like someone walking through a dark parking lot

First, a little classification: “psychosis” actually only describes conditions that involve symptoms such as delusions and hallucinations. They can occur in many diseases, but usually involve schizophrenic disorders. The most visible symptom, apart from the previously mentioned changes in perception, is the feeling of being chased. In addition, many patients report that they “hear voices”, often more than one. The situation is made worse by the fact that they often discuss very unpleasant topics. Therefore, patients often attach great importance to these voices. It is very difficult for people affected by this disorder to ignore or question it.

What are the causes of psychotic diseases such as schizophrenia?

There is a so-called vulnerability-stress model. It assumes that there is a certain sensitivity that is, for example, genetically determined. However, the risk of developing the disease may also be increased by pregnancy complications and other factors affecting early brain development. However, these risk factors do not mean that psychosis will necessarily occur later in life. This usually only happens when external factors such as stress come into play. We often see people experience psychotic symptoms after a particular life event, such as a change of residence – it has even been proven that the risk of developing psychosis increases when migrating to another country.

Moving house can be a very stressful experience (illustrative photo)fizkes / Shutterstock

What role does cannabis consumption play in the development of psychotic illnesses?

Adolescents who regularly consume cannabis before the age of 15 are much more likely to develop psychosis. This is thought to be related to the effects of cannabis on the endocannabinoid system in young people's developing brains. If adults consume cannabis occasionally, their risk of psychosis is usually not increased. However, consuming cannabis at a young age is not a good idea.

It is often associated with concentration disorders, anxiety, social withdrawal and other negative consequences for mental, social and school development. The most important thing, however, is that young people do not learn to influence mood swings and social problems so well through their own actions and become accustomed to regulating unpleasant emotions using intoxicating substances. The fact that someone suddenly becomes psychotic after taking a single psychoactive substance such as LSD or cannabis is a rather unique situation.

How many people experience psychosis or at least a psychotic episode in their lives?

In the case of schizophrenia, this is quite well researched: it affects 1 to 2 percent. population. If we define it a bit more broadly and include all psychotic disorders, we get about 5%. Compared to depression or anxiety disorders, these are relatively rare diseases.

How can I as a friend or relative recognize if someone I care about is developing a psychotic disorder?

It is very typical for affected people to withdraw and appear anxious or depressed. Another early symptom is impaired concentration and thinking, and sometimes also altered visual and auditory perception. If such changes in behavior occur without a direct cause and persist for more than four weeks, you should see a doctor or psychologist.

Do people suffering from psychosis usually consult a doctor too late?

Many people do not like to talk about mental illnesses, even though they affect 30-40 percent of people. people throughout their lives. We have to learn to approach this topic normally. However, people affected by psychotic illnesses and their loved ones experience particular stigmatization. They often deny symptoms, delay treatment or do not want others to know about it.

In this case, it has particularly disastrous consequences: schizophrenia appears several years earlier – and usually first appears in young adulthood. The earlier treatment is started, the better the prognosis and the smaller the negative consequences for life. Even if a patient already has specific symptoms, in our health care system it usually takes another year before treatment is started. Lack of early diagnosis is the main problem. If we improved this situation, most of the unfavorable courses of the disease could be avoided.

The article continues below the video

What is the typical treatment for a psychotic illness such as schizophrenia?

If early symptoms are present, much can be achieved with psychotherapy alone, such as cognitive behavioral therapy. That's why early diagnosis is so important. If someone already has hallucinations or delusions, additional drug treatment is helpful. In modern therapy, family members are also involved in this process – for example, they are encouraged to exchange experiences with other families affected by this disease. A relatively new solution is to include people who have previously suffered from mental illness in the therapeutic team. These so-called recovery companions often have easier contact with patients, gain their trust more easily, and encourage them by telling them about their own recovery story. In modern treatment, people affected by the disease should also receive support from job and school coaches in taking up employment or continuing education.

There are many objections to pharmacological therapy with neuroleptics [lekami przeciwpsychotycznymi z grupy leków psychotropowych]. Many patients are afraid of side effects and subsequent consequences of taking them.

Ultimately, it depends largely on what drug is taken and at what dose. In the past, typical antipsychotics or neuroleptics had serious side effects that included “flattening” of emotions and movement disorders. This is primarily due to the fact that they affect dopamine metabolism [tzw. hormonu przyjemności]which is disturbed in psychotic diseases. With newer agents, so-called atypical antipsychotics, such side effects occur less frequently and only at higher doses. The goal is to keep the dose so low that there are no or very few side effects. Therefore, decisions [o przyjmowaniu neuroleptyków] should always be undertaken together with the patient and after explaining the situation as best as possible.

People suffering from psychotic illnesses are often stigmatized, called “crazy” or very dangerous. Are they really a threat?

Indeed, the likelihood that a person suffering from schizophrenia, for example, will harm someone else is higher compared to the general population. Unfortunately, however, people with serious mental illness are much more likely to become victims of violent crime themselves than the average person. Over 90 percent acts of violence in society are committed by mentally healthy people. The risk of becoming a victim of violence from a perpetrator suffering from a mental illness is therefore very small.

**

Andreas Bechdolf is head of the Berlin clinic for psychiatry, psychotherapy and psychosomatics at the Vivantes Klinikum am Urban and Friedrichshain and professor of psychiatry at the University of Cologne. A specialist in psychiatry and psychotherapy, he studied medicine in Aachen and Berlin and was awarded, among others, the Gerd Huber Preis for the prevention of psychoses.