Recent findings suggest psychosis can be triggered by an autoimmune response in the brain, and Oxford psychiatrists are leading a separate trial of the use of immunotherapy to treat patients with psychosis who test positive for certain antibodies. There is emerging evidence for a wider range of underlying causes, requiring different treatments. Treatment normally involves antipsychotic medicine and talking therapies, which can help people develop coping strategies. It can be a one-off experience or, for others, is a long-term mental health condition, such as schizophrenia. In some cases, an episode can be brought on by a traumatic experience, severe stress, drug use or a side-effect of medication. It can manifest as hallucinations or delusions, such as the belief that people are conspiring to spy on you or cause you harm. Psychosis is an experience rather than a medical diagnosis in itself, and involves losing touch with reality. “It can have huge implications on likely prognosis.” “At the moment often it can be difficult arranging a timely MRI scan because it’s not part of routine care,” Blackman said, adding that he was aware of cases involving patients with brain tumours who had waited months for a diagnostic scan, delaying crucial treatment. A previous appraisal by the National Institute for Health and Care Excellence (Nice) did not recommend scanning all patients because it was unclear how often clinically relevant brain abnormalities were discovered. “The reason this is so important is that in this subset of patients, the cause may be treatable and reversible but the window to treat successfully can be relatively narrow.”Īlthough it is considered good practice to carry out a brain scan in new patients with psychosis, it is not mandatory. “Patients presenting with psychosis may have another physical illness or condition causing their symptoms that can be identified using MRI scanning,” said Dr Graham Blackman, a psychiatrist and clinical lecturer at the University of Oxford and first author of the research. Conditions detected by scans included encephalitis, brain tumours, infections, stroke or dementia.
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