Psychosis: What is Psychosis?
Guest: Dr. Christopher Pelic – Psychiatry & Behavioral
Host: Dr. Kevin Gray – Psychiatry & Behavioral
Dr. Kevin Gray: Hello.
This is Dr. Kevin Gray, from the Medical University of South
Carolina. I’m talking with Dr.
Christopher Pelic, an inpatient attending psychiatrist at the medical
university. We’re talking about a
subject that’s one of the cornerstones in psychiatry, a broad subject called
psychosis. We’ve touched on that in
talking about schizophrenia, but there are other causes of psychosis. Thank you for being with us, Dr. Pelic.
Dr. Christopher Pelic: Thank you, Dr. Gray.
Kevin Gray: Now, I’m trying to put
myself in the situation of a concerned family member. Say I’m a father with the son that I’m
concerned about, a son who had been doing well, but maybe has been more
reluctant to leave the house and is saying things that don’t make a lot of
sense, that are very confusing, and actually sound concerning enough that I
think that he may be dangerous, and is really not the son that I remember. What steps should I take in order to get him
Christopher Pelic: Well, I think the
first thing that you bring up is that there needs to be some evaluation, and I think that’s an excellent point. Although, it can be very difficult getting
one’s loved one to a doctor or an emergency room, whichever is the appropriate
setting. And the example that you
mentioned, you mentioned it towards the end, that there were some concerns
about dangerousness or safety issues on top of the bizarre behavior or, as you
said, talking out of his head.
cases, if someone has been acting unusual or bizarre, you can set them up with
an appointment with a local mental health center for at least an evaluation to
see if there’s more going on. When an
element comes in where there’s some concern about safety or dangerousness,
whether it was threatening statements or behavior, in most of those cases, we
would consider that somewhat urgent.
Patients can act quite erratically if they’re ill. So, what we would recommend in most cases
like that, we suggest that the family try to get the patient to a local
emergency room. Or, if you’re fortunate
enough to be in a community where you have a psychiatric ER, that would do just
as well. But, the main concern here is
that you mentioned something about dangerousness, so the urgency of getting an
evaluation, and getting one soon, would be stressed.
Kevin Gray: So, say that I’ve brought my
son to see you, say this is in the emergency room and you’re there to evaluate
him, what sorts of things are you thinking might be causing this?
Christopher Pelic: When we have someone
with what we would call a new-onset psychosis, or a new-onset of bizarre
behavior, or hallucinations, or paranoia, the first thing we do is take a very
thorough history from the patient and the family and try to gather, really and
truly, how long the symptoms have been going on, maybe they were present but
just very subtle. So, we take a very
thorough history and ask some of those questions, if there’s a family history
of mental health problems, and we’d ask questions about whether or not the
person had been using drugs or had any major medical problems that could cause
second piece to this would be that we would consider, potentially, doing some
blood work, urine screens, and even a brain scan, mainly to look at potential
medical causes that could present with similar symptoms. So, in doing these two things, frequently, we
can gather quite a bit of information that would point us at least in the
direction of whether or not this sounds like it may be a primary mental illness
or something else.
Kevin Gray: One of the things you mentioned
was drug use, and certainly that’s something that is not uncommon in
adolescence and young adulthood. What
sorts of drug use patterns do you see associated with hallucinations, paranoia,
Christopher Pelic: Certainly, there are
a variety of drugs that can cause symptoms of psychosis, particularly during
use. And there’s another subset of
drugs, and alcohol, that can cause symptoms in withdrawal. As far as some of the illicit drugs that can
cause psychosis, or symptoms similar to schizophrenia, things like cocaine or
crack, amphetamines, hallucinogens, ecstasy, even high-dose marijuana use. Adolescents or young adults smoking heavy
amounts of marijuana can make people paranoid, or even have vague
hallucinations. Those would be the main
drugs. And then there are some others
that, on withdrawal, like alcohol, or medicines like valium, on withdrawal, can
cause symptoms that are very similar, that can have psychosis present.
Kevin Gray: You also mentioned medical
illnesses that you would want to rule out or to explore for. What are some common medical illnesses that
may present with psychosis?
Christopher Pelic: That’s a great
question and, interestingly, the number is almost infinite as to different
things that can cause it. Although, some
of things that even I’ve seen in my career, things like lupus, other things
like cancers, especially cancers of the brain, or metastases of cancers to the
brain, other conditions, we’ve even seen patients who’ve had heart attacks, or
stroke, present with symptoms similar to psychosis or schizophrenia, so some
very common things like that, but also some more rare things, like lupus.
Kevin Gray: Now, in imagining myself as
the parent of someone who is undergoing this evaluation and finding that the
evaluation yields nothing, we don’t find a drug use that may have caused it, we
don’t find a medical illness, what are we generally left with, and what does
that mean for my child?
Christopher Pelic: Well, frequently,
especially if it’s what we call a first break of psychosis, it has not been
diagnosed before, we will likely admit the person to the hospital, especially
if there were concerns about safety in the first place. And, during that time, we spend a lot of time
observing the patient and try to differentiate if there is something else that
might be going on, or whether or not it sounds like it may be something like
schizophrenia. And during that
observation period, sometimes we’ll even try medications to see if they help
target some of the symptoms.
then it becomes a little bit of a waiting game where, once the patient gets out
of the hospital, you have to observe and see whether or not the symptoms get
better, worse, or go away. And that
often gives us a clue as to what we’re dealing with. Sometimes there are medical conditions that
are missed initially that are later found, and other drug use that wasn’t
discovered initially is later found.
And, in other cases, it just becomes clear that it’s most likely schizophrenia.
Kevin Gray: Might there be some other
psychiatric or mental illnesses that may present as psychosis, other than
Christopher Pelic: Absolutely. I think even medical personnel don’t fully
understand this well, that there are a lot of other psychiatric conditions that
can cause psychosis. For example, we
mentioned withdrawal from drugs, delirium, which is a state of confusion that
can happen after a significant medical problem.
Depression can even present with some symptoms similar to schizophrenia
where people might hear voices telling them that they’re no good or that they
should hurt themselves. Bipolar mania
often has symptoms of psychosis associated with it.
are various types of dementias that often present with psychotic symptoms, such
as Alzheimer’s, dementia, or even Parkinson’s dementia. Frequently, patients will feel paranoid that
their spouse is cheating on them, that they’re seeing things that aren’t real. So, there are a variety of other mental conditions
that can cause psychotic symptoms, and not just schizophrenia.
Kevin Gray: This is certainly a broad
and very important topic. Thank you for
clarifying so much of this, Dr. Pelic.
Christopher Pelic: Thank you, Dr. Gray.
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