Misplaced Pages

Revision as of 16:19, 25 October 2010

Psychosis
Specialty	Psychiatry, clinical psychology

Psychosis (from the Greek ψυχή "psyche", for mind/soul, and -ωσις "-osis", for abnormal condition) means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality". People suffering from psychosis are described as psychotic. Psychosis is given to the more severe forms of psychiatric disorder, during which hallucinations and delusions and impaired insight may occur. Over the years, the term psychotic has been defined in various ways - in both restricted and broad terms but till date, there is no universally accepted definition (American Psychiatric Association 2000). People experiencing psychosis may report hallucinations or delusional beliefs, and may exhibit personality changes and thought disorder. Depending on its severity, this may be accompanied by unusual or bizarre behavior, as well as difficulty with social interaction and impairment in carrying out the daily life activities.

A wide variety of central nervous system diseases, from both external poisons and internal physiologic illness, can produce symptoms of psychosis.

However, many people have unusual and unshared (distinct) experiences of what they perceive to be different realities without fitting the clinical definition of psychosis. For example, many people in the general population have experienced hallucinations related to religious or paranormal experience. As a result, it has been argued that psychosis is simply an extreme state of consciousness that falls beyond the norms experienced by most. In this view, people who are clinically found to be psychotic may simply be having particularly intense or distressing experiences (see schizotypy).

Signs and symptoms

People with psychosis may have one or more of the following: hallucinations, delusions, or a thought disorder, as described below.

Hallucinations

A hallucination is defined as sensory perception in the absence of external stimuli. Hallucinations are different from illusions, or perceptual distortions, which are the misperception of external stimuli. Hallucinations may occur in any of the five senses and take on almost any form, which may include simple sensations (such as lights, colors, tastes, and smells) to more meaningful experiences such as seeing and interacting with fully formed animals and people, hearing voices, and having complex tactile sensations.

Auditory hallucinations, particularly experiences of hearing voices, are a common and often prominent feature of psychosis. Hallucinated voices may talk about, or to, the person, and may involve several speakers with distinct personas. Auditory hallucinations tend to be particularly distressing when they are derogatory, commanding or preoccupying. However, the experience of hearing voices need not always be a negative one. One research study has shown that the majority of people who hear voices are not in need of psychiatric help. The Hearing Voices Movement has subsequently been created to support voice hearers, regardless of whether they are considered to have a mental illness or not.

Delusions

Psychosis may involve delusional beliefs, some of which are paranoid in nature. Karl Jaspers has classified psychotic delusions into primary and secondary types. Primary delusions are defined as arising suddenly and not being comprehensible in terms of normal mental processes, whereas secondary delusions may be understood as being influenced by the person's background or current situation (e.g., ethnic or sexual orientation, religious beliefs, superstitious belief).

Thought disorder

Thought disorder describes an underlying disturbance to conscious thought and is classified largely by its effects on speech and writing. Affected persons show loosening of associations, that is, a disconnection and disorganization of the semantic content of speech and writing. In the severe form speech becomes incomprehensible and it is known as "word-salad".

Causes

Causes of symptoms of mental illness were customarily classified as "organic" or "functional". Organic conditions are primarily medical or pathophysiological, whereas, functional conditions are primarily psychiatric or psychological. The DSM-IV-TR no longer classifies psychotic disorders as functional or organic. Rather it lists traditional psychotic illnesses, psychosis due to General Medical conditions, and Substance induced psychosis.

Psychiatric

Functional causes of psychosis include the following:

• brain tumors
• drug abuse amphetamines, cocaine, alcohol among others
• brain damage
• schizophrenia, schizophreniform disorder, schizoaffective disorder, brief psychotic disorder
• bipolar disorder (manic depression)
• severe clinical depression
• severe psychosocial stress
• sleep deprivation
• some focal epileptic disorders especially if the temporal lobe is affected
• exposure to some traumatic event (violent death, etc.)
• abrupt or over-rapid withdrawal from certain recreational or prescribed drugs

A psychotic episode can be significantly affected by mood. For example, people experiencing a psychotic episode in the context of depression may experience persecutory or self-blaming delusions or hallucinations, while people experiencing a psychotic episode in the context of mania may form grandiose delusions.

Stress is known to contribute to and trigger psychotic states. A history of psychologically traumatic events, and the recent experience of a stressful event, can both contribute to the development of psychosis. Short-lived psychosis triggered by stress is known as brief reactive psychosis, and patients may spontaneously recover normal functioning within two weeks. In some rare cases, individuals may remain in a state of full-blown psychosis for many years, or perhaps have attenuated psychotic symptoms (such as low intensity hallucinations) present at most times.

Sleep deprivation has been linked to psychosis. However, this is not a risk for most people, who merely experience hypnagogic or hypnopompic hallucinations, i.e. unusual sensory experiences or thoughts that appear during waking or drifting off to sleep. These are normal sleep phenomena and are not considered signs of psychosis.

Vitamin B₁₂ deficiency can also cause symptoms of mania and psychosis.

Vitamin D overdose can cause altered thinking and psychosis.

Genetics may also have a role in psychosis. The Genain quadruplets were identical quadruplets who were all diagnosed with schizophrenia.

General medical

Psychosis arising from "organic" (non-psychological) conditions is sometimes known as secondary psychosis. It can be associated with the following pathologies:

• neurological disorders, including:
  • brain tumour
  • dementia with Lewy bodies
  • multiple sclerosis
  • sarcoidosis
  • Lyme Disease
  • syphilis
  • Alzheimer's Disease
  • Parkinson's Disease
  • Anti-NMDA receptor encephalitis

• electrolyte disorders such as:
  • hypocalcemia
  • hypernatremia
  • hyponatremia
  • hypokalemia
  • hypomagnesemia
  • hypermagnesemia
  • hypercalcemia
  • hypophosphatemia
• hypoglycemia
• lupus
• AIDS
• leprosy
• malaria
• Adult-onset vanishing white matter leukoencephalopathy
• Late-onset metachromatic leukodystrophy
• Cerebral involvement of scleroderma (a single case report).
• Hashimoto's encephalopathy, an extremely rare condition (about 100 reported cases).

Psychosis can even be caused by apparently innocuous ailments such as flu or mumps.

Psychoactive drug use

Various psychoactive substances (both legal and illegal) have been implicated in causing, exacerbating, and/or precipitating psychotic states and/or disorders in users.

Prescription medication

Some medications such as bromocriptine and phenylpropanolamine may also cause or worsen psychotic symptoms.

Pathophysiology

The first brain image of an individual with psychosis was completed as far back as 1935 using a technique called pneumoencephalography (a painful and now obsolete procedure where cerebrospinal fluid is drained from around the brain and replaced with air to allow the structure of the brain to show up more clearly on an X-ray picture).

The purpose of the brain is to collect information from the body (pain, hunger, etc.), and from the outside world, interpret it to a coherent world view, and produce a meaningful response. The information from the senses enter the brain in the primary sensory areas. They process the information and send it to the secondary areas where the information is interpreted. Spontaneous activity in the primary sensory areas may produce hallucinations which are misinterpreted by the secondary areas as information from the real world.

For example, a PET or fMRI scan of a person who claims to be hearing voices may show activation in the primary auditory cortex, or parts of the brain involved in the perception and understanding of speech.

Tertiary brain cortex collects the interpretations from the secondary cortexes and creates a coherent world view of it. A study investigating structural changes in the brains of people with psychosis showed there was significant grey matter reduction in the right medial temporal, lateral temporal, and inferior frontal gyrus, and in the cingulate cortex bilaterally of people before and after they became psychotic. Findings such as these have led to debate about whether psychosis itself causes excitotoxic brain damage and whether potentially damaging changes to the brain are related to the length of psychotic episode. Recent research has suggested that this is not the case although further investigation is still ongoing.

Studies with sensory deprivation have shown that the brain is dependent on signals from the outer world to function properly. If the spontaneous activity in the brain is not counterbalanced with information from the senses, loss from reality and psychosis may occur after some hours. A similar phenomenon is paranoia in the elderly when poor eyesight, hearing and memory causes the person to be abnormally suspicious of the environment.

On the other hand, loss from reality may also occur if the spontaneous cortical activity is increased so that it is no longer counterbalanced with information from the senses. The 5-HT2A receptor seems to be important for this, since drugs which activate them produce hallucinations.

However, the main feature of psychosis is not hallucinations, but the inability to distinguish between internal and external stimuli. Close relatives to psychotic patients may hear voices, but since they are aware that they are unreal they can ignore them, so that the hallucinations do not affect their reality perception. Hence they are not considered to be psychotic.

Psychosis has been traditionally linked to the neurotransmitter dopamine. In particular, the dopamine hypothesis of psychosis has been influential and states that psychosis results from an overactivity of dopamine function in the brain, particularly in the mesolimbic pathway. The two major sources of evidence given to support this theory are that dopamine receptor D2 blocking drugs (i.e., antipsychotics) tend to reduce the intensity of psychotic symptoms, and that drugs which boost dopamine activity (such as amphetamines and cocaine) can trigger psychosis in some people (see amphetamine psychosis). However, increasing evidence in recent times has pointed to a possible dysfunction of the excitory neurotransmitter glutamate, in particular, with the activity of the NMDA receptor. This theory is reinforced by the fact that dissociative NMDA receptor antagonists such as ketamine, PCP and dextromethorphan/detrorphan (at large overdoses) induce a psychotic state more readily than dopinergic stimulants, even at "normal" recreational doses. The symptoms of dissociative intoxication are also considered to mirror the symptoms of schizophrenia, including negative psychotic symptoms, more closely than amphetamine psychosis. Dissociative induced psychosis happens on a more reliable and predictable basis than amphetamine psychosis, which usually only occurs in cases of overdose, prolonged use or with sleep deprivation, which can independently produce psychosis. New antipsychotic drugs which act on glutamate and its receptors are currently undergoing clinical trials.

The connection between dopamine and psychosis is generally believed to be complex. While dopamine receptor D2 suppresses adenylate cyclase activity, the D1 receptor increases it. If D2-blocking drugs are administered the blocked dopamine spills over to the D1 receptors. The increased adenylate cyclase activity affects genetic expression in the nerve cell, a process which takes time. Hence antipsychotic drugs take a week or two to reduce the symptoms of psychosis. Moreover, newer and equally effective antipsychotic drugs actually block slightly less dopamine in the brain than older drugs whilst also blocking 5-HT2A receptors, suggesting the 'dopamine hypothesis' may be oversimplified. Soyka and colleagues found no evidence of dopaminergic dysfunction in people with alcohol-induced psychosis and Zoldan et al. reported moderately successful use of ondansetron, a 5-HT₃ receptor antagonist, in the treatment of levodopa psychosis in Parkinson's disease patients.

Psychiatrist David Healy has criticised pharmaceutical companies for promoting simplified biological theories of mental illness that seem to imply the primacy of pharmaceutical treatments while ignoring social and developmental factors which are known to be important influences in the aetiology of psychosis.

Some theories regard many psychotic symptoms to be a problem with the perception of ownership of internally generated thoughts and experiences. For example, the experience of hearing voices may arise from internally generated speech that is mislabeled by the psychotic person as coming from an external source.

One clear finding is that persons with bipolar disorder seem to have increased activity of the left hemisphere compared to the right hemisphere of the brain, while persons with schizophrenia have increased activity in the right hemisphere.

Increased level of right hemisphere activation has also been found in healthy people who have high levels of paranormal beliefs and in people who report mystical experiences. It also seems to be the case that people who are more creative are also more likely to show a similar pattern of brain activation. Some researchers have been quick to point out that this in no way suggests that paranormal, mystical or creative experiences are in any way by themselves a symptom of mental illness, as it is still not clear what makes some such experiences beneficial and others distressing.

Diagnosis

The Brief Psychiatric Rating Scale (BPRS) assesses the level of 18 symptom constructs of psychosis such as hostility, suspicion, hallucination, and grandiosity. It is based on the clinician's interview with the patient and observations of the patient's behavior over the previous 2–3 days. The patient's family can also provide the behavior report.

Treatment

The treatment of psychosis depends on the cause or diagnosis or diagnoses (such as schizophrenia, bipolar disorder and/ or substance intoxication). The first line treatment for many psychotic disorders is antipsychotic medication (oral or intramuscular injection), and sometimes hospitalization is needed. There is growing evidence that cognitive behavior therapy and family therapy can be effective in managing psychotic symptoms. When other treatments for psychosis are ineffective, electroconvulsive therapy (ECT) (aka shock treatment) is sometimes applied to relieve the underlying symptoms of psychosis due to depression. There is also increasing research suggesting that animal-assisted therapy can contribute to the improvement in general well-being of people with schizophrenia.

Early intervention

Early intervention in psychosis is a relatively new concept based on the observation that identifying and treating someone in the early stages of a psychosis can significantly improve their longer term outcome. This approach advocates the use of an intensive multi-disciplinary approach during what is known as the critical period, where intervention is the most effective, and prevents the long term morbidity associated with chronic psychotic illness.

Newer research into the effectiveness of cognitive behavioural therapy during the early pre-cursory stages of psychosis 88 (also known as the "prodrome" or "at risk mental state") suggests that such input can prevent or delay the onset of psychosis.

One of the international paradigms aimed at researching the prodrome is the North American Prodrome Longitudinal Study (NAPLS). The study is concerned with brain development, hormones, and neuropsychological functions that may play a role in risk for and prevention of mental illness in young adulthood. Specifically, the goal is to determine the neurobiological indicators present in prodromal patients that may contribute to the onset of severe mental illness as compared with those of control individuals.

History

The word psychosis was first used by Ernst von Feuchtersleben in 1845 as an alternative to insanity and mania and stems from the Greek ψύχωσις (psychosis), "a giving soul or life to, animating, quickening" and that from ψυχή (psyche), "soul" and the suffix -ωσις (-osis), in this case "abnormal condition". The word was used to distinguish disorders which were thought to be disorders of the mind, as opposed to "neurosis", which was thought to stem from a disorder of the nervous system. The psychoses thus became the modern equivalent of the old notion of madness, and hence there was much debate on whether there was only one (unitary) or many forms of the new disease.

The division of the major psychoses into manic depressive illness (now called bipolar disorder) and dementia praecox (now called schizophrenia) was made by Emil Kraepelin, who attempted to create a synthesis of the various mental disorders identified by 19th century psychiatrists, by grouping diseases together based on classification of common symptoms. Kraepelin used the term 'manic depressive insanity' to describe the whole spectrum of mood disorders, in a far wider sense than it is usually used today. In Kraepelin's classification this would include 'unipolar' clinical depression, as well as bipolar disorder and other mood disorders such as cyclothymia. These are characterised by problems with mood control and the psychotic episodes appear associated with disturbances in mood, and patients will often have periods of normal functioning between psychotic episodes even without medication. Schizophrenia is characterized by psychotic episodes which appear to be unrelated to disturbances in mood, and most non-medicated patients will show signs of disturbance between psychotic episodes.

During the 1960s and 1970s, psychosis was of particular interest to counterculture critics of mainstream psychiatric practice, who argued that it may simply be another way of constructing reality and is not necessarily a sign of illness. For example, R. D. Laing argued that psychosis is a symbolic way of expressing concerns in situations where such views may be unwelcome or uncomfortable to the recipients. He went on to say that psychosis could be also seen as a transcendental experience with healing and spiritual aspects. Arthur J. Deikman suggested use of the term "mystical psychosis" to characterize first-person accounts of psychotic experiences that are similar to reports of mystical experiences. Thomas Szasz focused on the social implications of labeling people as psychotic, a label he argues unjustly medicalises different views of reality so such unorthodox people can be controlled by society. Psychoanalysis has a detailed account of psychosis which differs markedly from that of psychiatry. Freud and Lacan outlined their perspective on the structure of psychosis in a number of works.

Since the 1970s, the introduction of a recovery approach to mental health, which has been driven mainly by people who have experienced psychosis (or whatever name is used to describe their experiences), has led to a greater awareness that mental illness is not a lifelong disability, and that there is an expectation that recovery is possible, and probable with effective support.

See also

• Catastrophic schizophrenia
• Delusional disorder
• Depersonalization
• Hallucinations in the sane
• Jerusalem syndrome
• Menstrual psychosis
• Monothematic delusions
• Mystical psychosis
• Psychedelic experience
• Psychonautics
• Schizophrenia
• Social construction of schizophrenia

References

1. Gelder, Michael (2005). "Psychiatry", P. 12. Oxford University Press Inc., New York. ISBN 9780198528630.
2. Tien AY (1991). "Distributions of hallucinations in the population". Soc Psychiatry Psychiatr Epidemiol. 26 (6): 287–92. doi:10.1007/BF00789221. PMID 1792560. {{cite journal}}: Unknown parameter |month= ignored (help)
3. van Os J, Hanssen M, Bijl RV, Ravelli A (2000). "Strauss (1969) revisited: a psychosis continuum in the general population?". Schizophr. Res. 45 (1–2): 11–20. doi:10.1016/S0920-9964(99)00224-8. PMID 10978868. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
4. Johns, Louise C. (2001). "The continuity of psychotic experiences in the general population". Clinical Psychology Review. 21 (8): 1125–41. doi:10.1016/S0272-7358(01)00103-9. PMID 11702510. Retrieved 2006-08-19. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
5. Harper, Douglas (2001). "hallucinate". Online Etymology Dictionary. Retrieved October 15, 2006. {{cite web}}: Unknown parameter |month= ignored (help)
6. Honig A, Romme MA, Ensink BJ, Escher SD, Pennings MH, deVries MW (1998). "Auditory hallucinations: a comparison between patients and nonpatients". J. Nerv. Ment. Dis. 186 (10): 646–51. doi:10.1097/00005053-199810000-00009. PMID 9788642. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
7. Jaspers, Karl (1997-11-27) . Allgemeine Psychopathologie (General Psychopathology). Translated by J. Hoenig & M.W. Hamilton from German (Reprint ed.). Baltimore, Maryland: Johns Hopkins University Press. ISBN 0-8018-5775-9.
8. Tien AY, Anthony JC (1990). "Epidemiological analysis of alcohol and drug use as risk factors for psychotic experiences". J. Nerv. Ment. Dis. 178 (8): 473–80. doi:10.1097/00005053-199017880-00001. PMID 2380692. {{cite journal}}: Unknown parameter |month= ignored (help)
9. Jauch, D. A. (1988). "Reactive psychosis. I. Does the pre-DSM-III concept define a third psychosis?". Journal of Nervous and Mental Disease. 176 (2): 72–81. doi:10.1097/00005053-198802000-00002. PMID 3276813. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
10. Sharma, Verinder (2003). "Sleep loss and postpartum psychosis". Bipolar Disorders. 5 (2): 98–105. doi:10.1034/j.1399-5618.2003.00015.x. PMID 12680898. Retrieved 2006-09-27. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
11. Chan-Ob, T. (1999). "Meditation in association with psychosis". Journal of the Medical Association of Thailand. 82 (9): 925–930. PMID 10561951. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
12. Devillieres, P. (1996). "". L'Encéphale. 22 (3): 229–31. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
13. Ohayon, M. M. (1996). "Hypnagogic and hypnopompic hallucinations: pathological phenomena?". British Journal of Psychiatry. 169 (4): 459–67. doi:10.1192/bjp.169.4.459. PMID 8894197. Retrieved 2006-10-21. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
14. Sethi NK, Robilotti E, Sadan Y (2005). "Neurological Manifestations Of Vitamin B-12 Deficiency". The Internet Journal of Nutrition and Wellness. 2 (1).{{cite journal}}: CS1 maint: multiple names: authors list (link)
15. Masalha R, Chudakov B, Muhamad M, Rudoy I, Volkov I, Wirguin I (2001). "Cobalamin-responsive psychosis as the sole manifestation of vitamin B₁₂ deficiency". Isr. Med. Assoc. J. 3 (9): 701–3. PMID 11574992. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
16. The Dana Guide to Brain Health
17. Lisanby, S. H. (1998). "Psychosis Secondary to Brain Tumor". Seminars in clinical neuropsychiatry. 3 (1): 12–22. PMID 10085187. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
18. McKeith, Ian G. (2002). "Dementia with Lewy bodies". British Journal of Psychiatry. 180: 144–7. doi:10.1192/bjp.180.2.144. PMID 11823325. {{cite journal}}: Unknown parameter |month= ignored (help)
19. Template:Es icon Rodriguez Gomez, Diego (August 16–31, 2005). "Psicosis aguda como inicio de esclerosis multiple / Acute psychosis as the presenting symptom of multiple sclerosis / Psicose aguda como inicio de esclerose multipla". Revista de Neurología. 41 (4): 255–6. PMID 16075405. Retrieved 2006-09-27. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
20. Bona, Joseph R. (1 August 1998). "Neurosarcoidosis as a Cause of Refractory Psychosis: A Complicated Case Report". American Journal of Psychiatry. 155 (8): 1106–8. PMID 9699702. Retrieved 2006-09-29. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
21. Fallon BA, Nields JA (1994). "Lyme disease: a neuropsychiatric illness". Am J Psychiatry. 151 (11): 1571–83. PMID 7943444. {{cite journal}}: Unknown parameter |month= ignored (help)
22. Hess A, Buchmann J, Zettl UK; et al. (1999). "Borrelia burgdorferi central nervous system infection presenting as an organic schizophrenialike disorder". Biol. Psychiatry. 45 (6): 795. doi:10.1016/S0006-3223(98)00277-7. PMID 10188012. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
23. van den Bergen HA, Smith JP, van der Zwan A (1993). "". Ned Tijdschr Geneeskd (in Dutch; Flemish). 137 (41): 2098–100. PMID 8413733. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link) CS1 maint: unrecognized language (link)
24. Kararizou E, Mitsonis C, Dimopoulos N, Gkiatas K, Markou I, Kalfakis N (May–Jun 2006). "Psychosis or simply a new manifestation of neurosyphilis?". J. Int. Med. Res. 34 (3): 335–7. PMID 16866029.{{cite journal}}: CS1 maint: date format (link) CS1 maint: multiple names: authors list (link)
25. Brooke D, Jamie P, Slack R, Sulaiman M, Tyrer P (1987). "Neurosyphilis—a treatable psychosis". Br J Psychiatry. 151: 556. doi:10.1192/bjp.151.4.556. PMID 3447677. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
26. Lesser JM, Hughes S (2006). "Psychosis-related disturbances. Psychosis, agitation, and disinhibition in Alzheimer's disease: definitions and treatment options". Geriatrics. 61 (12): 14–20. PMID 17184138. {{cite journal}}: Unknown parameter |month= ignored (help)
27. Wedekind S (2005). "". MMW Fortschr Med (in German). 147 (22): 11. PMID 15977623. {{cite journal}}: Unknown parameter |month= ignored (help)
28. Nasky KM, Knittel DR, Manos GH (2008). "Psychosis associated with anti-N-methyl-D-aspartate receptor antibodies". CNS Spectr. 13 (8): 699–703. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
29. Rossman, Phillip L. (1956). "Postpartum Tetany and Psychosis Due to Hypocalcemia". California Medicine. 85 (3): 190–3. PMC 1531921. PMID 13356186. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
30. Jana, D. K. (1973). "Hypernatremic psychosis in the elderly: case reports". Journal of the American Geriatrics Society. 21 (10): 473–7. PMID 4729012. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
31. Haensch, C. A. (1996). "". Der Nervenarzt. 67 (4): 319–22. PMID 8684511. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
32. Hafez, H. (1984). "Hypokalemia-induced psychosis in a chronic schizophrenic patient". Journal of Clinical Psychiatry. 45 (6): 277–9. PMID 6725222. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
33. Konstantakos, Anastasios K. (May 25, 2006). "Hypomagnesemia". eMedicine. WebMD. Retrieved October 16, 2006. {{cite web}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
34. Velasco, P. Joel (1 December 1999). "Psychiatric Aspects of Parathyroid Disease". Psychosomatics. 40 (6): 486–90. PMID 10581976. Retrieved 2006-10-17. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
35. Rosenthal, M. (1997). "Primary hyperparathyroidism: neuropsychiatric manifestations and case report". Israel Journal of Psychiatry and Related Sciences. 34 (2): 122–125. PMID 9231574. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
36. Nanji, A. A. (1984). "The psychiatric aspect of hypophosphatemia". Canadian Journal of Psychiatry. 29 (7): 599–600. PMID 6391648. {{cite journal}}: Unknown parameter |month= ignored (help)
37. Padder, Tanveer (2005). "Acute Hypoglycemia Presenting as Acute Psychosis". Psychiatry online. Retrieved 2006-09-27. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
38. Robert, M. (1 March 2006). "Neuropsychiatric manifestations systemic lupus erythematosus: A study from South India". Neurology India. 54 (1): 75–7. doi:10.4103/0028-3886.24713. PMID 16679649. Retrieved 2006-09-29. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)CS1 maint: unflagged free DOI (link)
39. Evans, Dwight L. (2002-02-01). "Chapter 90: Neuropsychiatric Manifestations of HIV-1 Infection and AIDS". In Kenneth L Davis, Dennis Charney, Joseph T Coyle, Charles Nemeroff (ed.). Neuropsychopharmacology: The Fifth Generation of Progress (5th ed.). Philadelphia: Lippincott Williams & Wilkins. pp. 1281–1301. ISBN 0-7817-2837-1. Retrieved 2006-10-16. {{cite book}}: External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)CS1 maint: multiple names: editors list (link)
40. Lowinger, Paul (1959). "Leprosy And Psychosis". American Journal of Psychiatry. 116 (1): 32–37. doi:10.1176/appi.ajp.116.1.32. PMID 13661445. Retrieved 2006-10-17. {{cite journal}}: Unknown parameter |doi_brokendate= ignored (|doi-broken-date= suggested) (help); Unknown parameter |month= ignored (help)
41. Ponomareff, G. L. (1965). "Phenomenology Of Delusions In A Case Of Leprosy" (PDF). American Journal of Psychiatry. 121 (12): 1211. PMID 14286061. Retrieved 2006-10-17. {{cite journal}}: Unknown parameter |month= ignored (help)
42. Tilluckdharry, C. C. (1996). "A case of vivax malaria presenting with psychosis". West Indian Medical Journal. 45 (1): 39–40. PMID 8693739. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
43. Denier C, Orgibet A, Roffi F, Jouvent E, Buhl C, Niel F, Boespflug-Tanguy O, Said G, Ducreux D (2007). "Adult-onset vanishing white matter leukoencephalopathy presenting as psychosis". Neurology. 68 (18): 1538–9. doi:10.1212/01.wnl.0000260701.76868.44. PMID 17470759.{{cite journal}}: CS1 maint: multiple names: authors list (link)
44. Hermle L, Becker FW, Egan PJ, Kolb G, Wesiack B, Spitzer M (1997). "". Der Nervenarzt (in German). 68 (9): 754–8. PMID 9411279.{{cite journal}}: CS1 maint: multiple names: authors list (link)
45. Black DN, Taber KH, Hurley RA (2003). "Metachromatic leukodystrophy: a model for the study of psychosis". The Journal of neuropsychiatry and clinical neurosciences. 15 (3): 289–93. PMID 12928504.{{cite journal}}: CS1 maint: multiple names: authors list (link)free full text
46. Kumperscak HG, Paschke E, Gradisnik P, Vidmar J, Bradac SU (2005). "Adult metachromatic leukodystrophy: disorganized schizophrenia-like symptoms and postpartum depression in 2 sisters". Journal of psychiatry & neuroscience : JPN. 30 (1): 33–6. PMC 543838. PMID 15644995.{{cite journal}}: CS1 maint: multiple names: authors list (link)
47. Müller N, Gizycki-Nienhaus B, Botschev C, Meurer M (1993). "Cerebral involvement of scleroderma presenting as schizophrenia-like psychosis". Schizophr. Res. 10 (2): 179–81. doi:10.1016/0920-9964(93)90054-M. PMID 8398950. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
48. Wilcox RA, To T, Koukourou A, Frasca J (2008). "Hashimoto's encephalopathy masquerading as acute psychosis". J Clin Neurosci. 15 (11): 1301–4. doi:10.1016/j.jocn.2006.10.019. PMID 18313925. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
49. Gómez-Bernal GJ, Reboreda A, Romero F, Bernal MM, Gómez F (2007). "A Case of Hashimoto's Encephalopathy Manifesting as Psychosis". Prim Care Companion J Clin Psychiatry. 9 (4): 318–9. doi:10.4088/PCC.v09n0411f. PMC 2018852. PMID 17934563.{{cite journal}}: CS1 maint: multiple names: authors list (link)
50. Ray M, Kothur K, Padhy SK, Saran P (2007). "Hashimoto's encephalopathy in an adolescent boy". Indian J Pediatr. 74 (5): 492–4. doi:10.1007/s12098-007-0084-0. PMID 17526963. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
51. Steinberg, D. (1972). "Influenza infection causing manic psychosis". British Journal of Psychiatry. 120 (558): 531–535. doi:10.1192/bjp.120.558.531. PMID 5041533. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
52. Maurizi, C. P. (1985). "Influenza and mania: a possible connection with the locus ceruleus". Southern Medical Journal. 78 (2): 207–209. PMID 3975719. {{cite journal}}: Unknown parameter |month= ignored (help)
53. Keddie, K. M. (1965). "Toxic psychosis following mumps". British Journal of Psychiatry. 111: 691–696. doi:10.1192/bjp.111.477.691. PMID 14337417. {{cite journal}}: Unknown parameter |month= ignored (help)
54. Lake CR, Masson EB, Quirk RS. (1988). "Psychiatric side effects attributed to phenylpropanolamine". Pharmacopsychiatry. 21 (4): 171–81. doi:10.1055/s-2007-1014671. PMID 3060884.{{cite journal}}: CS1 maint: multiple names: authors list (link)
55. Boyd, Alan (1995). "Bromocriptine and psychosis: A literature review". Psychiatric Quarterly. 66 (1): 87–95. doi:10.1007/BF02238717. PMID 7701022. Retrieved 2008-09-06.
57. Moore, M T (1935). "Encephalographic studies in mental disease". American Journal of Psychiatry. 92 (1): 43–67. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
58. Copolov DL, Seal ML, Maruff P; et al. (2003). "Cortical activation associated with the experience of auditory hallucinations and perception of human speech in schizophrenia: a PET correlation study". Psychiatry Res. 122 (3): 139–52. doi:10.1016/S0925-4927(02)00121-X. PMID 12694889. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
59. Pantelis, C (2003). "Neuroanatomical abnormalities before and after onset of psychosis: a cross-sectional and longitudinal MRI comparison". Lancet. 25 (361 (9354)): 281–8. doi:10.1016/S0140-6736(03)12323-9. PMID 12559861. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
60. Ho, BC (2003). "Untreated initial psychosis: relation to cognitive deficits and brain morphology in first-episode schizophrenia". American Journal of Psychiatry. 160 (1): 142–8. doi:10.1176/appi.ajp.160.1.142. PMID 12505813. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
61. Kapur S, Mizrahi R, Li M (2005). "From dopamine to salience to psychosis--linking biology, pharmacology and phenomenology of psychosis". Schizophr. Res. 79 (1): 59–68. doi:10.1016/j.schres.2005.01.003. PMID 16005191. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
62. Jones HM, Pilowsky LS (2002). "Dopamine and antipsychotic drug action revisited". Br J Psychiatry. 181: 271–5. doi:10.1192/bjp.181.4.271. PMID 12356650. {{cite journal}}: Unknown parameter |month= ignored (help)
63. Soyka, Michael (2000). "FDG-PET and IBZM-SPECT Suggest Reduced Thalamic Activity but No Dopaminergic Dysfunction in Chronic Alcohol Hallucinosis". Journal of Neuropsychiatry & Clinical Neurosciences. 12 (2): 287–288. doi:10.1176/appi.neuropsych.12.2.287. PMID 11001615. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
64. Zoldan, J. (1995). "Psychosis in advanced Parkinson's disease: treatment with ondansetron, a 5-HT3 receptor antagonist". Neurology. 45 (7): 1305–1308. PMID 7617188. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
65. Healy, David (2002). The Creation of Psychopharmacology. Cambridge: Harvard University Press. ISBN 0-674-00619-4. {{cite book}}: Cite has empty unknown parameter: |coauthors= (help)
66. Blakemore, SJ (2000). "The perception of self-produced sensory stimuli in patients with auditory hallucinations and passivity experiences: evidence for a breakdown in self-monitoring". Psychological Medicine. 30 (5): 1131–9. doi:10.1017/S0033291799002676. PMID 12027049. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
67. Lohr, JB (1997). "Lateralized hemispheric dysfunction in the major psychotic disorders: historical perspectives and findings from a study of motor asymmetry in older patients". Schizophrophrenia Research. 30 (27 (2-3)): 191–8. doi:10.1016/S0920-9964(97)00062-5. PMID 9416648. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
68. Pizaagalli, D (2000). "Brain electric correlates of strong belief in paranormal phenomena: intracerebral EEG source and regional Omega complexity analyses". Psychiatry Research. 100 (3): 139–154. doi:10.1016/S0925-4927(00)00070-6. PMID 11120441. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
69. Makarec, K (1985). "Temporal lobe signs: electroencephalographic validity and enhanced scores in special populations". Perceptual and Motor Skills. 60 (3): 831–42. PMID 3927256. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
70. Weinstein, S (2002). "Are creativity and schizotypy products of a right hemisphere bias?". Brain and Cognition. 49 (1): 138–51. doi:10.1006/brcg.2001.1493. PMID 12027399. Retrieved 2006-08-19. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
71. Overall JE, Gorham DR. The Brief Psychiatric Rating Scale. Psychol Rep. 1962;10:799-812
72. Birchwood, M (2006). "The future of cognitive-behavioural therapy for psychosis: not a quasi-neuroleptic". British Journal of Psychiatry. 188: 108–108. doi:10.1192/bjp.bp.105.014985. PMID 16449695. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
73. Haddock, G (2005). "Psychological interventions in early psychosis". Schizophrenia Bulletin. 31 (3): 697–704. doi:10.1093/schbul/sbi029. PMID 16006594. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
74. Nathans-Barel, I. (2005). "Animal-assisted therapy ameliorates anhedonia in schizophrenia patients". Psychotherapy and Psychosomatics. 74 (1): 31–35. doi:10.1159/000082024. PMID 15627854. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
75. Birchwood, M (1998). "Early Intervention in Psychosis: The Critical Period Hypothesis". British Journal of Psychiatry. 172 (33): 53–59. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
76. French, Paul (2004). Early Detection and cognitive therapy for people at high risk of developing psychosis. Chichester: John Wiley and Sons. ISBN 0-470-86314-5. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |unused_data= ignored (help)
77. Beer, M D (1995). "Psychosis: from mental disorder to disease concept". Hist Psychiatry. 6 (22(II)): 177–200. doi:10.1177/0957154X9500602204. PMID 11639691. {{cite journal}}: |access-date= requires |url= (help); Cite has empty unknown parameter: |coauthors= (help)
78. Psychosis, Henry George Liddell, Robert Scott, A Greek-English Lexicon, at Perseus
79. "Online Etymology Dictionary". Douglas Harper. 2001. Retrieved 2006-08-19. {{cite web}}: Cite has empty unknown parameter: |coauthors= (help)
80. Berrios G E (1987) Historical Aspects of Psychoses: 19th Century Issues. British Medical Bulletin 43: 484-498
81. Berrios G E and Beer D (1994) The notion of Unitary Psychosis: a conceptual history. History of Psychiatry 5: 13-36

Further reading

• Sims, A. (2002) Symptoms in the mind: An introduction to descriptive psychopathology (3rd edition). Edinburgh: Elsevier Science Ltd. ISBN 0-7020-2627-1

Personal accounts

• Dick, P.K. (1981) VALIS. London: Gollancz. ISBN 0-679-73446-5
• Hinshaw, S.P. (2002) The Years of Silence are Past: My Father's Life with Bipolar Disorder. Cambridge: Cambridge University Press.
• Jamison, K.R. (1995) An Unquiet Mind: A Memoir of Moods and Madness. London: Picador.
  ISBN 0-679-76330-9
• Schreber, Daniel Paul (2000) Memoirs of My Nervous Illness. New York: New York Review of Books. ISBN 0-940322-20-X
• McLean, R (2003) Recovered Not Cured: A Journey Through Schizophrenia. Allen & Unwin. Australia. ISBN 1-86508-974-5
• The Eden Express by Mark Vonnegut
• James Tilly Matthews
• Saks, Elyn R. (2007) The Center Cannot Hold—My Journey Through Madness. New York: Hyperion. ISBN 978-1-4013-0138-5

External links

• www.psychosis-bipolar.com - For persons afflicted, relatives and professionals: information, trialog, interactive therapy portal
• Understanding psychotic experiences from mental health charity Mind
• Psychosis - Causes and symptoms at WikiAnswers

• Disability
• Psychosis
• Greek loanwords