Broadly speaking, psychosis is a lack of interaction with reality; it is a symptom of a variety of mental disorders, rather than an actual medical condition.
This page includes a full overview of psychosis, what induces it, some psychotic disorders descriptions and how it is treated.
Important facts about psychosis
Here are a few key points on psychosis. The main article includes more details and supporting information.
- Psychosis is not a disease in its own right; it is a symptom
- A common psychotic delusion is a belief that the individual is an important figure
- Earlier diagnosis of psychosis improves long-term outcomes
What is psychosis?
Psychosis is an umbrella term; it means an person has sensory experiences of things that do not exist, and/or beliefs which have no real basis.
An individual may experience hallucinations and/or delusions during a psychotic episode. They can see things that do not exist, or hear them.
For the individual, this can be extremely frightening and, often, the symptoms can cause them to lash out and harm themselves or others.
Psychosis is classically associated with schizophrenia spectrum disorders, and Psychosis is one of the defining criteria for schizophrenia although there are other symptoms.
Symptoms of psychosis
The classic signs and symptoms of psychosis are:
- Hallucinations – hearing, seeing, or feeling things that do not exist
- Delusions – false beliefs, especially based on fear or suspicion of things that are not real
- Disorganization – in thought, speech, or behavior
- Disordered thinking – jumping between unrelated topics, making strange connections between thoughts
- Catatonia – unresponsiveness
- Difficulty concentrating
Psychosis can come on quickly or slowly, depending on the cause. The same is real for schizophrenia, although symptoms may have a slow onset and begin with milder psychosis, if they stop taking their medication, some people may experience a rapid transition back to psychosis.
The milder, initial symptoms of psychosis might include:
- Feelings of suspicion
- General anxiety
- Distorted perceptions
- Obsessive thinking
- Sleep problems
Hallucinations can affect any of the senses in a person with psychosis (sight, sound , smell , taste, and touch), but in about two-thirds of schizophrenic patients, hallucinations are auditory – hearing things and believing that they are real when they don’t exist.
Below are common auditory hallucinations:
- Hearing several voices talking, often negatively, about the patient
- A voice giving a commentary on what the patient is doing
- A voice repeating what the patient is thinking
Bizarre delusions during psychosis
Examples of the kind of paranoid psychotic delusions – more likely to be associated with schizophrenia – and delusions of grandeur.
paranoid delusions – this can cause people with psychosis being too suspicious of individuals or organizations, believing they were planning to cause them damage.
Delusions of grandeur – obviously false but extremely hold the belief in special power or authority – for example, they believe that they are world leaders.
Diagnosis of psychosis
In this section, we will discuss the available tests and methods for diagnosing psychosis.
Early diagnosis of psychosis improves outcomes for the long term. However, that isn’t always achieved. The milder forms of psychosis that may lead to schizophrenia are left untreated for an average of 2 years, and even full psychosis can take several years before it gets medical professionals’ attention.
To increase early detection chances, guidance for healthcare systems drawn up by psychiatrists recommend that the “possibility of a psychotic disorder be carefully considered” in a young person who is:
- Becoming more socially withdrawn
- Performing worse for a sustained period at school or work, or
- Becoming more distressed or agitated yet unable to explain why
For psychosis itself, there is no biological test, and if laboratory tests are carried out, it is to rule out other medical problems which could provide an alternative explanation.
Questions for patient and family
Psychosis is primarily diagnosed through clinical examination and history-the doctor examines the patient and asks about their symptoms, experiences , thoughts, and daily activities; they will also ask if there is a family history of psychiatric disorder.
First of all, other medical conditions are excluded, in particular delirium (sudden onset of a confused state), but epilepsy and a variety of other medical causes are possible.
Doctors may also check for any history of drug intoxication, both legal and illicit, and toxins, usually requiring a sample of urine to check this out.
When psychosis is narrowed down to a psychiatric cause, clearly defined requirements must be met before accepting a diagnosis. Psychiatrists generally rely on the American Psychiatric Association ( APA) to make psychiatric diagnoses, known as the DSM (Diagnostic and Statistical Manual of Mental Disorders).
In the early stages of medical care, brain scans can be done so that other conditions – often treatable and reversible – can be ruled out.
EEG testing (electroencephalography) records the electrical activity of the brain and may help rule out delirium, head injury, or epilepsy as possible causes of psychotic symptoms.
Causes of psychosis
The specific psychosis causes are not well known, but might include:
- Genetics – research shows that schizophrenia and bipolar disorder may share a common genetic cause.
- Brain changes – alterations in brain structure and changes in certain chemicals are found in people who have psychosis. Brain scans have revealed reduced gray matter in the brains of some individuals who have a history of psychosis, which may explain effects on thought processing.
- Hormones/sleep – postpartum psychosis occurs very soon after giving birth (normally within 2 weeks). The exact causes are not known, but some researchers believe it might be due to changes in hormone levels and disrupted sleep patterns.
Treatments for psychosis
Within this section we will discuss the psychosis treatments and some preventive strategies.
The most popular therapy for people with a psychological disorder is treatment with a class of drugs known as antipsychotics.
Antipsychotics are effective in reducing symptoms of psychosis in psychiatric conditions such as schizophrenia but they do not treat or cure underlying psychotic illnesses themselves.
Doctors most commonly use the so-called second-generation antipsychotics to treat psychosis. While their use in the United States is widespread, that is indeed controversial. These are not approved by the World Health Organization (WHO), except for clozapine (the U.S. branded Clozaril and FazaClo), which can be used under special supervision if no response to other antipsychotic medicines has been identified.
Acute and maintenance phases of schizophrenia
Schizophrenia antipsychotic treatment is in two phases-the acute phase of treating initial psychotic episodes and a lifelong maintenance therapy phase.
A stay in hospital is often required during the acute phase. A technique is often used, called rapid tranquilization. A fast-acting drug that will calm the patient should be used to make sure they ‘re not hurting themselves or others.
Schizophrenia treatment occurs in the community during the recovery process and antipsychotics help avoid more psychotic episodes, while relapses also occur, often due to a failure to take the medications. Many interventions and support may include lifelong treatment of schizophrenia, including the family’s role in care.
Psychotherapy can also be effective in treating symptoms of schizophrenia and other psychotic disorders, both cognitive and residual.
Types of psychosis
A number of disorders can display psychotic symptoms, including:
- Schizophrenia – a serious mental health disorder affecting the way someone feels, thinks, and acts. Individuals find it difficult to distinguish between what is real and what is imaginary.
- Schizoaffective disorder – a condition similar to schizophrenia that includes periods of mood disturbances.
- Brief psychotic disorder – psychotic symptoms last at least 1 day but no longer than 1 month. Often occurring in response to a stressful life event. Once symptoms have gone, they may never return.
- Delusional disorder – the individual has a strong belief in something irrational and often bizarre with no factual basis. Symptoms last for 1 month or longer.
- Bipolar psychosis – individuals have the symptoms of bipolar disorder (intense highs and lows in mood) and also experience episodes of psychosis. The psychosis more commonly occurs during manic phases.
- Psychotic depression – also known as major depressive disorder with psychotic features.
- Postpartum (also called postnatal) psychosis – a severe form of postnatal depression.
- Substance-induced psychosis – including alcohol, certain illegal drugs, and some prescription drugs, including steroids and stimulants.
These are the main causes of psychotic symptoms, but also certain conditions and diseases, including:
- Brain tumor or cyst
- Dementia – Alzheimer’s disease, for example
- Neurological illness – such as Parkinson’s disease and Huntington’s disease
- HIV and other infections that can affect the brain
- Some types of epilepsy