DSM-IV Classifications of Psychosis

By consensual agreement within the American Psychiatric Association psychiatric diagnoses are descriptive labels only for phenomenology, not etiological or mechanistic explanation for syndromes. Thus, a psychiatric diagnosis labels a pattern of signs and symptoms, but offers no hypothesis concerning the mechanism(s) of the clinical phenomena.(Davidoff et al., 1991).

The DSM-IV-TR classifies psychotic illnesses as “Psychosis Due to General Medical Conditions”, and “Substance Induced Psychosis”. (DSM-IV Codes 293.81 & 292.11)

A substance-induced psychotic disorder, by definition, is directly caused by the effects of drugs including alcohol, medications, and toxins. Psychotic symptoms can result from intoxication on alcohol, amphetamines (and related substances), cannabis (marijuana), cocaine, hallucinogens, inhalants, opioids, phencyclidine (PCP) and related substances, sedatives, hypnotics, anxiolytics, and other or unknown substances. Psychotic symptoms can also result from withdrawal from alcohol, sedatives, hypnotics, anxiolytics, and other or unknown substances.

Some medications that may induce psychotic symptoms include anesthetics and analgesics, anticholinergic agents, anticonvulsants, antihistamines, antihypertensive and cardiovascular medications, antimicrobial medications, antiparkinsonian medications, chemotherapeutic agents, corticosteroids, gastrointestinal medications, muscle relaxants, nonsteroidal anti-inflammatory medications, other over-the-counter medications, antidepressant medications, and disulfiram . Toxins that may induce psychotic symptoms include anticholinesterase, organophosphate insecticides, nerve gases, carbon monoxide, carbon dioxide, and volatile substances (such as fuel or paint).

Psychosis Due to a Medical Condition also includes a large number of different medical conditions. Neurological conditions that may cause psychosis include brain tumors, cerebrovascular disease, Huntington's disease, multiple sclerosis, epilepsy, auditory or visual nerve injury or impairment, deafness, migraine, and infections of the central nervous system. Endocrine disturbances include increases or decreases in the activity of the thyroid, parathyroid, or adrenocortical system. A decrease in blood gases such as oxygen or carbon dioxide or imbalances in blood sugar or electrolytes are some metabolic causes of psychosis. Finally, autoimmune disorders with central nervous system involvement such as systemic lupus erythematosus have also been known to cause psychosis.

Many individuals who experience psychosis, mania, hallucinations, or delusions as a result of a medical condition, or substance induced, engage in criminal or harmful behavior resulting in arrest and imprisonment.

Erroneously, these individuals are labeled with Bipolar Disorder or Schizophrenia and endure forced psychiatric treatment.

Individuals labeled with Bipolar Disorder and Schizophrenia are led to believe “mental illness” is incurable and symptoms of mental illness are primarily due to hereditary factors.

Public perception and medical opinion of “mental illness” are strongly influenced by the main stream psychiatric belief system resulting in stigmatism and prejudice.