Can Conditions Other Than Schizophrenia Cause Psychosis?

Reader’s Question

My husband had a “nervous breakdown” a few months ago. It started with his becoming withdrawn and suspicious about what others were saying about him. At the time, he was finishing up his degree and trying to get a job. In the end, however, he couldn’t find work. He has always been quiet and introspective, so I thought that the change in him was because of the stress of looking for a job. He thought that he was being offered a job, but the way he was talking about it I thought he was confused. Then, he became very delusional and was convinced I was cheating on him. I later found out that there had been no job offer and that he had only been imagining it.

He recovered after one long month, and he now knows that the things he used to believe never really happened. He is no longer fully delusional, but it is difficult to have a conversation with him because he is so preoccupied with his own thoughts. He says he is thinking about work and about finding a job all the time, and he is trying to be careful and think of scenarios that would stop him from getting a job.

He is currently obsessing about a past advisor who he feels may prohibit him from getting a job by sending a letter to a potential employer saying that he is incompetent. Yesterday he imagined some people at work talking about an email from his former advisor saying that he was mentally not stable. He imagined his current advisor saying that his former advisor hates him. After he told me all of this, I realized that he was imagining it and after talking it over with him, he agreed with me. This makes me think that he doesn’t have a major psychotic disorder like schizophrenia. But he is also afraid that someone will sue us or frame us for something. He realizes such thoughts are not rational, but he cannot stop them. I have a hard time talking and joking with him because he is so preoccupied.

How do I help my husband focus at home and at work and stop thinking about these terrible things? He is on a low dose of anti-psychotic medications, which I do not think help that much. I wonder if his brain is deficient in serotonin which is causing OCD and depression which is causing his psychosis.

Any thoughts or suggestions would be greatly appreciated.

Psychologist’s Reply

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(Please read our important explanation below.)

Delusional behavior and other psychotic symptoms need not necessarily be the result of schizophrenia. Indeed, psychotic features can accompany clinical depressions and other mood disturbances. Further, individuals can have more than one clinical condition occurring at any given time. An accurate and complete diagnosis can only be made on the basis of comprehensive evaluation.

Medication is often essential in helping control symptoms, and sometimes it can take some time and experimentation to determine the most effective medication regimen. But even when the regimen is optimal, medication alone is generally insufficient in helping people overcome serious mental health conditions. Not only are there often some contributing or underlying “dynamics” to the problems people experience, but also certain stressors can exacerbate clinical conditions. So, it’s best for the afflicted person (as well as the family) to be involved in a comprehensive program of care that includes counseling or therapy. Talk these issues over with the physician prescribing the medication, and secure a referral to a clinician who specializes in adjunctive therapy for conditions such as your husband’s.

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