What is mental decompensation?

What is decompensation?

The term "decompensation" refers to when a bodily structure or system, previously in balance (compensated), becomes unbalanced (decompensated), causing symptoms to appear. The term implies a structural fragility, a potential imbalance, which was previously compensated and then suddenly is no longer so, following destabilizing circumstances. 

In medicine, decompensation is a general term used to describe a variety of situations. Decompensation can be, for example, cardiac, metabolic, respiratory, or psychological in nature. In each case, it is a question of the breakdown or functional deterioration of an organ, an organism or a psychological structure.  

Mental decompensation is therefore a breakdown of the psychic balance in a person following an emotional crisis, traumatic event, etc. It can imply a break with reality and most often occurs after the fact, once the "danger" has been averted.    

Decompensation can occur in mental illnesses such as schizophrenia, bipolar disorder, or chronic hallucinatory psychosis and can also affect people with neurosis and/or depression. However, it can also occur in people without any mental health conditions. 

The patient may not be aware that he or she is decompensating.

What are the causes and symptoms of mental decompensation? How is it diagnosed?

Mental decompensation is marked by serious and debilitating symptoms. It can manifest both physically and psychologically. These symptoms may fade or persist depending on how the new psychic balance is established. 

Physically, there are symptoms of sweating, chest pain, cardiac arrhythmia, and insomnia.  

Psychologically, this sudden imbalance triggers powerful and unusual symptoms, such as:

• Delusions: Their onset is sudden, and they typically fade within a few days or weeks. The person may describe persecution (conspiracies, possession), grandeur (power, discoveries), or mystical themes. Mood can be variable.
• Mental (thoughts) or sensory (auditory, visual, olfactory, and/or sensory) illusions or hallucinations
• Confusion
• Phobias
• Addictions
• Anxiety attacks
• OCD
• Depression

Frequently, the first episode of decompensation occurs in people who may already experience psychosis, such as those with schizophrenia or borderline personality disorder.

The causes of mental decompensation are still poorly understood. Mental disorders are thought to be due to a combination of biological, psychological, and social factors. It can, therefore, be caused by an external factor, such as drugs and/or alcohol abuse, overwork, lack of sleep, etc. Lockdowns and isolation can also encourage these manifestations. 

Adolescence may also be a triggering factor, which would explain why the first psychotic episodes are often triggered between the ages of 15 and 25

The diagnostic criteria for mental decompensation are listed in the two main classification systems used in mental health care: the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM). 

How is mental decompensation treated?

When faced with an episode of mental decompensation, the first reaction should be to accompany the person to hospital. Often, hospitalization in a psychiatric unit is necessary, to allow the patient to regain his or her psychological balance. 

As a first step, therapists will often prescribe medication. These may include anxiolytics, antidepressants and/or antipsychotics (neuroleptics). The latter aim to reduce the excess of dopamine in the body that is involved during a delusional episode. A balanced dosage is important to maintain the patient's emotional and social life.

Antipsychotic drugs can cause dyskinesia, or the occurrence of abnormal muscle movements or discomfort in voluntary movements, which must be corrected. 

Next a psychological approach will be undertaken, which is essential in the care of a patient experiencing psychosis. It is important in this situation to establish a dialogue and active listening with the patient, as well as with relatives and professionals. Family and friends play a crucial role in supporting a person affected by mental decompensation.

It is advisable to treat the psychotic episode as soon as possible, to avoid endangering the life of the person or their family. 

There are other forms of care aimed at helping the patient regain his or her psychological balance. This may include sports, meditation, sophrology, cardiac coherence and also music, art, and theatre. 

It can take several years to find a lasting balance, but it is attainable. Regular psychotherapeutic follow-up helps to work on oneself, to regain confidence and to reclaim one's environment. The establishment of rituals, mentalization and the anticipation of tasks and activities are methods that help to lead an almost normal life.

How to prevent mental decompensation?

Prevention of decompensation is a public health issue. To reduce the risks, we need to inform and support those the most at risk.

The current pandemic has shown that a stressful or sudden change can lead a large number of people to decompensate. The COVID-19 lockdowns were a triggering factor for many, as they disrupted our routines and habits. A new balance and way of living had to be established. Then, later, the end of lockdown was another significant change requiring us to readapt and restore our balance once again.

To prevent a possible decompensation, it is necessary to maintain one's habits and environment, avoid boredom, continue to have a social life, be aware of current events without focusing on the negative, and be able to connect with others. 

For people who have already experienced one or more mental decompensations, it is important to work on managing the triggering factors in order to better avoid or control them.