If imaging of the brain is needed in a patient with first-episode psychosis, an MRI should be preferred over a CT scan. This is because an MRI has much greater sensitivity for picking up brain pathology and because an MRI avoids exposure to ionizing radiation (Forbes and Stuckey, 2020).
MRIs and related technology are becoming increasingly adept at diagnosing mental illness. Currently, magnetic resonance imaging can play an important role alongside the observations of physicians and other mental health care professionals.
In a subset of psychotic patients, symptoms are attributable to an organic disease. It is important to identify these organic causes of psychosis early, as urgent treatment of the primary disease may be required. Some of these underlying organic disorders can be identified on magnetic resonance imaging (MRI) scans.
Exams and Tests
Psychiatric evaluation and testing are used to diagnose the cause of the psychosis. Laboratory testing and brain scans may not be needed, but sometimes can help pinpoint the diagnosis. Tests may include: Blood tests for abnormal electrolyte and hormone levels.
There's no test to positively diagnose psychosis. However, your GP will ask about your symptoms and possible causes. For example, they may ask you: whether you're taking any medicines.
Brain scans for psychiatric disorders can identify lesions in the frontal or temporal lobes or the thalamus and hypothalamus of the brain that can occur with psychosis. Brain scans have shown that the volume of various regions in the brain decrease during psychotic episodes.
Unlike taking someone's temperature, recognizing whether psychosis is present can be difficult – especially when it is in its early stages. These early stages can be associated with a wide variety of nonspecific changes such as mood swings, taking up of new philosophies or “odd” behaviours or beliefs.
Current American Psychiatric Association guidelines recommend brain imaging in first-episode psychosis (FEP), favoring MRI or CT 1; however, other national guidelines do not make similar recommendations.
Psychosis can also be triggered by traumatic experiences, stress, or physical conditions, such as Parkinson's disease, a brain tumour, or as a result of drug misuse or alcohol misuse. How often a psychotic episode occurs and how long it lasts can depend on the underlying cause.
First episode psychosis (FEP) is defined as the first time a person outwardly shows symptoms of psychosis. When patients with FEP become aware of their problems, they show distress and confusion, ruminate their symptoms, and have interpersonal problems caused by enhanced sensitivity (1).
It is suggested that psychosis is due to an affection of the supplementary motor area (SMA), located at the centre of the Medial Frontal Lobe network.
Although studies on volumetric magnetic resonance imaging (MRI) analysis in schizophrenia have shown relatively consistent results over several decades (7), diagnosing schizophrenia based on these findings is still challenging and has little clinical utility.
Currently, doctors do not use brain images to diagnose bipolar disorder. However, as research advances, more evidence may help doctors use MRI scans or other imaging technology to accurately diagnose bipolar disorder.
It can help to understand an individual's psychiatric condition from a neurologic perspective: its core biological underpinnings, and how various brain centers (or wiring) may be involved in one's psychiatric problems. This may be very helpful in building insight, planning treatment, and ongoing recovery.
Signs of early or first-episode psychosis
Strong and inappropriate emotions or no emotions at all. Withdrawing from family or friends. A sudden decline in self-care. Trouble thinking clearly or concentrating.
Most people make a good recovery and have their symptoms disappear. An increased understanding of psychosis has led to new interventions to help young people recover. People with psychosis can be treated in their community and if hospitalization is required, it is usually only for a brief period.
“What we do know is that during an episode of psychosis, the brain is basically in a state of stress overload,” says Garrett. Stress can be caused by anything, including poor physical health, loss, trauma or other major life changes. When stress becomes frequent, it can affect your body, both physically and mentally.
For an individual with new delirium (disturbed state of mind), CT of the head without IV contrast is usually appropriate. For an individual with new psychosis (disconnection from reality), CT or MRI of the head without IV contrast or MRI of the head without and with IV contrast may be appropriate.
APA Dictionary of Psychology
a form of magnetic resonance imaging used to localize areas of cognitive activation, based on the correlation between brain activity and blood property changes linked to local changes in blood flow to the brain.
Brain changes can happen in people whose psychosis goes untreated. "The more relapses and episodes a person has, the more we see that it can permanently change their brain function and structure," says Tso.
For many people, there is no quick and simple treatment for psychosis, but with the right support it is possible to manage the symptoms of psychosis and recover. This does not mean that the experience of psychosis will go away entirely. You may find that you still experience symptoms during and after treatment.
Fluphenazine (Prolixin): This drug treats schizophrenia and psychotic symptoms such as hallucinations, delusions, and hostility. Haloperidol (Haldol): Doctors prescribe this drug to treat psychotic disorders, tics associated with Tourette's syndrome, and severe behavioral problems in children.