Demystifying Psychosis: Understanding Hallucinations, Delusions, Causes, and Treatment

This podcast episode, hosted by psychiatrist Dr. Tracey Marks, provides a comprehensive overview of psychosis, defining it as a state where an individual is unable to distinguish between what is real and what is not. Dr. Marks meticulously breaks down the two primary manifestations of psychosis: hallucinations and delusions. She explains that hallucinations can involve any of the five senses, detailing auditory, visual, olfactory, tactile, and gustatory types, and provides clear examples for each, such as hearing one's name called or feeling bugs crawling on the skin. She also makes a crucial distinction between a true hallucination and a misperception or illusion, using the common experience of mistaking a chair for a person in the dark.

The discussion then shifts to delusions, which are defined as fixed false beliefs that persist despite contradictory evidence or extreme unlikelihood. Dr. Marks outlines several common types of delusions, including persecutory (e.g., believing one is being followed), referential (e.g., receiving special messages from television), grandiose (e.g., believing oneself to be famous), religious (e.g., believing oneself to be a deity), somatic (e.g., believing a chip is planted in one's head), and delusions of control (e.g., believing one's mind is being controlled by others). This categorization helps listeners understand the diverse ways these false beliefs can manifest.

The episode further explores the various etiologies of psychosis, emphasizing that it is not exclusively linked to psychiatric disorders. While conditions like schizophrenia, bipolar disorder, and severe depression are common causes, Dr. Marks highlights other significant factors. These include medication side effects, such as "steroid psychosis," illicit substance use like marijuana and hallucinogens (e.g., LSD), and a range of medical problems, including seizures, thyroid disease, and even the postpartum period following childbirth. This broad perspective underscores the complex interplay of biological, neurological, and pharmacological factors that can lead to a psychotic state.

Finally, Dr. Marks addresses the critical aspect of treatment, stressing that the approach must be tailored to the underlying cause. If psychosis stems from a medical illness, treating that specific condition is paramount. For psychosis arising from a psychiatric disorder, medication is presented as the primary and necessary intervention. She explicitly states that individuals experiencing delusions and other psychotic symptoms "just can't be talked down," highlighting the biological basis of these conditions and the limitations of non-pharmacological approaches in acute phases. This reinforces the importance of professional medical and psychiatric care for effective management.

Psychosis is simply a state where you're unable to tell what's real and what's not real.

Hallucinations can involve any of your five senses.

With a misperception there is something there you just may think it's something else.

Auditory and visual hallucinations tend to be the most common in psychiatric illnesses.

Delusions are fixed false beliefs and that's the textbook definition.

Another way of saying it is believing something false despite facts that that say that it's not true or it being extremely unlikely to be true.

You don't have to have a psychiatric disorder to become psychotic.

If it's from a medical illness you treat that illness. If it's from a psychiatric disorder you the treatment is medication.

And sorry to say that for the pill haters out there but someone just can't be talked down from their delusions and their psychotic symptoms.