Psychotic Disorder Due to Another Medical Condition
A diagnosis of psychotic disorder due to another medical condition is given when psychotic symptoms occur alongside a temporary or chronic illness. This may range from a migraine headache to a stroke or traumatic brain injury. People who are genetically disposed or otherwise at high risk of developing a psychotic disorder are more likely to experience a co-occurrence of psychosis and another medical event.
This diagnosis is not given when symptoms are a result of drug use or drug withdrawal; the DSM-5 classifies this as substance-induced psychotic disorder. The diagnosis is also not given if psychosis occurs only during the course of delirium.
According to the DSM-5, symptoms of psychotic disorder due to another medical condition include:
- Hallucinations (hearing or seeing things that don't exist).
- Disorganized speech and thought patterns.
- Symptoms of a medical condition not associated with mental disorders that may cause psychosis, such as schizophrenia spectrum disorder.
Symptoms may be temporary and brief or long-term, persisting long after the associated medical condition has been resolved.
One way in which a person might experience psychosis is through hallucinations. Hallucinations are instances in which a patient will see objects or people that are not in front of them, or sees objects or people that are there, but in a different and distorted way. Hallucinations can be auditory, hearing sounds that do not exist. Psychosis can also include physical feelings on the body that have no explanation and strong feelings or ideas that have no obvious cause.
Another aspect of psychosis can be delusions, which are not just sensory but mental. These can include the feeling that external forces are controlling one’s brain and body. These external forces can be nearly anything, although a frequent one people in psychotic episodes describe is that of God. Delusions can also manifest as the belief that a patient has superhuman or supernatural powers. Delusions can also present themselves as beliefs that remarks that may be mundane or trivial in nature have a secret meaning, typically with the patient believing they’re being persecuted in some manner.
It is possible to be aware of your own hallucinations or delusions to varying degrees. Psychosis has several phases: prodrome, acute, and recovery. During the acute phase of psychosis, it is definitionally the case that the patient believes what they are seeing, feeling, or thinking. That being said, people do not remain in the acute phase forever, and those who have experienced psychosis before may be able to realize they are vulnerable to an oncoming psychotic episode during the prodrome phase. Symptoms of this phase include a depressed mood, a ramping up of anxiety, increased anger, impaired sleeping, and others, all of which can be a warning sign for the patient. In psychiatry, the realization of one’s own psychotic experience is called “insight,” and while a patient in an acute psychotic episode may believe what they’re experiencing, they may also suspect that something has changed and have an awareness that they’re experiencing the world differently. More often, insight can be inferred through the willingness of patients to accept treatment and medication.
Psychotic thoughts can manifest differently in each person, so “typical” thoughts should not be conflated as the only thoughts one might experience. Still, there are some themes for those experiencing psychotic delusions, including the belief of being followed by others, being watched by cameras, having supernatural abilities, songs or comments containing hidden messages, and having one’s thoughts controlled by outside forces.
Psychotic disorder due to another medical condition arises due to changes in brain function associated with the primary medical condition. This condition may include brain tumors, traumatic brain injury, epilepsy, autoimmune disorders, thyroid disease, Huntington’s disease, central nervous system infections, cerebrovascular disease, auditory or visual nerve damage, multiple sclerosis, stroke, or a migraine headache.
Approximately seven percent of people with epilepsy have experienced psychotic episodes. This type of psychosis may occur as a single incident or may come and go, depending on the course of the medical condition.
Medical researchers speculate that some patients with psychotic disorder due to another medical condition have underlying inflammatory or autoimmune disorders that play a role in both the medical condition and the related psychosis. These disorders may also work in tandem with a genetic predisposition to both the medical condition and the associated psychosis.
The most common individual illnesses that can lead to a psychotic episode include dementia, epilepsy, Huntingdon’s Disease, multiple sclerosis, stroke, and many autoimmune conditions, including HIV/AIDs and lupus. Psychosis due to epilepsy has been observed in 2-7.8% of patients. Advanced age is the underlying factor that is most commonly associated with the onset of a psychotic episode associated with another condition.
Epileptic psychosis is one of the most common causes of psychotic disorder due to another medical condition. Psychotic symptoms can arise during seizures (ictal psychosis), following seizures (postictal psychosis), or at a time not related to seizures (interictal psychosis). The prevalence of epileptic psychosis has been reported to be between two and ten percent of those with epilepsy, and is one of the most dangerous outcomes of the disorder. Of the three periods during which psychotic symptoms may occur, postictal psychosis is the most frequent.
Postictal psychosis typically occurs in the days immediately following a seizure but can occur up to a week out. Research has suggested that postictal psychosis is more prevalent in those with seizure foci on both sides of the brain. There are often warning signs before postictal psychosis, with insomnia, restlessness, and irritability being most common. Symptoms of postictal psychosis generally dissipate rapidly when treated with medication such as antipsychotics and benzodiazepines. Postictal psychosis is common enough that some doctors administer low doses of antipsychotic medication prophylactically after a seizure. Postictal psychosis is most commonly seen in people with a long history of drug-resistant seizures. According to research, between 10 and 25 percent of people who experience repeated postictal psychosis will eventually develop interictal psychosis.
Ictal psychosis, a psychotic episode that occurs concurrently with a seizure, is more rare. It typically presents with unresponsiveness and automatic body movements.
Interictal psychosis can occur at any time for people with epilepsy. Data suggests that interictal psychosis is not the result of normal epileptic pathology. The occurrence of interictal psychosis may indicate widespread abnormalities in the brain, or a brain tumor. Typically, interictal psychosis begins only after several years of epileptic seizures. Interictal psychosis is likely to be a chronic condition and should be treated with antipsychotic medication. Some evidence suggests that anti-epileptic drugs may induce psychotic symptoms in patients with interictal psychosis.
In the case of psychotic disorder due to another medical condition, the question of genetics has more to do with the medical condition itself. Epilepsy and Alzheimer’s are known to have a genetic component, as are autoimmune disorders, although autoimmune disorders can also arise due to viral infections, diet, and other environmental conditions. Disorders such as schizophrenia and bipolar disorder, which can cause psychotic episodes, are their own separate conditions and so, therefore, are outside the boundaries of diagnosis of psychotic disorder due to another medical condition.
One way in which medical conditions result in psychotic episodes is through damage to the brain or central nervous system, including auditory or visual nerves. Autoimmune disorders can cause damage to the central nervous system. Epilepsy can be a result of and cause damage to the parietal and temporal lobes of the brain. Generally speaking, the method by which psychotic disorder due to another medical condition arises is due to the specific medical conditions themselves: there is no single instance of damage or dysregulation common to all cases.
Treatment for psychotic episodes of this nature is based on treatment for the triggering condition. Often, treating the primary medical condition results in a remission of psychotic symptoms, but sometimes psychosis continues long after the medical issue has been resolved and further treatment is required if residual symptoms affect daily activities and social relationships.
Antipsychotic medications may be prescribed to help control delusions and hallucinations and prevent the reoccurrence of symptoms.
Whether psychotic disorder due to another medical condition will be temporary or continuous depends on the medical condition. In those conditions that can improve or be resolved through treatment, psychotic episodes are likely to improve along with the resolution of the condition. In recurrent medical conditions, psychotic episodes may cycle through exacerbation and remission along with the condition.
Treatment is dependent largely upon the treatment of the medical condition that caused the psychotic disorder. If the other medical condition is treatable, the concurrent psychosis will likely wane with the treatment of the underlying condition. If the original condition is recurrent and psychotic reactions become frequent, benzodiazepines can be used to calm the patient, anti-depressants, and anti-psychotic medications can also be used to treat the symptoms of psychosis.