National Drug Strategy
National Drug Strategy

Comorbidity of mental disorders and substance use: a brief guide for the primary care clinician

7.1 Psychosis

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Psychosis is characterised by a loss of connectedness with reality. A person may develop false ideas or beliefs about reality (delusions) which in themselves may be based on false perceptions (hallucinations).

People experiencing psychosis also have characteristic flaws in the ways they think. These are termed 'thought disorders'. Examples are tangential thinking, loose associations between ideas, and incoherence.

Psychosis significantly impairs work, family and social functioning. People with psychoses often experience poorer physical health. The worse the psychotic symptoms are, the higher the associated level of impairment(251).

Psychotic symptoms can occur in response to physical conditions, e.g. acute delirium with septicaemia. Alternatively, psychoses can be functional. There are two broad classes of functional psychotic disorders: schizophrenia and bipolar disorder.

Generally, schizophrenia is a chronic condition with exacerbations, but always with some background symptoms. Bipolar disorder is generally an intermittent condition with the expectation of full recovery between episodes. There is considerable overlap between the two conditions and fluidity of diagnosis.

Symptoms of schizophrenia are sometimes grouped into two categories:

While the clinician may realise that the psychosis could be drug-induced and is cautious in the prescription of neuroleptics or sedatives to control the symptoms, they may be under pressure to respond to the manifestation of bizarre or potentially destructive thinking or behaviour. On the other hand, alterations to the way the person behaves and thinks may be subtle in the early stages when early intervention may be most appropriate.

Shortening the period of untreated psychosis (whether this be substance induced or the early stages of psychotic disorders) has the potential to have a positive impact on treatment outcomes.
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7.1.1 Management approaches to psychosis

Schizophrenia

Bipolar disorder

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