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Psychosis: Patients
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Psychosis produces emotional and behavioral changes in patients. Tell—tale symptoms include hallucinations, delusions, and confusion [Table 2]. Psychotic hallucinations are often visual or auditory. Patients may see things that are not there or hear voices. Occasionally, hallucinations involve the other senses — taste, touch, and smell. Psychotic patients suffering from delusions are so convinced of their false belief that even the most rational argument cannot dissuade them.
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Psychosis is defined as "a serious mental disorder (as schizophrenia) characterized by defective or lost contact with reality often with hallucinations or delusions." Psychosis is an end-stage condition arising from a variety of possible causes. Anti-psychotic drugs control the symptoms of psychosis, and in many cases are effective in controlling the symptoms of other disorders that may lead to psychosis, including bipolar mood disorder (formerly termed manic-depressive), in which the patient cycles from severe depression to feelings of extreme excitation. This class of drugs is primarily composed of the major tranquilizers; ... lithium carbonate, a drug that is largely specific to bipolar mood disorder, is commonly classified among the antipsychotic agents.
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The dose of the steroid administered has a clear relationship to the likelihood of the patient developing a subsequent steroid psychosis. There is a statistically significant increase in the incidence of psychiatric disturbances with increasing daily doses of steroid. Patients treated with a mean daily dose of Prednisone below 40mg/day in The Boston Collaborative Drug Surveillance Study, had an incidence of psychotic symptoms of 1.3% while patients treated with doses between 41 and 80mg/day had an incidence of 4.6%. Patients receiving more than 80mg/day of Prednisone or its equivalent had an incidence of steroid psychosis of 18.4%. The average daily dose of steroids for patients who developed psychosis was 59.5mg/day of Prednisone or equivalent as compared with 31.1mg/day for patients who did not develop adverse psychiatric effects.
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Hallucinations are a major symptom of psychosis and can be defined as sense perceptions that are not based in reality. Auditory hallucinations are the most common form. Patients hear voices that seem to be either outside or inside their heads. The voices may be argumentative or congratulatory. Patients who experience visual hallucinations may have an organic problem, such as a brain lesion. Other types of hallucinations involve the sense of smell and touch.
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The good news is that hospital psychosis generally resolves within a few days of the patient's return to familiar circumstances. It may be very frightening to see a loved one act irrationally or seem completely disconnected from reality, but it is not always controllable. Many sleep-deprived or anxious patients may not understand why they are so confused or delusional. During more lucid moments they may regret their actions while under the effects of hospital psychosis.
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There is evidence of several neuropsychiatric symptoms associated with bupropion in patients with depression, including delusions, hallucinations, psychosis, concentration disturbance, paranoia, and confusion. In some cases, these symptoms are reduced or eliminated by decreasing the dose or ceasing treatment. The prescribing information notes that "it is generally believed (though not established in controlled trials)" that, should an episode of depression actually be the first presentation of bipolar disorder, treating it with antidepressants, including bupropion, may precipitate a manic episode.[52] More recent data indicate that the addition of newer antidepressants, including bupropion, to a mood stabilizer does not cause the switch to mania more often than the addition of placebo.[48] Moreover, when added to a mood stabilizer, bupropion and sertraline had a twice lower switch risk than venlafaxine.[59]
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