What Is Psychosis?

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Psychosis is an experience in which a person loses touch with reality. People experiencing psychosis may have sensations that are not really there, such as hearing voices others cannot hear. They may also have firmly held beliefs in something that is demonstrably false, even after being confronted with evidence of its falsehood.

About 3% of Americans will experience psychosis at some point in their lifetime.

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Definition of Psychosis

While it has multiple characteristics and stages, psychosis is not a condition in and of itself, but rather a symptom or an experience.

A psychotic episode can happen on its own, or be part of a larger illness such as schizophrenia.

The hallmark characteristic of psychosis is difficulty in interpreting what is real and what is not, but people experiencing psychosis can also have other symptoms such as:

  • Incoherent or nonsense speech
  • Inappropriate or incongruous behavior
  • Social withdrawal
  • Difficulty in overall functioning

Psychosis vs. Psychopathy

People experiencing psychosis are not psychopathic. The difference:

  • Psychosis is the experience of symptoms that can often be alleviated by treatment.
  • Psychopath is a term used in the medical and legal communities to denote someone who lacks empathy and guilt, among other symptoms, and is associated with antisocial personality disorder.

Symptoms

Certain psychotic disorders (like schizophrenia) may come on in stages with different manifestations in each stage. By knowing the symptoms of each stage, it is possible to recognize psychosis at its onset and start early interventions.

Early Warning Signs

These symptoms usually come on gradually and do not necessarily indicate an impending psychotic episode.

They overlap with symptoms for other conditions, and in young people, they can be hard to distinguish from normal developmental adolescent behavior.

These symptoms may or may not be indicative of the beginning of psychosis, but a person exhibiting these warning signs should see a healthcare professional for an assessment. These include:

  • Difficulty thinking clearly
  • Difficulty concentrating
  • A drop in school or work performance
  • Spending more time alone than usual
  • Neglecting self-care or personal hygiene
  • Feeling suspicious or uneasy with others
  • Strong, inappropriate emotions, or a lack of any emotions at all
  • Difficulty distinguishing reality from fantasy
  • Trouble communicating or confused speech

Signs of Early or First-Episode Psychosis

These symptoms are less ambiguous than early warning signs and strongly suggest the beginnings of a psychotic illness.

There is some overlap with early warning signs as it is difficult to pinpoint exactly when the first episode of psychosis begins. These signs include:

  • Sensory experiences (hearing, seeing, tasting, and less commonly, feeling or smelling things) that are not real
  • Social withdrawal/withdrawing from family or friends
  • Strong, inappropriate emotions, or not feeling anything at all
  • Sudden decline in self-care
  • Strong, persistent, unusual thoughts or beliefs that are false, and do not change regardless of evidence to the contrary
  • Difficulty concentrating or thinking clearly

Psychosis

Most symptoms of psychosis fall into two categories: positive and negative.

Positive symptoms involve the existence or appearance of experiences and behavior that should not be there. The most common ones are:

  • Hallucinations: A sensory experience of hearing, seeing, tasting, smelling, or feeling something that is not real. Visual and auditory hallucinations are most common.
  • Delusions: Strong, persistent beliefs that are out of touch with reality and remain unchanged by evidence that disputes them. This can include things like believing people on TV are sending them secret messages, thinking they are someone of great importance or God-like, paranoia that they are being persecuted or spied on, and other false and intrusive beliefs.
  • Disorganized speech, thoughts, or behavior: This can include rapidly switching between subjects when speaking, "word salad" (random, confused words and phrases linked together in incoherent ways), unpredictable behaviors, or agitation.

Negative symptoms involve the absence of or a decrease in normal functions and behaviors that should be there. They include:

  • Trouble generating thoughts and ideas
  • Reduced motivation and difficulty beginning tasks
  • Concentration problems
  • Trouble with decision-making
  • Flat affect (showing reduced or no emotions, fixed facial expression)
  • Alogia (reduced or absent speech)
  • Restricted or reduced verbal fluency
  • Reduced socialization

Other symptoms that can be present in psychotic disorders include:

  • Cognitive symptoms, such as difficulties with attention and memory issues
  • Changes in mood
  • Substance use and misuse
  • Sleep difficulties
  • Suicidal thoughts or behaviors

Seek Help

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

Diagnosis

A number of steps are taken when seeking a diagnosis related to symptoms of psychosis.

Discussion

A healthcare provider will ask about a person's:

  • Medical history
  • Family history
  • The symptoms they are experiencing
  • The duration of the symptoms
  • Any other information that may be pertinent

They will note the person's age, and other personal information, and may ask about recent stressors or life events and changes.

Speaking With Family

The healthcare provider may speak with family members or people that are close to the person experiencing psychosis, particularly if the person is having a difficult time giving the information themselves.

Physical Examination

The healthcare provider is likely to perform a physical examination, which may include:

  • Listening to the heart
  • Checking reflexes
  • Noting observations about the general health of the individual

Psychosis can be caused by physical conditions, so the healthcare provider will seek to find any physical causes that might be contributing to the symptoms.

Diagnostic Testing

Lab tests such as blood or urine samples may be run to look for signs of physical illness that could explain the person's psychosis symptoms.

In some cases, imaging tests such as X-ray, MRI, or CT scans, may be ordered, but this is less common.

Referral

Unless it is an emergency situation, a primary care provider is usually the first point of contact when seeking a diagnosis surrounding symptoms of psychosis.

They may refer the person to a specialist, either for further examination if a diagnosis has not been made or for treatment.

These specialists can include:

  • Doctors of physical conditions such as a cardiologist or immunologist
  • Psychiatrists to explore mental health conditions
  • Therapists
  • Social workers

Diagnosing and treating psychosis and the conditions associated with it is often a team effort.

Causes

Psychosis can stem from several different causes.

Mental Health Disorders

Psychosis is often a symptom of a larger mental health disorder. These disorders include:

  • Schizophrenia
  • Bipolar disorder
  • Schizoaffective disorder
  • Substance-induced psychosis (including withdrawal from drugs or alcohol)
  • Depression with psychotic features
  • Postpartum psychosis
  • Delusional disorder
  • Brief psychotic disorder
  • Schizophreniform disorder

Physical Health Conditions

Psychosis may be indicative of a physical problem, such as:

  • Autoimmune disorders (e.g., multiple sclerosis or lupus)
  • Endocrine disorders (e.g., Cushing disease or thyroid disease)
  • Neurologic conditions (e.g., dementia, encephalitis, epilepsy, Parkinson's disease)
  • Nutritional imbalances, such as vitamin B deficiency
  • Electrolyte or metabolic abnormalities
  • Certain genetic conditions
  • Substance use or misuse, withdrawal of substances, medication interactions
  • Sleep deprivation
  • Traumatic brain injury
  • Stroke
  • Brain tumors
  • HIV
  • Delirium (A state of mental confusion which may follow a serious physical illness, brain toxicity, or an operation)

Risk Factors

The exact cause of psychosis and psychotic disorders is unknown, but there are some factors thought to make a person more susceptible to developing them. These include:

  • Genetics: Psychosis and several of the mental health conditions associated with them appear to run in families.
  • Brain chemistry: An imbalance in various neurotransmitters including dopamine and serotonin may play a role in psychosis.
  • Age: The first psychotic episode is more likely to occur when a person is a teenager or young adult than at other ages.
  • Life experiences: Stress, grief, major life events such as childbirth, experiencing homelessness, trauma, abuse, and other experiences that greatly impact a person's life may play a role in triggering psychosis in susceptible individuals.

Types

There are three phases involved in first-episode psychosis: prodrome, acute, and recovery.

Prodrome

In this phase, a person is experiencing changes in:

  • Feelings
  • Thought
  • Perceptions
  • Behavior

They are not yet showing more obvious signs of psychosis, such as hallucinations or delusions.

Symptoms in this phase tend to change over time and vary between people.

This phase usually lasts several months, but the duration can be highly variable, and some people do not experience a prodromal phase at all.

Acute

The acute phase usually lasts until appropriate treatment is received and symptoms are relieved.

Hallmark symptoms of psychosis occur in this phase, including:

  • Hallucinations
  • Delusions
  • Other positive and negative symptoms
  • Disorganized speech, thoughts, or behavior

Recovery

With treatment, most people reach the recovery stage, and many do not have another psychotic episode within their lifetime.

The focus during this stage is:

  • Setting up continued support and maintenance treatment for the person
  • Reestablishing normalcy
  • Addressing anything that may have arisen as the result of or in addition to the psychotic episode such as ongoing mental health disorders, housing, or employment.

Treatment

Treatment is most effective when started as early as possible.

A common and effective treatment for psychosis is a team approach such as coordinated specialty care (CSC), which involves a number of professionals from varying fields working together to form a treatment plan.

CSC employs:

  • Case management
  • Family support and education
  • Psychotherapy
  • Medication management
  • Supported education and employment
  • Peer support

The two primary treatments for psychosis are psychotherapy and medication.

Psychotherapy

Psychotherapy, also called "talk therapy", encompasses several types of treatments, including:

  • Cognitive-behavioral therapy (CBT): CBT helps a person identify and challenge dysfunctional thoughts and behaviors.
  • Family intervention: With this therapy, the person experiencing psychosis and the people close to them learn more about the condition, how best to support each other, and form coping strategies.
  • Art therapy: This can help with expressing and understanding emotions, and encourage interaction with other people.
  • Therapy for trauma: If a person's psychosis is associated with trauma, treatment addressing the trauma may be undertaken in addition to treatment for the psychosis.

Medication

Treatment for psychosis usually involves medication, most frequently antipsychotics.

Most antipsychotics fall under two categories.

Second generation:

  • Also called atypical antipsychotics
  • Most commonly prescribed
  • Newer than first-generation antipsychotics
  • Less likely to cause movement-related side effects
  • Affects dopamine and serotonin levels
  • Types include risperidone (Risperdal), quetiapine (Seroquel), olanzapine (Zyprexa)

First-generation:

  • Also called typical antipsychotics
  • Older than second-generation antipsychotics
  • Usually prescribed when second-generation antipsychotics are not successful
  • Affects dopamine levels, but not serotonin
  • Higher risk of serious movement-related side effects than second-generation antipsychotics but less risk of weight gain and metabolic side-effects.
  • Types include flupenthixol (Fluanxol) and haloperidol (Haldol)

Side effects of antipsychotics include:

  • Drowsiness
  • Agitation
  • Dry mouth
  • Constipation
  • Blurred vision
  • Emotional blunting
  • Dizziness
  • Weight gain
  • Liquid discharge from breasts
  • Missed periods
  • Muscle stiffness or spasms

Never Stop Cold Turkey

Stopping any medication abruptly can be dangerous, including antipsychotics.

Always consult a healthcare provider before stopping a medication or changing a treatment plan.

Coping

In addition to formal treatment, there are ways to help cope with psychosis.

  • Talk to someone: Talk to friends, family, a support group, an online group, or anyone else with whom you feel comfortable.
  • Practice relaxation, mindfulness, and breathing techniques: There are classes, informational videos, and other resources to help you learn these tools. You can also relax by doing things you enjoy, such as taking a hot shower or bubble bath.
  • Take care of yourself: Eat healthy foods, exercise, get plenty of rest, avoid substances such as smoking, alcohol, and recreational drugs.
  • Explore complementary therapies: Meditation, massage, reflexology, or aromatherapy may be relaxing.
  • Set small, achievable goals: Give yourself goals at which you can succeed, and reward yourself when you do. These can be very simple such as self-care activities or going outside each day.
  • Express your feelings: Keep a diary, paint, draw, make music, do any activity that lets you be creative and expressive.
  • Take advantage of technology: Use programs and apps for help with organization, motivation, or anything else that helps you stay on track with your goals.

A Word From Verywell

Experiencing psychosis can be scary and difficult. Knowing the early warning signs of psychosis can help you or someone you know seek early treatment.

While treatment can be difficult, most people who experience psychosis and receive proper treatment make a recovery, and many do not experience psychotic episodes again.

If you or someone close to you is experiencing symptoms of psychosis, see a healthcare provider for an assessment and to make a treatment plan if necessary.

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Article Sources
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