Sulit Health: Psychotic and Schizzy

by Johanna Patricia A. Cañal, MD, MHA, MSc

I’ve heard it often in social media, in movies and on TV.  Any kind of “crazy” behavior is called schizophrenic or psychotic, but, like many things in Medicine, things are not as simple as that.

First, we talk about psychosis.  Psychosis is not a disease.  It is a symptom of disease.  Psychosis describes patients who have abnormal perceptions, hallucinations and delusions.  These patients have lost touch with reality.  There may be incoherent or confused speech.  There may be unusual anxiety, paranoia and sleep problems.  Some patients who have psychosis become socially withdrawn, not just from friends but possibly also from family.  Self-care may decline, i.e., not taking baths, not changing clothes, etc.

So, what causes psychosis?  It could be a number of things.  There could be real psychiatric / mental illness.  But psychosis can also be due to a brain tumor, a brain infection, alcoholism, drug addiction or even a metabolic disorder.  Psychosis is therefore a general term that describes certain behaviors.

So, what is the connection with schizophrenia?  A person with schizophrenia has some form or degree of psychosis.  In fact, to diagnose schizophrenia, a patient must have exhibited psychotic behaviors for at least 6 months.

Schizophrenia is a serious psychiatric diagnosis.  A hallmark of this disease is auditory and visual hallucinations.  In other words, a schizophrenic patient hears things and sees things that aren’t there. [“Auditory” has to do with hearing and sound.]  This is your classic “I hear voices.”  You’ve probably seen these patients before.  They look like they’re talking to themselves or to some invisible someone.  They’re confused because they have trouble differentiating what is reality from what is fantasy.  Visions of “taong grasa” walking the streets, talking to themselves come to mind.

Schizophrenia is NOT multiple personalities or a split personality.  That is a different psychiatric diagnosis altogether.  There is no cure for schizophrenia but there are very good treatments that keep the symptoms in check.  If schizophrenia is diagnosed early, medication is more than adequate to control it.

If you suspect that a friend or relative may have schizophrenia or might be psychotic, what becomes really important is to first look for the cause of it.  In medical parlance, we look for an organic cause first.  We’d just like to make sure that there is no tumor or metabolic problem or infection that should be treated immediately.  If there is no organic cause, then a psychiatric consult should get done.


This short article is part of a series of articles that is designed to make health care more understandable to non-doctors.

As a way of disclosure, I am a radiologist and a radiation oncologist.  My strengths, therefore, are diagnosing illness, particularly cancer, and cancer treatment.  Thus, I will be talking about medical tests and what these are about.

I shall also be talking about the dreaded disease, cancer.  In the 2nd decade of the 21st century, cancer is the #4 cause of death worldwide. NUMBER 4!  It used to be #10.  It has obviously been going up.  The number 1 and 2 killers are cardiovascular diseases…translated into heart attacks and strokes.  Number 3 is pneumonias and lung diseases.

The previous century was known as the century of infectious diseases.  The most common causes of disease and death were bacterial and viral pneumonia and tuberculosis.  The present century is the century of the lifestyle disease.  That is, infections don’t play as big a part as lifestyle diseases.  What are those?  Heart disease, strokes, cancers and injuries/accidents.

But then again, the 21st century has just started, and we already have a pandemic.  One never knows what will happen in the next 10, 20 or 30 years.  Thus, this series will discuss a range of topics, hopefully the topics most relevant to you.

If there is a topic that you want clarified, please do drop me an e-mail at [email protected]Please just fill in the subject line with: [SULIT] Your question