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Hans de Vries

Brain damaga due to psychosis

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What kind of changes occur in the brain due to psychosis/schizophrenia? 

 

Is there actual loss of neurons and damage to white matter tracts?

 

If yes, can similar permanent brain changes occur due to milder psychiatric diseases i.e. depression/anciety or bipolar?

Edited by Hans de Vries

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I do not feel like citing the correct references, but as a matter of fact, yes. Nearly all psychiatric illnesses have organic impact on the brain. And not a good impact, for that matter. During my internship in psychiatry, I observed a lot of MRI scans of people admitted with depression, psychosis, bipolar disorder ... 

1 thing they had in common: white matter lesions.

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In the tertiary care centre where I had my internship, yes, they did, as should be done quite routinely to exclude large organic causes (such as acquired brain injuries) for their pathology.

Here, it's important to not that it's a tertiary care centre we're talking about. As a GP, you shouldn't have MRI scans done of anyone seeing you for depression ...

Edited by Function

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3 hours ago, Hans de Vries said:

What kind of changes occur in the brain due to psychosis/schizophrenia? 

 

Is there actual loss of neurons and damage to white matter tracts?

 

If yes, can similar permanent brain changes occur due to milder psychiatric diseases i.e. depression/anciety or bipolar?

Your question is now unlike the perennial conundrum "Which came first, chicken or egg?"  For psychosis to occur there must be a cause that alters brain function, chemistry or structure.  Rather than a cause, psychosis is primarily an effect of some influence on brain function, chemistry or structure, which may lead to further functional and structural deterioration. The key is to determine and address the functional or structural cause of a psychosis--a determination of whether the disorder arises from some environmental, social or physical cause.

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I think it is important to make a distinction between psychosis and schizophrenia. While I am not an expert in the precise definition, from what I understand psychosis is a condition when the patient has issue with identifying something as real or not. Psychosis can be a symptom of a mental illness, such as schizophrenia, but they have additional diagnostic symptoms. 

As such, psychotic episodes can be caused by a variety of sources, such as drugs or sleep deprivation. While under these episodes brain activity may be altered (which could be visible on MRIs) in these examples the brain is not damaged per se. However, conditions that can cause prolonged psychosis are a different matter. Schizophrenia, for example is associated with a reduction of grey matter and this loss appears to be progressive. As DrmDoc mentioned, the mechanism behind that is not clear. However, since psychosis can occur without damages, and are the result of altered activities (at leas in some cases), there is good reason to assume they are more likely the result. 

On the other hand, there was some evidence that early treatment of psychosis with antipsychotics  may result in slower detoriation. It still unclear whether this is because prolonged psychosis can lead to additional damages, or whether antipsychotics deal with something that actually do the damage. As a whole it seems that the neurprotective hypothesis as well as the hypothesis that psychosis may result in neural damage does not have a lot of evidence to date.

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2 hours ago, CharonY said:

I think it is important to make a distinction between psychosis and schizophrenia. While I am not an expert in the precise definition, from what I understand psychosis is a condition when the patient has issue with identifying something as real or not. Psychosis can be a symptom of a mental illness, such as schizophrenia, but they have additional diagnostic symptoms. 

As such, psychotic episodes can be caused by a variety of sources, such as drugs or sleep deprivation. While under these episodes brain activity may be altered (which could be visible on MRIs) in these examples the brain is not damaged per se. However, conditions that can cause prolonged psychosis are a different matter. Schizophrenia, for example is associated with a reduction of grey matter and this loss appears to be progressive. As DrmDoc mentioned, the mechanism behind that is not clear. However, since psychosis can occur without damages, and are the result of altered activities (at leas in some cases), there is good reason to assume they are more likely the result. 

On the other hand, there was some evidence that early treatment of psychosis with antipsychotics  may result in slower detoriation. It still unclear whether this is because prolonged psychosis can lead to additional damages, or whether antipsychotics deal with something that actually do the damage. As a whole it seems that the neurprotective hypothesis as well as the hypothesis that psychosis may result in neural damage does not have a lot of evidence to date.

I suppose one difference is that schizophrenia describes a persistent illness and psychosis describes a symptom, which may be transient or not.

Edited by StringJunky

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9 minutes ago, StringJunky said:

I suppose one difference is that schizophrenia describes a persistent illness and psychosis describes a symptom, which may be transient or not.

That is how I organize it in head and in medical literature it is often referred to as a collection of symptoms (as it can manifest in different ways). However, there are parts which treat is as a condition (think brain state) which creates the various observable features that in conjunction we refer to as psychosis. It is not horribly different, but represents the various levels from which we could look at psychosis. I.e. the manifestation or symptom of some overarching disease/condition, or a condition itself that elicits some form of disjunction with reality.

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1 hour ago, StringJunky said:

I suppose one difference is that schizophrenia describes a persistent illness and psychosis describes a symptom, which may be transient or not.

Actually, schizophrenia is one of the "psychosis spectrum disorders", and "psychosis" as such is more of a syndrome, rather than a symptom in itself. A psychosis is an event or episode characterised by either hallucinations, delusions, very chaotic or catatone behaviour, inconsistent speach, or negative symptoms. For schizophrenia, at least two of these "psychotic" characteristics should be present (the "A criterium" for schizophrenia) for a duration of at least 6 months. Comparably, schizophreniform disorder is basically the same, but lasts between 1 month and 6 months.

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7 minutes ago, Function said:

Actually, schizophrenia is one of the "psychosis spectrum disorders", and "psychosis" as such is more of a syndrome, rather than a symptom in itself. A psychosis is an event or episode characterised by either hallucinations, delusions, very chaotic or catatone behaviour, inconsistent speach, or negative symptoms. For schizophrenia, at least two of these "psychotic" characteristics should be present (the "A criterium" for schizophrenia) for a duration of at least 6 months. Comparably, schizophreniform disorder is basically the same, but lasts between 1 month and 6 months.

OK. I was seeing "psychotic" as specific grade of lucidity i.e. none. You might  be schizophrenic but not psychotic all of the time. Is a person with schizophrenia, who is functioning socially normally but still hears voices in a psychotic state as per psychiatric conventions? 

Edited by StringJunky

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53 minutes ago, Function said:

Actually, schizophrenia is one of the "psychosis spectrum disorders", and "psychosis" as such is more of a syndrome, rather than a symptom in itself. A psychosis is an event or episode characterised by either hallucinations, delusions, very chaotic or catatone behaviour, inconsistent speach, or negative symptoms. For schizophrenia, at least two of these "psychotic" characteristics should be present (the "A criterium" for schizophrenia) for a duration of at least 6 months. Comparably, schizophreniform disorder is basically the same, but lasts between 1 month and 6 months.

I think that is what is confusing to me as it seems to shift dependent on what type of researcher you talk to. I have seen psychosis discussed as a syndrome, which makes sense as they are characterized as by different set of symptoms themselves. On the other hand, I have heard it referred to as a symptoms of certain conditions, including disorders, drug use etc. (i.e. what one could consider a higher level of classification), which are used as end-point classifiers. 

As a caveat, all I have learned is second-hand based on my medical collaboration partners, so there is also the possibility that I misunderstand things or that it is just lingo (e.g. they use symptom, when the accurate descriptor would be psychotic symptom perhaps?- I should ask next time). 

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19 minutes ago, CharonY said:

I think that is what is confusing to me as it seems to shift dependent on what type of researcher you talk to.

Yes I also find that to be the case.

However, this does not make sense

5 hours ago, CharonY said:

While I am not an expert in the precise definition, from what I understand psychosis is a condition when the patient has issue with identifying something as real or not. 

 

If a person sees, hears etc something that is not real, is that not a hallucination, whether that person distinguishes it as not real or not ?

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15 minutes ago, studiot said:

Yes I also find that to be the case.

However, this does not make sense

 

If a person sees, hears etc something that is not real, is that not a hallucination, whether that person distinguishes it as not real or not ?

You can have a hallucination and know it's not real, which I wouldn't class as a psychotic event but maybe that's not the expert view.

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21 minutes ago, studiot said:

Yes I also find that to be the case.

However, this does not make sense

 

If a person sees, hears etc something that is not real, is that not a hallucination, whether that person distinguishes it as not real or not ?

It is a rough layperson's description as from an outside observer it appears as if the patient is unable to distinguish real stimuli from something that is not there (i.e. hallucinations).  I think my wording might be ambiguous in that regard.

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1 hour ago, StringJunky said:

You can have a hallucination and know it's not real, which I wouldn't class as a psychotic event but maybe that's not the expert view.

Yes some psychotics live for years with 'voices' and realise they are not real but have come to terms with them.

I think one point is to distinguish between a delusion and a hallucination.

I think psychotic events or episodes tend to refer to something external to the sufferer), even though they are voices in the head, they are someone else's voice etc.
Visions, voices unearthly experiences are hallucinations.

Delusions tend to include the sufferer maybe self referentially, a belief that they are Napoleon, or can fly etc.

The difficulty comes (as so often) in the crossover grey area where the sufferer is  for instance imagining plots against him or her.
This involves both the sufferer and the outside world together.

That is the trouble with hard and fast demarcations.

 

 

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19 hours ago, studiot said:

The difficulty comes (as so often) in the crossover grey area where the sufferer is  for instance imagining plots against him or her.
This involves both the sufferer and the outside world together.

During my psychiatry internship, most psychotic delusions (and also delusions in, for instance, major unipolar depressive disorder with psychotic features) were such delusions. The tricky part is identifying whether this delusion or idea can be contradicted to the patient, or not. For instance, we had one female patient in her 40s, with the undeniable idea (ergo, delusion) that she was having Alzheimer's dementia. This made her "normal" major unipolar depressive disorder one with psychotic features, making her immediately eligible for electroconvulsive therapy. The delusion became more of a deniable idea as time progressed.

21 hours ago, StringJunky said:

You can have a hallucination and know it's not real, which I wouldn't class as a psychotic event but maybe that's not the expert view.

I think this is still a psychotic feature. Not knowing it's not real, that is, acknowledgeing the hallucination as something real, to me, is a delusion. But I'm not sure as to what guidelines and such state about this.

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2 hours ago, Function said:

During my psychiatry internship, most psychotic delusions (and also delusions in, for instance, major unipolar depressive disorder with psychotic features) were such delusions. The tricky part is identifying whether this delusion or idea can be contradicted to the patient, or not. For instance, we had one female patient in her 40s, with the undeniable idea (ergo, delusion) that she was having Alzheimer's dementia. This made her "normal" major unipolar depressive disorder one with psychotic features, making her immediately eligible for electroconvulsive therapy. The delusion became more of a deniable idea as time progressed.

I think this is still a psychotic feature. Not knowing it's not real, that is, acknowledgeing the hallucination as something real, to me, is a delusion. But I'm not sure as to what guidelines and such state about this.

Cheers.

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On 11/5/2019 at 12:09 AM, Hans de Vries said:

What kind of changes occur in the brain due to psychosis/schizophrenia? 

 

Is there actual loss of neurons and damage to white matter tracts?

 

If yes, can similar permanent brain changes occur due to milder psychiatric diseases i.e. depression/anciety or bipolar?

There is enough evidence for this atleast for schizophrenia.Multiple studies have suggested that schizophrenia will damage neurons on long run especially when untreated.

Diagnosis is still not straightforward and "objective" like other medical conditions but the day will come when we will be using some markers/imaging studies too to confirm the diagnosis.Often a psychotic episode might be diagnosed inappropriately as schizophrenia but when we evaluate the lonngitudinal history,talk to significant others and keep reviewing provisional diagnosis finally we come to a diagnostic clarity.

https://www.psychiatristahmedabad.com/2012/06/schizophrenia.html

 

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