About 3% of individuals will go into psychosis at some point in their life. Psychosis is not a disorder in itself but a symptom or condition that can occur for a variety of reasons. Psychosis can occur in mental disorders but can also occur without there being a disorder. Psychosis is a condition in the brain where the connection to reality is partially broken. Thus, it can be difficult for an individual with psychosis to distinguish between imagination and reality.
The main symptoms of psychosis are hallucinations, delusions and disturbance of thoughts. Hallucinations are seeing, hearing or perceiving something that is not happening in real life, such as hearing voices that others do not hear. Delusions are ideas that people believe to be true, but they are not the reality and other people in their community and cultural world do not believe in the idea. Delusions can be a variety of things, such as thinking that others are trying to hurt you. Disturbance of thoughts is described by disturbed structure and flow of thoughts. Thoughts either become very fast or slow, which makes it difficult to control or structure the thoughts. This often causes difficulties in expressionng and even speaking can even becomes incomprehensible.
Psychosis affects thoughts, emotions and how people experience the world. Psychosis is often accompanied by anxiety and sadness and the symptoms of psychosis can lead to social isolation, both because people in psychosis can be scared of or avoid others as well as because others often feel the symptoms to be repulsive and experience incomprehension of the situation.
The manifestation of psychosis in books, episodes and movies is often psychosis in its most exaggerated form and very unrealistic. There, psychosis is often associated with violence and crime when the reality is that people with psychosis are no more dangerous than others, neither to themselves nor others. The recourses for people with a psychosis illness are also often shown in a very unrealistic way. In most books and movies where psychosis occurs, the recourses are either archaic and are not related to the treatments used today or they are very inhumane and in fact illegal. Resources for people with psychotic disorders are many, diverse and completely different to what is often shown in books and the media.
Psychosis is often seen in people with drug abuse but it can also occur when people experience very serious depression or are in a mania and lose connection with reality. Some substances are purely intended to induce a psychotic-like condition, such as hallucinogen drugs that are supposed to produce psychotic symptoms of hallucinations. When people experience such symptoms and are high on drugs it is not considered psychosis but, on the other hand, it can become abuse related psychosis when the drug has passed through the body and psychotic symptoms are still present or appear.
Psychotic disorders are several, but the most common psychotic disorder is schizophrenia. Schizophrenia is a term that many people misunderstand and think that a person with schizophrenia has a split personality or a multiple personality which is not a symptom of schizophrenia. People with schizophrenia experience at least one psychosis. Schizophrenia is accompanied by so-called negative symptoms as well as psychotic symptoms. These symptoms can cause difficulties and impairments in skills, such as communication skills, performing daily activities, studying, working and more. Sometimes people with schizophrenia who are in a psychosis or have recently experienced psychosis have less of a need for communication with others, which can contribute to social isolation. People with schizophrenia are not more violent than other people, although it is often the manifestation of schizophrenia in the media and movies. In fact, people with schizophrenia are usually restrained and do not interact much with others. Violence is a personality trait and if a person with schizophrenia is violent they were violent before the disorder occurred and that would be independent from the disorder.
Although schizophrenia is often portrayed as a difficult disorder that is almost impossible to overcome, the reality is that many people achieve full recovery and most learn to live with the disorder.
How does psychosis manifest itself?
Psychosis is not a disorder in itself but a symptom or condition that can occur for a variety of reasons. Psychosis can occur in mental disorders but can also occur without any disorder. Psychosis is a condition in the brain where the connection with reality is partially broken. Thus, it can be difficult for a person with psychosis to distinguish between imagination and reality. For psychosis to exist, hallucinations and/or delusions need to be present that are not caused by the effects of drugs. Along with hallucinations and delusions, it is common to see a disturbance of thoughts or behaviour.
Hallucinations can come from all of our senses (sight, hearing, smell, taste and touch). Hearing hallucinations are the most common, particularly a voice or voices. You can also experience misperception where perception is misinterpreted, for example hearing the wind and interpreting that as someone whispering.
Delusions are ideas that people believe to be true, but they do not match reality and others in their community and cultural world do not believe in the idea. Common themes of delusions are, for example:
- Persecutory delusions
Example: The FBI is following me.
- Delusions of reference
Example: The news has a message specifically for me.
- Grandiose delusions
Example: I am supposed to save humanity.
- Thought broadcasting/insertion ideas
Example: Everyone can read my thoughts.
Disturbance of thought
In psychosis, it is common for disturbance to occur in the flow of thought that appears as speech disturbance. Speaking will often be inconsistent, too fast or too slow. The person can take a long time to answer questions, respond with ready-made words and move quickly between topics that are only loosely connected and, therefore, often difficult to understand the individual.
Disrupted behaviour can often be associated with the hallucinations and delusions that the individual is experiencing. It can also be described as chaos in behaviour, agitation, inappropriate social behaviour and staring (holding the same body posture for a long time).
The prevalence of schizophrenia is 0.6-1% and it affects both sexes. Symptoms of schizophrenia are divided into positive and negative symptoms. The name of the categories does not describe their severity but their manifestation.
Positive symptoms include hallucinations, delusions, disrupted speech and disruptive behaviour that did not exist before the mental disorder. "Positive" means only that something is added to the person's perception. Positive symptoms today are often called psychotic symptoms, as people's experience of these symptoms is not always positive.
Negative symptoms are a lack of skills that existed before the mental disorder, such as difficulties in concentration and attention, lack of expression of emotion, incentive or initiative, lack of happiness and content-less speech. An example of content-less speech would be to answer the question "How was your day?" with the answer "Good", when it would be more natural to provide a longer answer.
Admissions ward of the mental health department - The mental health emergency department is located on the 1st floor of the mental health facility at Hringbraut. The emergency reception is open from 12:00 to 19:00 on weekdays and from 13:00 to 17:00 at weekends, and the phone number is 543 4050. In case of emergency outside of this time, you can contact the emergency department at Landspitali Fossvogur. https://www.landspitali.is/default.aspx?pageid=bad59938-e65f-11e7-a10b-005056be0005#panel-1fa820b3-e660-11e7-a10b-005056be0005-2
Laugarásinn (mental health treatment department) - For young people with psychotic illnesses in the early stages
Batamiðstöðin - The recovery centre is a "leisure centre" for individuals who are suffering from a mental illness and are admitted in or utilising the national hospital's outpatient department services.
A more detailed list of resources in Iceland can be found here.