How I understand Psychosis

My daughter has bipolar disorder, with psychosis and persistent delusions. When she is having an episode she will hear voices telling her terrible things. Also hears her brother that passed away screaming, or babies screaming and crying. She doesn’t understand why others don’t hear them. She thinks the tv is talking about her. She also always believes the family implanted something into her and is controlling and monitoring her. Thinks I am keeping the truth from her. Once she goes into the hospital she improves. But when it comes back she will have the same false beliefs as before

I have been unfortunate enough to experience a state of acute drug-induced psychosis requiring sedation and subsequent hospitalisation. Subjectively, I can remember a feeling of "everything making sense." I believed I was on the cusp of figuring out the universe, consciousness, meaning, etc... in a sense so profound and relevant to the narrative of my life leading up to that point that it is almost impossible to convey. There was this feeling of time and space ceasing to exist and just a constant presence, a place so familiar it's like I been there before an infinite number of times. The closest term I've found that describes the experience is "hyperreal" a state of experience that feels more real and familiar than reality itself. Simultaneously awe-inspiring and unimaginably terrifying. Thankfully emergency services intervened and administered sedatives before the situation became truly dangerous. One thing I gained for the experience is a greater understanding of the degree to which those suffering from psychosis are truly living in a seperate reality in the actual sense that their individual conscious experience is detached from normal day-to-day subjectivity.

how come command hallucinations are so negative? why are they never like “go volunteer at a soup kitchen” or “how about helping that old lady next door bring in her groceries”?

I have worked in mental health support , non clinical, for 12 years. Mainly with people who live with the major psychoses . The aim in such work is to assist with recovery of function. All cases are different within broad categories of symptoms. People have a baseline functioning and can fluctuate around their baseline. I have many happy stories I could relate. I love being a small part of clients progress in life.

I really like you. I think you’re probably a really good doctor. I can tell you’re pretty smart which is important but you’re also super passionate about this - which prob helps it not seems so much like work. And you seem to be a genuine good person that cares about others, especially sick people who are so sick they can’t necessarily help themselves. I trust you.

You are such a mental health nerd and it is adorable to watch you explain these things and refreshing to listen to such a soothing voice!! I love all things mental health because I have experienced and suffered from this you speak of once, and then twice in 1 year and hopefully never again! Its actually been several years of no serious symptoms and low-ish doses of 2 medications, it feels somewhat behind me now and I live really well. But I do get understandably anxious about the possibility of future relapse due to medications eventually failing or a possible life stressor happening...its just nice to know some people out there try to understand and be of help.

Unfortunately I experienced paranoid delusions, auditory and visual hallucinations from drug withdraw. Scariest thing ever

Great to see you back! Even with lived experience, I haven't really understood psychosis. Thanks for taking the time to explain it and give it some depth. And congrats on the house!

During my worst anxiety/depression breakdown, I experienced auditory hallucinations when I was falling asleep or waking up. I always (not seriously) say that I got cheated because my hallucinations were sooo boring. Bells. A cough once. 🤷‍♀️ What was weird was that I knew it was a hallucination.

I have a sort of theory I guess, as to how psychosis is pathologized in the brain... I would love to see what you think about this idea! As you obviously know, schizophrenia is mainly controlled by dysfunction of the mesolimbic pathway in the brain. This circuit contains three important types of receptors, they manage dopamine, serotonin, and glutamate (with many subtypes for each receptor, this is a simplification). We also know that this disorder can be expressed many different ways, and there is no universal experience of it, only "common" symptoms. Due to the varying symptoms of the disorder, we've even gone as far as to identify "types" of schizophrenia. This would be where terms like "paranoid" or "disorganized" are used. This got me thinking that it's possible the different expressions of the disorder are caused by differing levels of dysfunction among the three types of receptors involved in the symptoms of the disorder. To explain; It could be something like dopamine dysfunction primarily causing hallucinations, while serotonin causes paranoia and delusions, and glutamate causes disorganized thinking. Of course, these symptoms are just random examples, I have no concrete reason to believe these are the actual symptoms caused by each of the three receptors, it was just an example to explain my idea. I'd love to hear some input on this theory I've developed after tons of reading and research! Edit: If this is true, it would help find the appropriate meds much quicker for psychotic patients. You would be able to infer which receptors are the most dysfunctional based on the symptoms, then target those specific receptors through medication!

Every time someone speaks of positive and negative symptoms; they should assume the person does not know the definition. Positive symptoms does NOT mean they are "good." It means "added on." Negative symptoms means "taken away."

Great video Dr. Syl! I'm currently studying to be a psychiatric nurse in Canada. I haven't touched base on any mental illnesses yet (still in my general medical semester), but I love how you talked about the complexity of the brain and how the tools we currently have are not fine tuned for the intricate work. How great is it to be a part of this vastly undiscovered side of health! I can only imagine the advancements that will be made in a few hundred years and how that will ultimately reduce stigma around mental illness.

Congrats on buying the house, mate. Best purchase I ever made, as it helped me set down roots and take some cognitive load off of my latent mental loopiness.

Thank you so much for sharing your knowledge and these videos. As a father of a now 24 year old son who was diagnosed with schizophrenia around age 18 I am still trying to learn more about this horrid progressive disease of the brain. My son is on Invega Sustenna and has gained about 150 pounds over the past 3 years while on this drug though he is “stabilized” he seems to be less and less active and less interested in even simple fun activities that we’ve been able to share and experience with him during these past few years. I am hoping that there may be a breakthrough so that I may get my fun-loving, bright, athletic son back. I wouldn’t wish this disease on any person/parent.

Thanks for the explanation about dopamine's relationship to psychosis, that was really easy to understand. I was diagnosed with ADHD a couple years ago and my doctor always asks at every checkup if I'm experiencing any delusions or hallucinations. My problem is obviously too little dopamine activity, but it makes sense that my medication could accidentally go too far the other way and push me into psychosis rather than just getting me to the baseline most people are at. Edit: By the way, if you take requests for topics, I'd love to hear what you think of the preliminary studies on the relationship between childhood brain trauma and ADHD. I sustained a severe accidental head/facial injury when I was two years old, and I wonder if it may have contributed to my various mental health issues later on.

Thank you for explaining this in the way that you have. I feel a lot of professionals think we won't understand but some of us have some understanding and wish to learn more.

i have this sort of reoccuring delusion that there is a man living in my basement. At one point it was really bad, I was terrified to even go on the first floor of the house because of its proximity to the basement door. Now I'm mostly only afraid of him at night. I'm bipolar, but I've had episodes "with psychotic features" tagged on. I don't remember much, but I was in the hospital.

From personal experience, the onset of delusions and paranoia are so subtle and progress so covertly that you do not even know you are becoming psychotic. It took the police to come to my home and seek acute mental health support before I became aware that I was mentally ill. That lasted 3 years before treatment.

DOC...your presentation and cadence is superb! Thank you!

Very informative, Dr Syl. I am a nurse practitioner training to work in psychiatric and mental health. I throughly enjoy watching your videos. Could you go over the differences between psychosis induced by bipolar and one attributed to schizophrenia? Thank you so much. I look forward to your new videos.