Thought disorders

Overview
Thought disorders are a group of mental illnesses characterized by psychotic symptoms. The term psychotic may refer to delusions and prominent hallucinations or focus on the social and occupational impairment caused by the symptoms.
Delusions are erroneous beliefs on various themes that usually involve a misinterpretation of perceptions or experiences. Delusions are further categorized as bizarre and nonbizarre. Bizarre delusions are clearly implausible, such as delusions of thought withdrawal, thought insertion or thought control. For example, a person might think, "My mind is being controlled by external forces." Nonbizarre delusions may be plausible. For example, a person may believe he or she is under surveillance by the police.

Hallucinations are false perceptions having no relation to reality. They may occur in various forms, often through sound, sight, smell or touch. Hallucinations that occur while falling asleep or waking up are considered to be within the range of normal experience.


Types of thought disorders
Schizophrenia is perhaps the most commonly known thought disorder. By definition, schizophrenia is a chronic, severe and disabling mental illness characterized by symptoms of delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior that last more than six months. The symptoms of schizophrenia significantly impact occupational and social functioning.
Approximately 2 million American adults have schizophrenia, according to the National Institute of Mental Health. It typically appears between the late teens and mid-30s. Diagnosis before adolescence is rare. The first psychotic episode often appears earlier in men, usually in the early to mid-20s. For women, the first psychotic episode is typically in the late 20s. Some people fluctuate between periods of worsening symptoms and periods of remission, while others remain chronically ill. The natural course of schizophrenia without treatment is gradual deterioration. Although treatment may delay deterioration, there is no cure.

Delusional disorder is the occurrence of at least one month of nonbizarre delusions. Schizoaffective disorder is the occurrence of a mood disorder with active-phase symptoms of schizophrenia, such as delusions and hallucinations. With schizophreniform disorder, symptoms are similar to those of schizophrenia but don't last as long.

A brief psychotic disorder is the presence of psychotic features that last more than one day but less than one month. Shared psychotic disorder is the presence of a delusion in one person that is influenced by the delusion of another person. The other person's delusion has similar content but is more firmly established or longer standing. A substance-induced psychotic disorder occurs when psychotic symptoms are related to a physiological cause resulting from drug abuse, medication or toxin exposure.

In some cases, psychotic symptoms develop in relation to a general medical condition. In other cases, a psychotic disorder may be considered unspecified when the symptoms do not meet the criteria for any of the disorders listed above.


Causes/associated factors
A variety of factors may induce an acute psychotic episode, including:
delirium due to medical conditions (such as encephalitis, inflammation of the brain)
Alzheimer's disease
cancer
endocrine disorders
kidney failure
closed head injuries
other medical conditions
sleep deprivation
intoxication or long-term substance abuse
steroid overuse or toxicity
poisoning from substances such as lead, mercury, aluminum or arsenic
electrolyte imbalance
A psychotic episode may also be related to mental health conditions such as depression, anorexia nervosa and post-traumatic stress disorder.

Schizophrenia has a strong genetic basis. First-degree biological relatives of people who have schizophrenia (such as parents, siblings and children) have a 10 times greater risk of developing schizophrenia than the general population, according to the American Psychiatric Association. Some research supports the role of neurotransmitters in the development of schizophrenia, such as the dopamine hypothesis, which states that people who have schizophrenia have excessive activity in the dopamine systems in their brains. Research supported by the National Institute of Mental Health recently discovered evidence of a specific gene that appears to present a vulnerability to schizophrenia. Evidence suggests that several genes on different chromosomes interact with environmental factors to cause illness.

It's important to remember that cultural differences must be taken into account when psychotic symptoms are evaluated. For example, hallucinations may be a normal part of a religious experience in certain cultural contexts. Seemingly inappropriate speech may be influenced by linguistic variations or language barriers across cultures.


Characteristics
Physically, a person who has a thought disorder may experience tics, tardive dyskinesia (slow, involuntary muscular movements), an erratic sleep-wake cycle, or an unusual posture and gait. Some people repeat words spoken by others, while others become mute. Some physical characteristics may be the result of neuroleptic medication.
Psychologically, the person may experience delusions and hallucinations as described above. The person may become extremely negative or develop a flat or inappropriate emotional state. He or she may be unable to initiate or pursue goal-directed activities and experience faulty logic. A preoccupation with bodily functions is also common.

Socially, the person may be argumentative with occasional angry outbursts. He or she may experience a downward drift in lifestyle, such as a deterioration of personal hygiene or a lower socioeconomic status. The person may also display poor social functioning and the inability to pick up on social cues. Alcohol or substance abuse are also common.


Coping
A thought disorder must be assessed and diagnosed by a medical or mental health professional. Antipsychotic medication is typically prescribed. Electroconvulsive therapy (ECT) has been shown to be effective for people on their first admission to inpatient schizophrenia treatment. ECT may also be considered for people who are actively psychotic or in cases that don't respond to neuroleptic medications.
Hospitalization is needed in severe relapse cases or if the person threatens to harm himself, herself or others. Day hospitals are intended for stabilization after an inpatient hospitalization. Day hospitals are typically more intensive and heavily staffed than day treatment centers, but a person is only treated there for a limited time period. Day treatment programs are intended to provide continuing support for people who are in the stabilization phase of their illness. Day treatment programs place a greater emphasis on recreational and prevocational activities. A person's enrollment in a day treatment program is typically not time-limited.

Supportive psychotherapy may also be helpful. This type of treatment can help the person address "here and now" issues such as meeting basic needs, adapting to the illness adaptation strategies, and learning about the illness. Social skills training may also be helpful.

Rehabilitation and community support services can be helpful for people with thought disorders who live on their own. Such services include case management (to help with accessing necessary services and needs) and vocational rehabilitation, including training in job search skills, work skills and supported employment. In some cases, supervised living situations may be helpful to ensure treatment compliance. Long-term institutional care may be needed for people who have severe cognitive deficits or resist treatment.

Tips for managing a thought disorder

Take your prescribed medication on a regular basis, at the same time each day if possible. If you're not satisfied with your medication regimen, work with your psychiatrist to find one that's more effective. New antipsychotics with fewer side effects are being developed all the time.

Maintain structure in your daily life. Eat regular and nutritious meals and get plenty of exercise and rest. Going to school or working, even on a part-time basis, can help create a routine that provides an opportunity to socialize with others.

Set short- and long-term goals. Write them down so you can refer to them often.

Avoid street drugs and alcohol. They may interfere with your medication, as well as aggravate the schizophrenia process.

Explore unusual thoughts and behaviors with the assistance of a mental health professional. Understanding what's real and what's not can help you cope with societal expectations. Try to understand the possible triggers for psychotic episodes and avoid them if possible. It's also helpful to recognize the signs and symptoms of a relapse.
Tips for loved ones

Treat your loved one with respect. Most thought disorders do not occur 24 hours a day -- normal thinking and behavior are typically present at least some of the time.

Stay safe. If your loved one seems threatening, remain calm. Don't argue or escalate the situation. Do your best to make sure your loved one is safe, but know that you may have to leave the situation temporarily. Seek additional help if necessary. Most law enforcement professionals are trained to deal with violent situations.

Do not challenge a harmless delusion. If a delusion is paranoid and causes your loved one discomfort or danger, you might try to redirect his or her thinking in another direction. Try to stay as "normal" as possible during the interaction and don't let the situation become violent. Be a role model for appropriate behavior and thinking.

Do not lie to your loved one. If he or she asks for feedback about delusional thinking, state simply that others would not share that view.

Encourage your loved one to continue taking his or her medication. If possible, develop a method to monitor your loved one's behavior with the assistance of a mental health professional.

If possible, establish a relationship with your loved one's psychiatrist or other mental health professional. Your loved one may need to sign a legal release of information.

Join or start a support group. Dealing with mental illness can create stressful situations for family members and friends. Sharing this stress and concern with others who are in a similar situation may be very helpful.