About psychosis or loss of touch with reality

two docsPsychosis can manifest itself in many ways. Some people will hear voices or see things that are not there. Other people will have fixed false beliefs called delusions. Yet other people will have the sensation the radio or television is speaking to them directly or that thoughts are being inserted or withdrawn against their will. Disorganized speech and grossly disorganized behavior can occur. Anything that demonstrates a loss of touch with reality is a psychosis.

Numerous things can cause psychosis like some medical disorders. Substance use is one of the more common causes of psychosis. Also, a personality disorder called Schizotypal Disorder can cause it. Delusional Disorder is also fairly common and simply means that fixed false beliefs predominate the clinical picture. Schizophreniform Disorder is thought of as early schizophrenia but not all people with it go one to develop schizophrenia. Schizoaffective disorder is best thought of as a particular combination of schizophrenia and a mood disorder.

Schizophrenia is a brain disease characterized by a breakdown of thought processes and by a deficit of typical emotional responses. Common symptoms are delusions and disorganized thinking including auditory hallucinations, paranoia, bizarre delusions, disorganized speech, and it is accompanied by significant social or occupational dysfunction. About 1 in 200 people will develop schizophrenia in their lifetime.

How we treat psychosis

Treatment of psychosis depends on accurate diagnosis of the cause of the psychosis. Usually, an a typical antipsychotic will be prescribed such as Seroquel, Abilify, Geodon, Zyprexa or Saphris if the disorder is schizophrenia or its related conditions. With only traditional treatment, in people with a first episode of psychosis a good long-term outcome occurs in 42%, an intermediate outcome in 35% and a poor outcome in 27% but we think adequate attention to nutritional supplements will make the prognosis better.

Many patients with psychosis understandably have depression and anxiety as well. We think it is important to treat these conditions as well as the psychosis. It is the rare patient with schizophrenia who never gets depressed or never develops an anxiety disorder.

It is important to know, that at this time, dietary supplements play an adjunctive role in the treatment of psychosis. That is, they are used in association with an atypical antipsychotic, not in place of one. The potential complications and side effects of psychosis are too severe and to life threating to only try dietary supplements without atypical antipsychotics.

We think vitamin D deficiency plays a role in first episode psychosis so we will send you for a vitamin D blood test. A recent study of first episode psychosis found that vitamin D deficiency was three times more common in such psychosis than in controls. 1  In another recent study, the association of vitamin D deficiency with psychotic features was substantial, with vitamin D deficient subjects 3.5 times more likely to be psychotic than controls.2 Do not be surprised if we put you on high dose vitamin D supplements if you are deficient.

Supplemental antioxidants such as ascorbic acid (vitamin C) have been shown to be helpful. Scientists conducted a controlled trial of vitamin C supplementation in patients being treated for schizophrenia with antipsychotics.3 Forty patients were randomly assigned to either placebo or 500-mg/day of vitamin C for 8 weeks. A significant reduction in total score on the Brief Psychiatric Rating Scale was found in the vitamin C group. We think even higher doses of vitamin C may have helped more.

happy coupleGlutathione is called the body’s master antioxidant because glutathione recharges other antioxidants. People with psychosis have low levels of glutathione and that is often because they do not have enough cysteine in their diet. Dietary availability of cysteine is the rate-limiting step in the production of glutathione.

Branched chain amino acid protein powders are a good source of cysteine and we will also put you on a multivitamin that contain cysteine.  Two grams per day of the most common form of dietary cysteine supplement, N-acetyl cysteine, was much better than placebo in a randomized controlled trial of patients with schizophrenia who were being treated with antipsychotics.4 The multivitamin we put you on also contains selenium, which some studies show may be related to psychosis.5

To date there are eight randomized controlled trial of omega-3 fatty acids in psychosis, some showing benefits and some no benefits.6 However, fatty acids play critical roles in cell membranes of neurons, and certain fatty acids appear to be abnormally low in brains of patients with schizophrenia. The attempt to enhance endogenous levels thus seems a rational and worthwhile goal so expect to be put on omega-3 fatty acids.

Diet plays a role in psychosis in that a diet rich in flavonoids appears to mitigate the symptoms due to their antioxidant properties.7 Good sources of flavonoids include parsley, onions, blueberries and other berries, black tea, green tea, bananas, all citrus fruits, Ginkgo biloba, and very dark chocolate (with a cocoa content of 70% or greater).

References

  1. Crews M, et al. Vitamin D deficiency in first episode psychosis: A case-control study. Schizophr Res. 2013 Sep 20.
  2. Gracious BL, et al.  Vitamin D deficiency and psychotic features in mentally ill adolescents: a cross-sectional study. BMC Psychiatry. 2012 May 9;12:38.
  3. Dakhale GN, Khanzode SD, Khanzode SS, and Saoji A. Supplementation of vitamin C with atypical antipsychotics reduces oxidative stress and improves the outcome of schizophrenia. Psychopharmacology (Berl) 182: 494–498, 2005.
  4. Berk M, Copolov D, Dean O, Lu K, Jeavons S, Schapkaitz I, Anderson-Hunt M, Judd F, Katz F, Katz P, Ording-Jespersen S, Little J, Conus P, Cuenod M, Do KQ, and Bush AI. N- acetyl cysteine as a glutathione precursor for schizophrenia: a double-blind, randomized, placebo-controlled trial. Biol Psychiatry 64: 360–368, 2008.
  5. Benton D. Selenium intake, mood and other aspects of psychological functioning. Nutr Neurosci. 2002 Dec;5(6):363-74. Review.
  6. Akter K, et al. A review of the possible role of the essential fatty acids and fish oils in the aetiology, prevention or pharmacotherapy of schizophrenia. J Clin Pharm Ther. 2012 Apr;37(2):132-9.
  7. Grosso C, Valentao P, Ferreres F, Andrade PB. The use of flavonoids in central nervous system disorders. Curr Med Chem. 2013 Jun 25. [Epub ahead of print].