Published March 29, 2012
| The Wall Street Journal
What causes a seemingly healthy person to suddenly lose it?
It’s a question likely on many minds in light of a series of recent episodes, such as when a JetBlue pilot had to be subdued Tuesday by passengers after behaving erratically during a flight.
We don’t know exactly what caused the pilot’s disruptive actions, or why the co-founder of a group behind the “Kony 2012″ viral video had a public meltdown, or why an American Airlines flight attendant began speaking erratically on a taxiing flight’s intercom.
There’s a long list of medical and psychiatric conditions that can trigger a psychotic episode, when a person seems to lose touch with reality. Among the possibilities: a brain tumor, head injury, thyroid condition, fever, infection, recreational drug use or a prescription-drug reaction. Several causes can lie behind incidences of what used to be called a nervous breakdown, too, as WSJ reported last month.
Agitated and delusional behavior can also accompany several mental disorders. People with bipolar disorder and major depression can have psychotic symptoms, especially when under major stress, Dr. David Hellerstein, a professor of clinical psychiatry at Columbia University, told the Wall Street Journal ‘Health Blog’.
There are usually warning signs, however, even if they are only noticed after the fact. “When people present in a kind of rapid onset of a psychotic state that hasn’t been noticed before and that seems to come out of the blue, in retrospect there is usually some clinical prodrome,” or early symptom, Hellerstein said.
T. Byram Karasu, chief psychiatrist at Montefiore Medical Center in the Bronx, N.Y., said excessive stimuli, especially sounds and lights, can trigger psychotic symptoms in people with underlying psychological issues. Age also plays a factor in diagnosis: A young adult who has a psychotic episode might be developing schizophrenia. In an elderly person, it could indicate dementia, Hellerstein said.
Then there is “brief psychotic disorder,” an illness that is defined in the Diagnostic and Statistical Manual (DSM), the handbook of psychiatric diagnoses, as lasting at least a day but less than a month.
Symptoms include hallucinations and disorganized speech. “I’ve seen people who have a brief psychotic reaction in response to some major stress and then it would resolve,” Hellerstein said. “Probably given enough stress, anybody could have that.”