Psychosis: integrative approaches

Psychosis has many complex causes
Symptoms of psychosis may be temporary or chronic and moderate or severe in their intensity. Schizophrenia and other chronic psychotic disorders are characterized by so-called ‘positive’ and ‘negative’ symptoms. Positive symptoms include auditory hallucinations, paranoia (the belief that someone is following you or trying to harm you), delusional beliefs, and disorganized speech. Negative symptoms include distortions in the perception of reality, extreme apathy, grossly impaired social functioning, and the inappropriate expression of emotions. Individuals develop schizophrenia in stages starting with an early ‘phase’ in which they begin to experience psychotic symptoms but are able to function in day to day activities. The early or ‘prodromal’ of schizophrenia phase soon transitions to an ‘active’ phase in which symptoms of psychosis become more severe often impairing one’s ability to function at work, in school or in society. The initial ‘active’ phase may be followed by a ‘residual’ phase characterized by improved functioning and decreased symptom severity even in the absence of treatment.

Symptoms of schizophrenia usually begin in the second or third decade of life but may occur much later. There is no single explanation of the cause of schizophrenia and other mental health problems in which symptoms of psychosis take place. Strong genetic risk factors have been established in the case of schizophrenia. Other known causes of schizophrenia include exposure to the influenza virus before birth and abnormal fetal brain development. Different medical problems sometimes cause symptoms of psychosis that may be mistaken for schizophrenia but typically resolve with proper treatment. Examples include brain tumors, hyperthyroidism, seizure disorders, Parkinson’s disease, HIV/AIDS and stroke. Psychosis often accompanies Alzheimer’s disease and other forms of dementia. Acute intoxication with methamphetamine, cocaine and other drugs of abuse, high dose steroids and some prescription medications can cause temporary symptoms of psychosis.

Psychotic symptoms associated with schizophrenia and other chronic mental health problems may change over time and wax and wane in severity even in the absence of treatment. According to Western biomedical diagnostic criteria, all ‘phases’ must last for at least 6 months to qualify for a diagnosis of schizophrenia. Schizoaffective disorder is a chronic psychotic disorder in which an individual experiences periods of psychosis that alternate with severe mood swings typical of bipolar disorder. Other psychotic disorders last for a shorter time for example some individuals experience transient symptoms of psychosis that resolve after days or weeks even in the absence of treatment. Individuals who are severely depressed or manic may experience symptoms of psychosis which resolve with treatment. Individuals diagnosed with PTSD or severe personality disorders may also experience transient symptoms of psychosis that resolve with treatment.
Limitations of conventional treatments of psychosis

More recently introduced “atypical” antipsychotics carry a relatively reduced risk of serious adverse effects compared to older antipsychotics, including a reduce risk of permanent neurological syndromes including tardive dyskinesia and tardive dystonia. In spite of the early promise of these so-called ‘atypical’ agents, a meta-analysis concluded that they have only a slight advantage over first generation antipsychotics in both efficacy and frequency of adverse neurological effects. A meta-analysis comparing outcomes of all randomized controlled trials of conventional antipsychotics conducted between 1953 and 2002 concluded that only one atypical agent (clozapine) yielded outcomes that were significantly better than first generation antipsychotics. The same meta-analysis concluded that the antipsychotic efficacy of haloperidol, an important first generation antipsychotic, was superior to all atypical agents. Unfortunately, a 1% risk of a potentially fatal blood disorder (agranulocytosis) with clozapine, generally restricts the use of this medication to patients who are refractory to other antipsychotics.

Limitations and safety issues associated with antipsychotics
Few studies have been done to evaluate the long-term effectiveness of conventional antipsychotic medications in the management of schizophrenia and other chronic psychotic syndromes. At the same time there are increasing safety concerns over the long-term use of antipsychotics. Many atypical agents cause the so-called ‘metabolic syndrome’ including weight gain with a significant associated risk of acquiring non-insulin-dependent diabetes. Other serious medical consequences associated with atypical antipsychotics include hypotension, cardiac arrhythmias, and a potentially fatal condition called Stevens-Johnson syndrome. Because of these serious safety concerns the U.S. Food and Drug Administration (FDA) requires drug companies to issue warnings to physicians and patients about the risk of developing hyperglycemia and diabetes associated with prolonged use of most atypical antipsychotic agents, potentially progressing to diabetic coma and death.

Non-medication approaches used to treat psychosis
The limited effectiveness of available mainstream treatments of psychosis invites serious consideration of non-medication approaches. Natural supplements used to treat psychosis include estrogen, Ginkgo (Ginkgo biloba), Ginseng (Panax quinquefolium), glycine, melatonin, Ayurvedic herbal formulas, and omega-3 essential fatty acids. Eating fish and other foods rich in omega-3 essential fatty acids may be associated with reduced symptom severity in chronic schizophrenics. Glycine is another natural substance that shows promise as a treatment of psychosis. Taking a standardized Ginkgo biloba extract with a conventional antipsychotic may improve negative and positive psychotic symptoms more than antipsychotics alone while reducing the risk of neurological adverse effects. While most natural supplements are safe when used as recommended some herbals may have serious adverse effects when taken at inappropriate high dosages or in combination with certain prescription medications.

Though less effective than prescription antipsychotics and the above natural supplements, acupuncture, animal-assisted therapy, meditation and some mind-body practices may help decrease the severity of psychotic symptoms in some cases. Regular acupuncture treatment using laser light to stimulate specific acupoints may lessen the severity of auditory hallucinations and other positive psychotic symptoms and have efficacy comparable to conventional antipsychotics. Other non-medication approaches that may help individuals struggling with chronic psychosis remain more stable include yoga, and qigong.

If you or a loved one are struggling with symptoms of psychosis, taking a medication that isn’t helping, experiencing adverse effects, or you simply can’t afford to continue taking a prescription medication that is working you will benefit from my book Psychosis: The Integrative Mental Health Solution. In the book I provide practical information about a variety of non-medication alternatives that will help you manage symptoms of psychosis such as herbals, vitamins and other natural supplements, whole body approaches, meditation and mind-body practices, and energy therapies.

Psychosis: The Integrative Mental Health Solution will help you:
• Understand psychosis better
• Take inventory of your symptoms
• Learn about non-medication treatments of psychosis
• Develop a customized treatment plan that is right for you
• Re-evaluate your treatment plan and make changes if your initial plan doesn’t work
Click here to preview or buy my book, Psychosis: The Integrative Mental Health Solution.

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