There has been a lot in the news lately about people suffering from psychotic episodes. Recently, a man, whom many thought was under the influence of bath salts, took off his clothes and chewed off the face of a homeless man. Toxicology reports denied him being under the influence of bath salts but confirmed marijuana being in his system. Another news event broadcasted the sad episode of a Jet Blue pilot who started behaving in an erratic way, talking in religion themes and Iraq and the end of the world. He had to be restrained by flight attendants and passengers on the airplane before the plane making an emergency landing.
What causes psychosis? Is this a biochemical or genetic condition? Are there environmental factors or health habits that contribute to it? What can be done to treat or prevent the condition from happening?
The definition of psychosis found in Wikepedia is: refers to an abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a “loss of contact with reality”. People suffering from psychosis are described as psychotic. Psychosis is given to the more severe forms of psychiatric disorder, during which hallucinations and delusions and impaired insight may occur.
The two major categories of mental illnesses we often associate with psychosis are the mood disorders such as Depression and Bipolar Disorder as its substypes as well as Schizophrenia. In Bipolar Disorder these psychotic episodes occur during the manic phases of the illness. There are other condtions that can cause psychosis. People under the influence of psychostimulants such as Ritalin or Cocaine or Methamphetamine may become psychotic, particularly if predisposed genetically to psychosis. Lately, in the news we have heard about people acting strangely under the influence of Bath Salts. And very recently, marijuana may have been a factor in the face eating incident.
In later years there is another cause that is being more and more recognized. Children who experience trauma may exhibit psychotic symptoms, particularly hearing voices. These children often don’t meet criteria for drug usage, mood disorders like Bipolar illness or Schizophrenia.
I personally have concerns about Marijuana. Many people would like to think that Marijuana is harmless. It is used for some chronic health issues like pain control and lack of appetite. Unfortunately, it is also being used inappropriately. I have had patients who come see me for an Anxiety problem who have complained to me that pot makes them anxious or even “crazy”. Pot will do this in people that are genetically predisposed toward psychosis. I once saw a promising young 18 year old man deterioriate and contract Schizophrenia, and Marijuana was believed to be the major culprit.
What is the treatment? It depends on the cause. If it is Bipolar Disorder, mood stabilizers and psychotherapy are the treatment of choice. Schizophrenia will probably require antipsychotic medication. If psychostimulants brought it on, they probably will need to be discontinued. For children with the history of trauma, medications may not be as effective as psychotherapy. Although many may find some benefit from both. Finally, the cause of the psychosis of the Jet Blue pilot was found to be the lack of sleep. I can’t emphasize enough the role of sleep in good mental health. I teach all my patients sleep hygiene who come to see me. A brain cannot heal or function optimally without a good nights sleep. What is the optimal amount? About 7-8 hours for most people.
Obesity is sadly at epidemic proportions. Most of us are very aware of the devastating health consequences of obesity: diabetes and other metabolic syndromes, heart disease, stroke, even Cancer. So many are trying to fight the battle of the budge whether it be Weight Watchers, Jenny Craig, Nutrisystem, Atkins and others. There is numerous studies identifying the pros and cons of these programs.
This month I read a very interesting article in the journal of “Diabetes, Obesity and Metabolism” (December) This article reported a very intriguing study not normally looked at in weight loss studies. The study looked at how different weight loss programs effected weight loss success. There were three groups. (1) standard nutrition counseling; or (2) the Department of Veterans Affairs (VA) weight loss program called “MOVE” ;, or (3) methylphenidate treatment plus the MOVE program together. The intervention was for 6 months (26 weeks). The last group targeted decreasing apathy. They did this by administering a medication that decreased apathy (Methylphenidate. ) The results showed all groups to lose weight but it was observed that those in the group that targeted the symptom of apathy lost the most weight. This is no surprise to me.
In my practice I see many people who present with the symptom of apathy, a state of being where this a lack of interest or caring in the things around them. Often a patient will have no motivation or energy to eat healthy, to exercise, to address a health problem or do those things that will help them feel better or be in a healthier state. Many of these patients are depressed but others have anxiety, psychotic illness or sometimes ADHD. Interestingly, I will notice after treatment which may include Cognitive Behavivoral Therapy, nutritional supplements, goal setting, and for some, the use of medication that has an added effect in decreasing apathy, that many report they lose weight. They notice a higher engagement in healthy habits that wasn’t there before. They may notice less binge behavior.
While I don’t advocate the use of medication for everyone, for some people with diagnosable mental health conditions medication may be quite helpful in losing or preventing weight gain through the mechnism of decreasing apathy. Psychotherapy, particularly CBT, is also very useful in helping with weight issues. Anything that will help a person be more mentally healthy I believe will contribute to healthy weight.
Now, I know it is the holiday season, but please do not pass the eggnog!
There have been numerous articles extolling both the benefits and harmfulness of caffeine. Less often has there been research on the effects on mental health. What’s my opinion? I advise caution in its usage.
There has been insufficient studies showing any benefit of caffeine on mental health. A few studies have suggested caffeine has a positive effective on depression and ADHD. This may due to caffeine increasing alertness, attention and cognitive functioning and by possibly elevating mood. There is also preliminary evidence of caffeine benefiting some people struggling with Obsessive Compulsive Disorder which I thought was interesting because OCD is a subset of an anxiety disorder and my experience has seen caffeine making anxiety worse. Neveretheless, the research is compelling.
But do the benefits outweigh the negative side effects? We know that caffeine can increase heart palpitations and contribute to stomach problems such as Gerd. These are annoying troublesome physical side effects. What do we know about its mental health downside? We do know that caffeine is addicting and may encourage other types of addictions like cigarette smoking. We also know that caffeine in large amounts can bring out psychosis and manic behavior as well as exascerbate general anxious states, panic disorder or social anxiety disorder.
My advice is to keep caffeine to a minimum. If you struggle with Depression, OCD or ADHD, see your primary care mental health provider to investigate safer, healthier treatment for your mental health conditions. There are other things less harmful and that can do the job more effectively than caffeine.
Attention families with psychosis among relatives! Omega-3 fatty acids may prevent onset of psychotic disorders in high-risk populations. This is according to a study published by Amminger and associates in the Arch Gen Psychiatry, 2010 Feb;67(2):146-54. The study suggests that a common supplement that we use for heart disease and stroke prevention may also prevent the progression of psychotic illness in those who have what is called prodromal symptoms (or what I call “pre-psychotic symptoms”). What are pre-psychotic symptoms? Early symptoms may include hearing voices or having some unusual sensory experiences; mood disorders; disorganization in surroundings, speech or actions; and unusual motor activities or posturing. My opinion with this study is that it is certainly worth trying as we all have heard how good Omega-3s are for the body and brain. I think too often we are inclined to jump to powerful drugs earlier than is necessary. How about trying upping our fatty fish consumption or using a supplement? For many the Omega-3s may be enough!