Psychosis: Between 15 & 25? Be a little more careful

Mental illness. What kind of a picture does the word conjure up in your mind?

The most striking feature of a severely ill person is his odd behaviour. He may do any of a number of things, none of which can be understood by people around him. He may talk or laugh to self, or may appear to be holding a conversation with imaginary people.

That is because he is probably hearing voices or seeing visions of people and responding to them. He might suddenly get angry, stare at you and accuse you of trying to harm him, or even turn violent. His speech may make no sense at all as sentences may be unconnected, or he may switch topics mid-sentence.

He may appear extremely frightened, complaining of being watched or followed by people, or even by airplanes or satellites, or people on television.

However, it is also possible that he may do none of these things, but keep severely to himself, not speaking, not making eye contact when spoken to, preferring to stay in his own inner world, sometimes even breaking down and crying for no obvious reason.
If you had known this person as a quiet, gentle and responsible individual you will be baffled and distressed to see him in this state. What happened to the conscientious person who worked diligently at his job? Why did he stop working? When did the angry scowl replace the ready smile you were used to seeing? How did such a polite person turn so misanthropic and violent?

This mental state is referred to as psychosis. Psychosis is a syndrome, ie, a group of symptoms that can be associated with different psychiatric disorders, but is not a specific disorder itself. It affects males and females equally. Unfortunately, the most common age of onset is between 15 and 25 years, when a person is going through the most important part of his education, or the early days of his career and marriage. But no age group is completely exempt as anyone can become mentally ill at any age, nothing in his past giving an indication that this is going to happen.

Why does it happen?
There are several theories that attempt to explain the reasons for these symptoms. One well-accepted theory points to increased activity of certain chemicals, primarily dopamine and serotonin, in certain parts of the brain.

How do you deal with it?
The aim of treatment is to lower the activity of these chemicals using medicines. However, every case does not respond equally well to the same medicines anymore than all headaches respond equally to all painkillers. If the response to a drug is unsatisfactory the doctor may switch the patient to another one after an adequate trial.

Even so, medicines work extremely well in controlling most of the symptoms, which is what is required at the point when a person has just had a psychotic breakdown. This is a medical emergency as he may be a danger to himself or to others. He should be seen as soon as possible by a psychiatrist, and helped to calm down and rest with the help of appropriate medication. Investigations to rule out physical causes like some forms of epilepsy, infections like encephalitis, deficiency of vitamin B 12, endocrine disorders, electrolyte disturbances and abuse of recreational drugs like cannabis, may need to be done.

It is most important for everybody else to understand that the person is not misbehaving, but has lost touch with reality and has no control over his mind. His thought process has shut down. It is like the effect of a voltage surge on a trip switch; however, ‘resetting’ it takes as much time as it takes for the medicine to work, which may be a few days or weeks.

Once he has returned to his normal — or nearly normal — level of functioning, both the patient and his family members have to understand the implications of the episode for the future.
This should be discussed at length with the treating doctor, so that a relapse or recurrence can be prevented.

— Dr Shyamala Vatsa is a consultant psychiatrist