22. April 2020
“Actually, everything was fine. Sure, work was stressful and my days were long. But I got along well so far and everything ran its usual course. However, my well-being changed with every stroke. My sleep became worse, my concentration decreased and I felt empty. The situation then worsened very quickly. I was permanently under power. Restless, disjointed and with shaky hands, I could hardly go about my work.
And then came the thoughts: “My boss controls me. He has his spies everywhere. He’s part of a secret society that wants to take me down. He has installed cameras in my apartment. His accomplices are eavesdropping on me…”. My fear and despair became so great because I was convinced that my thoughts were reality. Then the situation escalated. Ruled by my delusion that my boss was spying on me, I tore apart my entire apartment looking for bugs and cameras.
After that, I fled without any preparation and took a train through across Germany. Finally, I was picked up by the police and hospitalized. Thank God the doctors were able to help me very quickly. Now I am working on putting what happened into perspective: What stresses led to my psychosis developing? What can I do to prevent it from happening again? In the meantime, I am stable. My medication is working well and I feel in good hands with my therapists. I am confident that I will soon be able to return to everyday life.”
Christian T., 34, about his psychotic disorder in the summer of 2018
Christian’s exact diagnosis means acute transient psychotic disorder. The disorder has a relatively abrupt onset and usually an abrupt end. It takes place over a period of a few weeks to a month. After the symptoms have subsided, patients in most cases make a full recovery.
Christian’s report already reveals some symptoms. An acute psychotic disorder manifests itself on the levels of emotions and behavior. In addition, there are changes in thoughts and perception. Overall, normal behavior is altered to such an extent that the illness hardly remains hidden from relatives and friends.
Overall, the following symptoms may indicate an acute psychotic disorder:
Symptoms on the emotional level
Symptoms at the behavioral level
Alteration of thoughts and perception
Of course, Christian’s course of illness is only one example of how acute psychotic disorder can progress. The content of the hallucinations or delusions can be quite different in other sufferers. Examples are religious delusions, delusions of grandeur or commanding voices.
Acute transient psychotic disorder shows overlap with other disorders. Schizophrenia, in particular, can manifest very similarly. In schizophrenia, however, there are additional periods of severe apathy and depression, alternating with delusional phases. In addition, the psychotic episodes usually last much longer than in acute psychotic disorder.
In addition, psychosis must be distinguished from the so-called “delirium.” It stands for mental confusion and bizarre behavior, but which can occur in the context of severe alcohol abuse, withdrawal symptoms, or advanced age.
Compared with other mental illnesses, such as depression, acute psychosis is relatively rare. 1 -2% of the population experience it once in their lifetime, compared with 8.2% for depression. There are risk factors that can promote the development of psychosis. These include, most notably, drug use, unusually severe psychological distress, clustering of psychosis in relatives, and other mental illnesses, such as severe depression or bipolar disorder.
If you notice warning signs of an incipient psychotic episode in yourself or a loved one, you should seek professional help as soon as possible. The primary care physician is always a good person to contact. In acute cases, where there is a possibility of danger to self or others, you can either contact the emergency services (call 112) or the psychiatric hospital responsible for your place of residence. A psychiatric specialist will then take care of the medical treatment. A differential diagnosis must be made to determine which explanations can be considered for the development of the psychotic episode. Antipsychotics are then primarily used, but also sedative medications.
After the initial stabilization, psychotherapeutic care ensures that the phase of the disease can be processed. Affected persons often suffer greatly from the memories of the psychosis and find it difficult to grasp what happened. Strategies for dealing with the illness are also developed. These include, for example, stress management, relapse prophylaxis and psychoeducation, i.e. imparting knowledge about psychotic illnesses.
Recognize the fears of those affected
As in the case of Christian, an acute transient psychosis can be associated with strong fears and panic. This is highly stressful for those affected. These fears should be addressed and the reasons for them explored. A compassionate and accepting approach gives those affected the space to communicate.
Christian is doing much better by now. He is still shocked by what happened to him. Nevertheless, he can also take something good from the disease. He has learned to pay much more attention to himself and his needs. With the help of his outpatient psychotherapy, he continues to build this ability to bring his life into a good balance.