I doubt that they any psychosis(as in a complete break or loss touch with reality), probably a more milder form of neurosis.
I think that with all the stress they are facing to keep their delusions of greatness alive that they may be prone to psychosis as their situation gets worse and worse they may experience a complete or more profound break with reality.
http://medical-dictionary.thefreedictionary.com/psychosis
Psychosis is a symptom or feature of mental illness typically characterized by radical changes in personality, impaired functioning, and adistorted or nonexistent sense of objective reality.
Description
Patients suffering from psychosis have impaired reality testing; that is, they are unable to
distinguish personal subjective experience from thereality of
the external world. They experience hallucinations and/or delusions that they believe are real, and may behave and communicate inan
inappropriate and incoherent fashion. Psychosis may appear as a
symptom of a
number of
mental disorders, including mood andpersonality disorders. It is
also the defining feature of
schizophrenia,
schizophreniform disorder, schizoaffective disorder,
delusionaldisorder, and the psychotic disorders (i.e., brief psychotic disorder, shared psychotic disorder, psychotic disorder due to a
general medicalcondition, and substance-induced psychotic disorder). Causes and symptoms
Psychosis may be caused by the interaction of biological and psychosocial factors depending on the disorder in which it presents; psychosiscan also be caused by purely social factors, with no biological component.
Biological factors that are regarded as contributing to the development of psychosis include genetic abnormalities and substance use. Withregard to chromosomal abnormalities, studies indicate that 30% of patients diagnosed with a psychotic disorder have a microdeletion atchromosome 22q11. Another group of researchers has identified the gene G72/G30 at chromosome 13q33.2 as a susceptibility gene for child-hood-onset schizophrenia and psychosis not otherwise specified.
With regard to
substance abuse, several different research groups reported in
2004 that cannabis (
marijuana)
use is a
risk factor for the onsetof
psychosis. Migration is a social factor that influences people's susceptibility to psychotic disorders. Psychiatrists in Europe have noted the increasing rateof schizophrenia and other psychotic disorders among immigrants to almost all Western European countries. Black immigrants from Africa orthe Caribbean appear to be especially vulnerable. The stresses involved in migration include family breakup, the need to adjust to living in largeurban areas, and social inequalities in the new country.
Schizophrenia, schizophreniform disorder, and schizoaffective disorder
Psychosis in
schizophrenia and perhaps schizophreniform disorder appears to be
related to
abnormalities in
the structure and chemistry of
thebrain, and appears to
have strong genetic links; but its course and severity can be
altered by
social factors such as
stress or a
lack of
supportwithin the family. The cause of
schizoaffective disorder is
less clear cut, but biological factors are also suspected. Delusional disorder
The exact cause of delusional disorder has not been conclusively determined, but potential causes include heredity, neurological abnormalities,and changes in brain chemistry. Some studies have indicated that delusions are generated by abnormalities in the limbic system, the portion ofthe brain on the inner edge of the cerebral cortex that is believed to regulate emotions. Delusional disorder is also more likely to develop inpersons who are isolated from others in their society by language difficulties and/or cultural differences.
Brief psychotic disorder
Trauma and stress can cause a
short-term psychosis (less than a
month's duration) known as
brief psychotic disorder. Major life-changingevents such as
the death of a
family member or a
natural disaster have been known to
stimulate brief psychotic disorder in
patients with no
prior history of
mental illness. Psychotic disorder due to a general medical condition
Psychosis may also be
triggered by an
organic cause, termed a
psychotic disorder due to a
general medical condition. Organic sources of
psychosis include neurological conditions (for example, epilepsy and cerebrovascular disease), metabolic conditions (for example, porphyria),endocrine conditions (for example, hyper- or
hypothyroidism),
renal failure, electrolyte imbalance, or
autoimmune disorders.
Substance-induced psychotic disorder
Psychosis is
also a
known side effect of
the use, abuse,
and withdrawal from certain drugs. So-called recreational drugs, such as
hallucinogenics, PCP, amphetamines, cocaine,
marijuana, and alcohol, may cause a
psychotic reaction during use or
withdrawal. Certainprescription medications such as
steroids, anticonvulsants, chemotherapeutic agents, and antiparkinsonian medications may also inducepsychotic symptoms. Toxic substances such as
carbon monoxide have also been reported to
cause substance-induced psychotic disorder. Shared psychotic disorder
Shared psychotic disorder, also known as folie à deux or psychosis by association, is a relatively rare delusional disorder involving two (ormore) people with close emotional ties. In the West, shared psychosis most commonly develops between two sisters or between husband andwife, while in Japan the most common form involves a parent and a son or daughter. Shared psychosis occasionally involves an entire nuclearfamily.
Psychosis is characterized by the following symptoms:
- Delusions. Those delusions that occur in schizophrenia and its related forms are typically bizarre (i.e., they could not occur in real life).Delusions occurring in delusional disorder are more plausible, but still patently untrue. In some cases, delusions may be accompanied byfeelings of paranoia.
- Hallucinations. Psychotic patients see, hear, smell, taste, or feel things that aren't there. Schizophrenic hallucinations are typically auditoryor, less commonly, visual; but psychotic hallucinations can involve any of the five senses.
- Disorganized speech. Psychotic patients, especially those with schizophrenia, often ramble on in incoherent, nonsensical speech patterns.
- Disorganized or catatonic behavior. The catatonic patient reacts inappropriately to his/her environment by either remaining rigid and immobileor by engaging in excessive motor activity. Disorganized behavior is behavior or activity that is inappropriate for the situation, orunpredictable.
Diagnosis
Patients with psychotic symptoms should undergo a
thorough physical examination and history to
rule out such possible organic causes as
seizures, delirium, or
alcohol withdrawal, and such other psychiatric conditions as
dissociation or
panic attacks. If a
psychiatric cause such as
schizophrenia is
suspected, a
mental health professional will typically conduct an
interview with the patient and administer one of
severalclinical inventories, or
tests, to
evaluate mental status. This assessment takes place in
either an
out-patient or
hospital setting. Psychotic symptoms and behaviors are considered psychiatric emergencies, and persons showing signs of
psychosis are frequently taken by
family, friends, or
the police to a
hospital emergency room. A
person diagnosed as
psychotic can be
legally hospitalized against his or
her will,particularly if he or
she is
violent, threatening to
commit suicide, or
threatening to
harm another person. A
psychotic person may also be
hospitalized if he or
she has become malnourished or
ill as a
result of
failure to
feed, dress appropriately for the climate, or
otherwise take careof
him- or
herself. Treatment
Psychosis that is symptomatic of schizophrenia or another psychiatric disorder should be treated by a psychologist and/or psychiatrist. Anappropriate course of medication and/or psychosocial therapy is employed to treat the underlying primary disorder. If the patient is considered tobe at risk for harming himself or others, inpatient treatment is usually recommended.
Treatment of shared psychotic disorder involves separating the affected persons from one another as well as using antipsychotic medicationsand psychotherapy.
Antipsychotic medication such as
thioridazine (Mellaril), haloperidol (Haldol), chlorpromazine (Thorazine), clozapine (Clozaril), sertindole(Serlect), olanzapine (Zyprexa), or
risperidone (Risperdal) is
usually prescribed to
bring psychotic symptoms under control and into remission.Possible side effects of
antipsychotics include dry mouth,
drowsiness, muscle stiffness, and tardive dyskinesia (involuntary movements of
the body). Agranulocytosis, a
potentially serious but reversible health condition in
which the white blood cells that fight infection in
the body aredestroyed, is a
possible side effect of
clozapine. Patients treated with this drug should undergo weekly blood tests to
monitor white blood cellcounts for the first six months, then every two weeks. After an acute psychotic episode has subsided, antipsychotic drug maintenance treatment is typically employed and psychosocial therapy andliving and vocational skills training may be attempted.
Prognosis
Prognosis for brief psychotic disorder is quite good; for schizophrenia, less so. Generally, the longer and more severe a psychotic episode, thepoorer the prognosis is for the patient. Early diagnosis and treatment are critical to improving outcomes for the patient across all psychoticdisorders.
Approximately 10% of America's permanently disabled population is comprised of schizophrenic individuals. The mortality rate of schizophrenicindividuals is also high—approximately 10% of schizophrenics commit suicide, and 20% attempt it. However, early diagnosis and long-termfollow up care can improve the outlook for these patients considerably. Roughly 60% of patients with schizophrenia will show substantialimprovement with appropriate treatment.
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