Medication wise, psychotic disorders are mainly treated with antipsychotics.
Psychosis, a mental disorder, is best thought of as a departure from reality; it does not cause an impairment of psychological abilities. Psychosis itself is not an illness; rather, it is a component which may be experienced as part of an illness. It occurs naturally throughout the worlds population but can be induced through substance abuse, particularly cannabis use. Additionally, psychotic states can be induced by severe stress, severe depression and/or anxiety and /or sleep deprivation.
Typical symptoms can include the following:
- Delusions - Essentially, false beliefs that the patient adamantly holds on to; an example would be the belief that one can fly.
- Hallucinations - The classic psychotic symptom. Hallucinations can assail all the senses, but is usually confined to hearing. Patients experience stimuli that are not real, such as voices that only the patient can hear or seeing things that only the patient can see. Such experiences can be very frightening.
- Paranoia - Going hand in hand with delusions, patients can experience paranoia. They can believe that news reports are about them, that there is a conspiracy going on to keep the patient under wraps and so on.
- Thought disorders - Basic disorders that are more noticeable by observers. Patients suffering from this particular group of symptoms could experience random subject jumping, speech and writing impairments and so on.
Symptoms can be split in two - positive symptoms and negative symptoms.
Positive symptoms are created by the psychotic illness and include hallucinations and delusions; negative symptoms are traits suppressed or erradicated by the psychotic illness, including emotional suppression and apathy.
"Any of several major mental illnesses that can cause delusions, hallucinations, serious defects in judgment and insight, defects in the thinking process, and the inability to objectively evaluate reality." - Encyclopædia Britannica
Psychotic Depression - Psychotic Depression is an extreme chronic affective disorder of the depressive type in which patients experience moderate to severe psychotic episodes. Usually, one experiences particular psychotic symptoms such as paranoia, hallucinations (usually audible and visual) and erratic episodes. The condition is particularly exacerbated by severe stress and chemical abuse and is cyclic in nature. Approximately one in four patients who are hospitalised for an extreme depressive illness suffer from Psychotic Depression and suicide is sadly all too common. Interestingly, unlike primarily psychotic illnesses, patients who suffer from Psychotic Depression are conscious to the fact that their psychosis induced experiences are farce.
Treatment: Whilst psychotherapy is very effective in this field, it is prudent to provide said treatment alongside drug therapy. Typically patients react best to a combination of tricyclic antidepressants and atypical antipsychotics whose doses are tailored to the individuals requirements. Electro Convulsive Therapy (ECT) is extremely effective, but is not a first line treatment due to longer lasting side effects, be they more trivial or more damaging than the side effects induced by psychiatric drugs of choice. Interestingly, the so called "morning after" [contraceptive] pill also appears to be very effective in the short term.
Schizo-affective Disorder - A relatively new diagnosis, a schizo-affective disorder is a psychiatric condition where both a psychotic condition and an affective condition are present at the same time. The affective disorder can either be unipolar depression or bipolar in nature. Of the two, it's better to have the bipolar type than it is to have the depressive type as it's less likely to leave a permanent scar on your mind; a schizo-affective disorder of the bipolar kind is more similar to bipolar disorder than it is to schizophrenia. The diagnosis is as follows: two or more psychotic symptoms for the majority of four weeks along with an affective disorder (such as a major depressive episode); none of the symptoms may the produce of substance abuse etc.
Treatment: The treatment for a schizo-affective disorder is largely subjective and depends on the affective component in question. Typically, antipsychotics are used and psychotherapy is undertaken. Additionally, hypnotics may be prescribed at the onset of treatment in order to give the patient a break from their hallucinations.
Schizophrenia - Meaning "shattered mind", schizophrenia is an illness that affects approximately 1.1% of the population. Schizophrenia is a debilitating and fierce illness; doctors are unsure as to how it manifests. Often mistaken for dissociative identity disorder (commonly referred to as a split personality), schizophrenia is in fact a psychotic illness which can range in seriousness from slight to severe; despite popular belief, schizophrenic patients are not typically aggressive; in fact they are remarkably gentle and more often than not, simply scared. Patients who suffer from schizophrenia are likely to suffer from other psychiatric illnesses as well.
Treatment: The most common (and thought to be the most effective) treatment for schizophrenia is a combination of psychotherapy and drug therapy. Insofar as drug therapy is concerned, atypical antipsychotics are the first port of call, most commonly (at the time of writing) risperidone. If the patient in question does not react to the more common atypical antipsychotics (such as aripiprazole and quetiapine) then they are usually prescribed an older typical antipsychotic such as trifluoperazine. If this in turn fails, then the atypical antipsychotic clozapine may be trialed and possibly augmented with lithium. Failing this the typical antipsychotic pimozide should be tried as a last chance drug treatment.
"Schizophrenia ... is the most common and the most potentially severe and disabling of the psychoses. Schizophrenia is characterized by a withdrawal from reality, delusions and hallucinations, a loosening and incoherence of a person's thought processes, and deficiencies in feeling appropriate or normal emotions. Other symptoms may include apathy, reduced drive and initiative, inability to feel any emotion whatsoever, and a preoccupation with silly or bizarre fantasies. The symptoms of schizophrenia typically first manifest themselves during the teen years or early adult life. The course of the disease is variable: some schizophrenics suffer one acute episode and then permanently recover; others suffer from repeated episodes with periods of remission in between; and still others become chronically psychotic and must be permanently hospitalized." - Encyclopædia Britannica