Chikugunya fever - a threat to travelers to the Caribbean and

symptoms of insane person

psychosisThe word “crazy” means different things to different people. A cat lady is crazy. That homeless guy on the street is crazy. Your ex girlfriend is crazy (or at least she has a personality disorder).

However, there is a much more interesting, much more dangerous form of crazy – psychosis.

I throw around the words “psychotic” and “psychosis” a lot at work, and sometimes I forget most people don’t know what those terms mean (I didn’t before going through medical school). So here I’m going to break down the concept.

When someone is psychotic it means they are experiencing one (or more) of the following symptoms:

  1. Hallucinations, or a sensory stimulus that isn’t there. For example, a person may see an image that isn’t there (visual hallucination) or hear voices that aren’t there (auditory hallucination).
  2. Delusions. A delusion is a firmly held, fixed, and false belief. Delusions can be nonbizarre, meaning that the belief is unlikely, but within the realm of possibility, such as thinking the CIA is following you. Or they can be bizarre, meaning that the belief is totally impossible, such as thinking aliens implanted a microchip in your brain (this type of delusion is characteristic of schizophrenia).
  3. Disordered thinking. Disordered thought is a hallmark of schizophrenia. It’s evidenced by disordered speech, such as loose associations (jumping from one unrelated topic to the next), thought blocking (stopping conversation midsentence), and “word salad” (speech that is incoherent because words are meaninglessly strung together).

The interesting thing about psychosis is that only a handful of disorders cause these symptoms, so it’s usually not too tricky to narrow down the diagnosis.

[As a side note: Psychosis is not caused by stress (although stress can bring out underlying symptoms). It is (usually) an indication of a serious mental or physical illness. Or an indication that you just did some LSD. It often requires treatment with heavy-duty antipsychotic medications.]

Here’s an overview of the most common conditions leading to psychosis.

Substance-induced psychosis

Probably the most common cause of psychosis is the use of illicit drugs, such as marijuana, hallucinogens (LSD, acid, schrooms), or amphetamines (meth, cocaine). If you don’t experience psychotic symptoms while using hallucinogens you’re probably not getting your money’s worth.

Usually the effect wears off when the drug wears off, although I’ve seen patients who used so many drugs for so long that they have lingering psychotic symptoms even after a period of time off substances.

I see patients who are psychotic after taking drugs at the VA all the time. They go out, do some meth, and then come into the ER sure that the Mexican mafia is trying to kill them or that they’re being followed.