The Unpredictability of Psychosis

Grayscale photo of psychotic woman holding belt around neck

0-60 In a Heartbeat

One thing to keep in mind with psychotic patients is that their behavior is very unpredictable. They can literally be having a pleasant conversation with you for 5-10 minutes, and 15 minutes later, they are yelling, cursing, agitated, banging on the walls and demanding medications! You scratch your head and wonder, “What in the world? I was just talking to them and everything seemed to be going well!” Psychosis could care less if everything was going well; when it wants its patient to terrorize, it will unleash all of hell’s dogs to get its fix. This does not mean that you should always expect psychotic patients to become dysregulated and violent; just be aware that the chances of that happening are higher than with other patients.

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Psychosis Meaning

Abandoned psychiatric asylum

What is Psychosis?

One thing to keep in mind with psychotic patients is their very unpredictable behavior. The unpredictability of psychosis is very obvious; they can literally be having a pleasant conversation with you in one moment, and then yelling, cursing, and agitated in the next. You scratch your head and wonder, “What in the world? I was just talking to them and everything seemed to be going well!” Psychosis could care less if everything was going well. When it wants its patient to terrorize, it will unleash all hell’s dogs to get its fix. This doesn’t mean that you should always expect psychotic patients to become dysregulated and violent. Just be aware that the chances of that happening are higher than with other patients. What’s a psychosis meaning? Let’s expand below.

Psychosis Meaning – Unpredictable Patients

You should never assume that you’re on the good side of a psychotic patient. This is because their psychosis does not care if you’re nice, treat them well or say good morning every day. Their psychosis is unpredictable even when you think they’re doing well. They can snap at any moment and randomly assault you when you least expect it. The unpredictability of psychosis is not always due to their treatment. Many patients are on multiple antipsychotics and mood stabilizers and still become aggressive without anyone expecting it. A combination of factors is responsible for their aggressive behavior: receiving bad news, fluctuating hormones and neurotransmitters, not taking their medications or a psychotic break. You don’t want a taste of psychotic aggression.

Even with stable outpatients, you never know how they’re really doing. They can present to your office in one way, and a totally different way when out and about. Keep in mind that patients with psychosis often abuse tobacco and drugs, in particular cheap drugs such as K2 and synthetic smart drugs. My point is that you should never underestimate their mental status. Sometimes you don’t suspect them of using any drugs and that is when they can snap and become violent. Always keep your guard around a person with a history of psychosis. This applies to families, friends and healthcare workers who spend time with psychotic persons.

Psychosis meaning - disheveled girl holding knife

There is Hope

Now this doesn’t mean that psychosis can’t be treated. Many people suffered from psychosis at one point in their lives and successfully recovered. Some people experience drug-induced psychosis caused by the abusing of drugs. They may be psychotic for a few days to a week after stopping the drug and become normal again after the drug clears out of their system. Others suffer from psychotic depression, bipolar depression, brief psychotic disorder, schizophrenia, etc. All of them have the potential to become violent! But they also have the potential to become normal and lead successful lives again. The beauty of psychiatry is that medications work and we have a lot of great mental health professionals who demonstrate a lot of empathy and patience.

Have you experienced psychosis or do you know anyone who has?

Are you Ready? (This is Defeating Stigma Mindfully)

Unpredictability of psychosis GIF face

Underestimating Psych Patients

Angry white man with tattoos on arm sitting on black leather padded chair

The Unpredictability Of Psychiatric Patients

There are some patients who are very unpredictable, despite knowing them very well and believing that everything will be all right on future encounters. These patients are unpredictable because they are either suffering from psychosis, borderline personality disorder, antisocial personality disorder or under the influence of drugs. A common mistake that many psychiatrists and other healthcare workers make is letting their guard down when around psychiatric patients with whom they previously have interacted with.

Whether you are a friend, family member or healthcare worker, you can never let your guard down around mental health patients. This does not mean that you should be rigid and not flexible or relaxed around them; just don’t lose your guard. This is because mental illness, personality disorders or traits are very unpredictable; they can often cause a person to change at the snap of a finger.

I personally had this happen to me recently with a chronic psychiatric patient suffering from schizophrenia. The nurse had called to inform me that the patient was pacing in the hallway, which is an early sign of agitation for him. As I made my way upstairs to the respective unit, the nurse called again and warned me to be careful as the patient was near the hallway next to the unit door; at first he warned me to stay out of the unit.

About thirty seconds later, he told me that I could come onto the unit. As I slowly unlocked the unit door, the coast was clear for a few seconds, until the patient appeared in the hallway looking straight at me. He started walking towards me in an agitated manner and not making any sense in what he was saying. My immediate inclination was to turn back towards the door and leave the unit as I had no way of making my way to the nurse’s station for more clarification of the situation.

The mistake I made is that I decided to bravely stand in the hallway and attempt to understand the patient as I figured, “What the hell, I’ve talked to him before when he was agitated and he never did anything!” But this time was different. As soon as he arrived next to me, he lunged for the keys that I was still holding in my hands without realizing. I was then struggling to hold onto my keys as he was diving deeper into my palms to snatch them.

At this point I knew that I couldn’t wrestle or fight with the patient because as healthcare workers, we are trained to defend ourselves but not actually engage in fights with patients. It is then that the unit staff came rushing onto the patient and retrieved the keys after a brief manual hold. The keys were returned to me. The point of the story is that I made the mistake of believing that this psychotically agitated patient who I had multiple previous encounters with, likely would not do anything on this encounter as well.

But I was wrong! This is evidence of the unpredictability of psychiatric patients and why you should never underestimate their potential for harm towards others. Always trust your intuition for it is there to guide you when your logical mind gets in the way. Even though logical, your mind does not always place you in the best positions in life and that is where your intuition steps in to protect and guide you. I was lucky that I came out of this situation unharmed!

Have you had any experiences that have gone wrong with psychiatric patients?

Are you Ready? (This is Defeating Stigma Mindfully)

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