Think You’re Going Crazy? A Beginner’s Guide To Psychosis. The word “crazy” means different things to different people. A cat lady is crazy.

That homeless guy on the street is crazy. Your ex girlfriend is crazy (or at least she has a personality disorder).

However, there is a much more interesting, much more dangerous form of crazy – psychosis. I throw around the words “psychotic” and “psychosis” a lot at work, and sometimes I forget most people don’t know what those terms mean (I didn’t before going through medical school). So here I’m going to break down the concept. When someone is psychotic it means they are experiencing one (or more) of the following symptoms: Hallucinations, or a sensory stimulus that isn’t there. For example, a person may see an image that isn’t there (visual hallucination) or hear voices that aren’t there (auditory hallucination).

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Delusions. A delusion is a firmly held, fixed, and false belief. Delusions can be nonbizarre, meaning that the belief is unlikely, but within the realm of possibility, such as thinking the CIA is following you.

Or they can be bizarre, meaning that the belief is totally impossible, such as thinking aliens implanted a microchip in your brain (this type of delusion is characteristic of schizophrenia). Disordered thinking. Disordered thought is a hallmark of schizophrenia. It’s evidenced by disordered speech, such as loose associations (jumping from one unrelated topic to the next), thought blocking (stopping conversation midsentence), and “word salad” (speech that is incoherent because words are meaninglessly strung together). The interesting thing about psychosis is that only a handful of disorders cause these symptoms, so it’s usually not too tricky to narrow down the diagnosis.[As a side note: Psychosis is not caused by stress (although stress can bring out underlying symptoms). It is (usually) an indication of a serious mental or physical illness.

Or an indication that you just did some LSD. It often requires treatment with heavy- duty antipsychotic medications.]Here’s an overview of the most common conditions leading to psychosis. Substance- induced psychosis. Probably the most common cause of psychosis is the use of illicit drugs, such as marijuana, hallucinogens (LSD, acid, schrooms), or amphetamines (meth, cocaine).

If you don’t experience  psychotic symptoms while using hallucinogens you’re probably not getting your money’s worth. Usually the effect wears off when the drug wears off, although I’ve seen patients who used so many drugs for so long that they have lingering psychotic symptoms even after a period of time off substances. I see patients who are psychotic after taking drugs at the VA all the time. They go out, do some meth, and then come into the ER sure that the Mexican mafia is trying to kill them or that they’re being followed.

I had a patient who, after snorting bath salts (a new synthetic amphetamine derivative that is can be purchased at head shops), abruptly left the hotel room where he was staying because he became paranoid that people were trying to break in and kill him. He left all of his stuff behind (including wallet, ID, money) and then after wandering the city streets for a few hours wasn’t able to find the hotel, and lost all of his valuables. Substance- induced psychosis will usually go away on it’s own once the person stops taking drugs.

However, for people with lingering symptoms off drugs, a psychiatrist may prescribe antipsychotic medication as treatment. Major Depressive Disorder with Psychotic Features.

When people get really, really depressed, they can become psychotic. This is extremely common in older adults.

I had a patient at UCLA last year who was a woman in her 8. Over a period of months prior to her hospitalization she became increasingly depressed. As she became worse, she started to have delusional beliefs that the devil was “influencing” her.” She was convinced the devil was calling her on the phone and then hanging up once she answered. She thought the devil had bugged her house and was listening in on all of her conversations.

Even in the hospital she attributed small incidents, such as not being able to find the remote, to the devil’s influence. The psychotic symptoms in psychotic depression are congruent with the person’s depressed mood. For example, people may here voices telling them they’re a bad person, or that they should hurt themselves. They may have delusional beliefs about people trying to punish them. Treating Major Depressive Disorder with Psychotic Features almost always requires medication. Psychotic symptoms indicate severe depression.

A psychiatrist would use both an antidepressant to treat the mood symptoms and an antipsychotic to treat the psychotic symptoms. In older adults, we often use ECT (electroconvulsive therapy) to treat psychotic depression because it’s extremely effective and has fewer side effects than medications. Bipolar Disorder in a Manic Episode. Bipolar Disorder is characterized by alternating periods of depression and mania. Mania is characterized by a period of a persistently elevated and euphoric mood, decreased need for sleep, rapid and pressured speech, increased goal- directed activity (such as staying up all night to write “the next great American novel”) and reckless behavior, such as gambling, sexual promiscuity, or spending large sums of money on things the person can’t afford (like buying a yacht). When people are manic, they often become psychotic.

People who are manic will have mood congruent, grandiose delusions. They’ll think they’re the president of the United States. They’ll think they’re Jesus.  They’ll think they have six Ph. Ds and that they’re dating Lindsay Lohan.

We typically treat a person who is manic and psychotic with a newer generation atypical antipsychotic, such as Zyprexa, Risperdal or Abilify, plus/minus a mood stabilizer such as Lithium or Depakote. Schizophrenia or Schizoaffective Disorder. Schizophrenia (or Schizoaffective Disorder, which is Schizophrenia plus a prominent mood disorder, such as Depression or Bipolar Disorder) is a primary psychotic disorder. This means that the psychotic symptoms are a primary feature of the disorder and are not resulting from mood symptoms. Schizophrenia is characterized by: Hallucinations (usually auditory hallucinations of voices)Delusions. Disordered speech or behavior. Negative symptoms, such as blunted affect, poverty of speech, and decreased motivation.

Certain psychotic symptoms are so characteristic of schizophrenia that they are diagnostic of the disorder. These are “first rank symptoms.” They include: Auditory hallucinations or two voices arguing with each other. Auditory hallucinations of a single voice making a running commentary on the person. Thought withdrawal – the delusion that thoughts are being pulled out of the person’s head. Thought insertion – the delusion that thoughts are being put into the person’s head. Thought broadcasting – the delusion that other people can “hear” a person’s thoughts. Schizophrenia is a serious, lifelong mental illness that requires ongoing treatment with antipsychotic medications.

Delusional Disorder. Delusional Disorder is uncommon and difficult to treat. It is diagnosed when a person who is otherwise normal has a fixed, nonbizarre delusion that they continue to believe even in the face of evidence to the contrary. For example, a woman who becomes absolutely fixated on the idea that her husband is cheating on her, which no evidence to support it, may have delusional disorder.

She’ll attribute small, insignificant things, such as seeing a door left ajar or there being less milk left in the fridge than she remembers, as evidence of her delusion. Psychosis Secondary to a General Medical Condition. Sometimes a person has psychotic symptoms because of a physical, rather than mental illness. For example, a brain tumor pushing on the visual cortex might lead to visual hallucinations.

Meet The People Who Say They’re Serious About Building The Hyperloop. Watch I Travel Alone Online more. The morning commute across Manhattan on Thursday was a typical- as- of- late snarl of bottlenecks and delays, with debris of unknown origins causing an oppressive backup of the city’s subway system.

It was the latest in a string of examples of the deteriorating, century- old system, another sign of the significant level of investment that’s needed to bring the subway up to 2. Though it was an otherwise unsurprising morning, I’m mentioning it because, several hundred miles away, as New Yorkers endured another annoying trek around town through a system of the past, a theoretical, futuristic solution to public transit woes in the U. S.—the Hyperloop—took another small- step toward coming to fruition. But, alluring as it is, the vacuum transit system remains a long- shot—even with 1. Remember when Elon Musk claimed he was so busy with space and cars that he was willing to hand over …Read more Read. That was the news from Hyperloop One, an ambitious startup among a number of companies that have taken on the challenge of building the hyperloop system, first outlined back in 2. Tesla CEO Elon Musk.

On Thursday, Hyperloop One named the ten potential routes—from Mumbai to Denver—as part of a long- running contest launched by the company to find ideal places to build the first hyperloop tracks. Hyperloop One has an extremely- ambitious timeline, aiming to have three full- scale systems operating by 2. Four of the proposed routes are situated in the U. S.—including the one in Denver, but also a run from Chicago, through Columbus, to Pittsburgh; a lengthier trek from Dallas to Laredo to Houston; and a shorter span between Miami and Orlando.

Expectedly, Hyperloop One’s CEO, Rob Lloyd, was elated to share the news.“We’re doing things faster than any other kind of infrastructure project has ever moved,” Lloyd said in an interview. That’s what’s exciting about this.” Beyond Hyperloop One, there’s Hyperloop Technologies. And Musk himself has indicated he’s willing to use his newfound Boring Company to get in the hyperloop game. Of course, that’s contingent on whether he receives anything beyond “verbal” government approval of his proposed system.) Hyperloop One recently crossed a major milestone, after it hurdled a vehicle through a…Read more Read.

But it’s Hyperloop One that touts itself as being furthest along in the process of making this dream a reality, saying it’s the “only company in the world that has built a full- scale Hyperloop system.” Sounds like 2. Not so much. There Is A Track Record Here.

A quick reminder of how a hyperloop is supposed to work: essentially, the idea involves building a tube system, in which people- carrying pods travel along a cushion of air, by way of a variety of methods. For Hyperloop One, the company developed a proprietary electric propulsion system, using linear electric motors that, it says, produces motion in a straight line. Air gets sucked out of the tube, making it incredibly- thin, and then the pods take off, levitating using electromagnetic currents. Or, as the company explains: In a traditional motor, the rotor (rotating part) spins inside the stator (static part), or vice- versa; in a linear motor, the stator is unwrapped and laid out flat, and the “rotor” moves past it in a straight line. In our case, the stators are installed along the track where we need acceleration. We add power to the stators, which produces electromagnetic currents that interact with the “rotor” elements underneath the vehicle to create propulsion. The rotor and stator never touch.

At least on a granular- scale, it’s not as farfetched as it sounds: the company indeed has a proven track record. In May, Hyperloop One successfully conducted a demo run of a device that traveled 7. Nevada desert. Then, last month, the company sent a 2. It’s hard not to be enraptured at the sight. The core idea of a hyperloop is to allow a bunch of people to travel between major cities quickly and easily, and with airlines originating from the seventh circle of Hell and woefully- underfunded train systems being targeted for potential cuts by lawmakers, a theoretical hyper- fast trip through a pneumatic tube doesn’t sound too bad.

It isn’t much of a question anymore whether the technology could work—the enjoyment of traveling in a hypothetical hyperloop, however, and whether it’ll effectively work at a large- scale, probably merits further debate—but it’s the logistical hurdles that remain. How much is a tube system from Chicago to Pittsburgh going to cost? That’s a gargantuan question, and it’s still basically anyone’s best guess. Lloyd demurred when asked about cost.)Hyperloop One generally offers that capital and operating costs will “range widely based on route and application,” but the company’s optimistic that it would remain competitive with the typically- significant up- front costs of rail.

The company said Thursday’s announcement is the next step in a process to answering those questions. In part, that’ll be done with a feasibility study that’s being conducted with the Colorado Department of Transportation and AECOM, Hyperloop One said. The study, the company said, will examine “transportation demand, economic benefits, proposed routes and potential strategies, regulatory environments and alignment with overall CDOT high- speed travel, rail and freight plans.” (A 3. Cheyenne, Wyoming, Denver, and Pueblo, Colorado, was picked as a finalist Thursday.)“These are multi- billion dollar projects,” Lloyd said by phone.

And, obviously, in order for them to make sense, they need to have an economic return.”Lloyd sounded an upbeat tone about finding a viable path forward to achieving a solid return because, as he put it, all funding options are on the table, including a public- private model. He said the feasibility study will give stakeholders a sense of the economic potential, engineering challenges, and other preliminary costs.“That’s our goal,” he said. That’s our objective.”The Entrance Of Musk. Lloyd didn’t budge when I asked about Musk’s recent entry into the field. In July, the Tesla chief stirred up a rousing comedic bit, when he haphazardly took to Twitter to announce he’d received “verbal” government approval to build a hyperloop between New York City and Washington D. C. In reality, verbal government approval could amount to receiving the green- light from someone named Mr. Government. But Musk has since indicated he’s serious about getting intimately involved in the hyperloop game.

He’s invested—to what degree, it still isn’t clear—in building tunnels using his Boring Company subsidiary, and a Bloomberg report last month said Musk wants to have a role in everything, from conception to construction, for his proposed NYC- DC route. It was a significant turnaround from when Musk first introduced the Hyperloop idea; he is running a car company and a space firm after all. Lloyd’s not phased, though. In a hypothetical world where flying taxis are real, autonomous cars ferry people around town, and hyperloops carry you and I between major hubs, Musk’s intercity routes could work seamlessly with Hyperloop One’s large- scale plans, Lloyd said.“I’d love to imagine that there would be more efficient last- mile technologies connecting to where we put a hyperloop portal,” he said, “and all of that is actually part of our strategy. There’s some really good things happening in transportation.”Is It The Right Investment. But those really good things—high- speed future vacuum travel tubes, the fantastical idea of flying cars—have a heavy burden of proving they can operate safely and effectively. Lloyd’s company wants his hyperloop pods to travel close to 7.

Chicago and Pittsburgh to roughly 4. Miami to Orlando would take 2.

Hyperloop One wants to bring that to life within a hopeful timeline that suggests a rapid development of seven years from inception to launching its first routes.