also result in something you might not expect — depression.

Most new moms experience postpartum “baby blues” after childbirth, which commonly include mood swings, crying spells, anxiety and difficulty sleeping. Baby blues typically begin within the first two to three days after delivery, and may last for up to two weeks.

But some new moms experience a more severe, long-lasting form of depression known as postpartum depression. Rarely, an extreme mood disorder called postpartum psychosis also may develop after childbirth.

Postpartum depression isn’t a character flaw or a weakness. Sometimes it’s simply a complication of giving birth. If you have postpartum depression, prompt treatment can help you manage your symptoms and help you bond with your baby.

Symptoms

Signs and symptoms of depression after childbirth vary, and they can range from mild to severe.

Baby blues symptoms

Signs and symptoms of baby blues — which last only a few days to a week or two after your baby is born — may include:

• Mood swings

• Anxiety

• Sadness

• Irritability

• Feeling overwhelmed

• Crying

• Reduced concentration

• Appetite problems

• Trouble sleeping

Postpartum depression symptoms

Postpartum depression may be mistaken for baby blues at first — but the signs and symptoms are more intense and last longer, and may eventually interfere with your ability to care for your baby and handle other daily tasks. Symptoms usually develop within the first few weeks after giving birth, but may begin earlier ― during pregnancy ― or later — up to a year after birth.

Postpartum depression signs and symptoms may include:

• Depressed mood or severe mood swings

• Excessive crying

• Difficulty bonding with your baby

• Withdrawing from family and friends

• Loss of appetite or eating much more than usual

• Inability to sleep (insomnia) or sleeping too much

• Overwhelming fatigue or loss of energy

• Reduced interest and pleasure in activities you used to enjoy

• Intense irritability and anger

• Fear that you’re not a good mother

• Hopelessness

• Feelings of worthlessness, shame, guilt or inadequacy

• Diminished ability to think clearly, concentrate or make decisions

• Restlessness

• Severe anxiety and panic attacks

• Thoughts of harming yourself or your baby

• Recurrent thoughts of death or suicide

Untreated, postpartum depression may last for many months or longer.

Postpartum psychosis

With postpartum psychosis — a rare condition that typically develops within the first week after delivery — the signs and symptoms are severe. Signs and symptoms may include:

• Confusion and disorientation

• Obsessive thoughts about your baby

• Hallucinations and delusions

• Sleep disturbances

• Excessive energy and agitation

• Paranoia

• Attempts to harm yourself or your baby

Postpartum psychosis may lead to life-threatening thoughts or behaviors and requires immediate treatment.

Postpartum depression in new fathers

New fathers can experience postpartum depression, too. They may feel sad or fatigued, be overwhelmed, experience anxiety, or have changes in their usual eating and sleeping patterns ― the same symptoms mothers with postpartum depression experience.

Fathers who are young, have a history of depression, experience relationship problems or are struggling financially are most at risk of postpartum depression. Postpartum depression in fathers ― sometimes called paternal postpartum depression ― can have the same negative effect on partner relationships and child development as postpartum depression in mothers can.

If you’re a new father and are experiencing symptoms of depression or anxiety during your partner’s pregnancy or in the first year after your child’s birth, talk to your health care professional. Similar treatments and supports provided to mothers with postpartum depression can be beneficial in treating postpartum depression in fathers.

Causes

There’s no single cause of postpartum depression, but physical and emotional issues may play a role.

• Physical changes. After childbirth, a dramatic drop in hormones (estrogen and progesterone) in your body may contribute to postpartum depression. Other hormones produced by your thyroid gland also may drop sharply — which can leave you feeling tired, sluggish and depressed.

• Emotional issues. When you’re sleep deprived and overwhelmed, you may have trouble handling even minor problems. You may be anxious about your ability to care for a newborn. You may feel less attractive, struggle with your sense of identity or feel that you’ve lost control over your life. Any of these issues can contribute to postpartum depression.

Risk factors

Any new mom can experience postpartum depression and it can develop after the birth of any child, not just the first. However, your risk increases if:

• You have a history of depression, either during pregnancy or at other times

• You have bipolar disorder

• You had postpartum depression after a previous pregnancy

• You have family members who’ve had depression or other mood disorders

• You’ve experienced stressful events during the past year, such as pregnancy complications, illness or job loss

• Your baby has health problems or other special needs

• You have twins, triplets or other multiple births

• You have difficulty breast-feeding

• You’re having problems in your relationship with your spouse or significant other

• You have a weak support system

• You have financial problems

• The pregnancy was unplanned or unwanted

Complications

Left untreated, postpartum depression can interfere with mother-child bonding and cause family problems.

• For mothers. Untreated postpartum depression can last for months or longer, sometimes becoming a chronic depressive disorder. Even when treated, postpartum depression increases a woman’s risk of future episodes of major depression.

• For fathers. Postpartum depression can have a ripple effect, causing emotional strain for everyone close to a new baby. When a new mother is depressed, the risk of depression in the baby’s father may also increase. And new dads are already at increased risk of depression, whether or not their partner is affected.

• For children. Children of mothers who have untreated postpartum depression are more likely to have emotional and behavioral problems, such as sleeping and eating difficulties, excessive crying, and delays in language development.

Prevention

If you have a history of depression — especially postpartum depression — tell your doctor if you’re planning on becoming pregnant or as soon as you find out you’re pregnant.

• During pregnancy, your doctor can monitor you closely for signs and symptoms of depression. He or she may have you complete a depression-screening questionnaire during your pregnancy and after delivery. Sometimes mild depression can be managed with support groups, counseling or other therapies. In other cases, antidepressants may be recommended — even during pregnancy.

• After your baby is born, your doctor may recommend an early postpartum checkup to screen for signs and symptoms of postpartum depression. The earlier it’s detected, the earlier treatment can begin. If you have a history of postpartum depression, your doctor may recommend antidepressant treatment or psychotherapy immediately after delivery.

Age 16, 1988

Auditory Hallucinations, My Schiz Life, Poetry, Psychosis, Sexual Assault, Stigma, Violence, Visual Hallucinations

Age 16, 1988

For me my mental illness came crashing into my life in full force when I was sixteen.

That was the year I first started hearing voices,

started to believe people could read my mind and insert thoughts into my head,

was the first time I was truly suicidal,

was the year I started to self harm,

dragging a razor blade across my left arm and watching my blood flow,

the first time I was dissociative,

when the world became vague, dreamlike, less real,

as I observed events as if from outside my body like a movie in slow motion,

the year the panic attacks began.

This was also the year I suffered as a survivor of sexual assault,

the most difficult event of my life as a biker held a knife to my throat and raped me,

beating me severely.

From then on I carried a knife in case I am in a similar situation,

not so I could defend myself, but so I could slit my wrists.

To this day the sound of a Harley Davidson makes me physically cringe.

That was when the night terrors began reliving my trauma every time I closed my eyes.

That was the year the negative coping mechanisms developed: cutting, isolating, alcohol, drugs.

That was when the abyss of depression swallowed me up whole,

and I wanted to die or crawl in a hole forever,

because I was worthless, pathetic, weak, and most importantly,

I was to blame for being raped,

I should have been able to stop it as a sixteen year old boy.

This is not how it should be at sixteen.