Psychosis and Psychotic Episodes

What Is Psychosis?

Psychosis is a condition that affects the way your brain processes information. It causes you to lose touch with reality. You might see, hear, or believe things that aren’t real. Psychosis is a symptom, not an illness. A mental or physical illness, substance abuse, or extreme stress or trauma can cause it.

Psychotic disorders, like schizophrenia, involve psychosis that usually affects you for the first time in the late teen years or early adulthood. Young people are especially likely to get it, but doctors don’t know why. Even before what doctors call the first episode of psychosis (FEP), you may show slight changes in the way you act or think. This is called the prodromal period and could last days, weeks, months, or even years.

Symptoms of Psychosis

Psychosis doesn’t suddenly start. It usually follows this pattern:

  • Warning signs before psychosis: It starts with gradual changes in the way you think about and understand the world. You or your family members may notice:
    • A drop in grades or job performance
    • Trouble thinking clearly or concentrating
    • Suspiciousness or unease around others
    • Lack of self-care or hygiene
    • Spending more time alone than usual
    • Stronger emotions than situations call for
    • No emotions at all
  • Signs of early psychosis: You may:
    • Hear, see, or taste things others don’t
    • Hang on to unusual beliefs or thoughts no matter what others say
    • Pull away from family and friends
    • Stop taking care of yourself
    • Not be able to think clearly or pay attention
  • Symptoms of a psychotic episode: Usually you’ll notice all of the above plus:
    • Hallucinations:
      • Auditory hallucinations: Hearing voices when no one is around
      • Tactile hallucinations: Strange sensations or feelings you can’t explain
      • Visual hallucinations: You see people or things that aren’t there, or you think the shape of things looks wrong
    • Delusions: Beliefs that aren’t in line with your culture and that don’t make sense to others, like:
      • Outside forces are in control of your feelings and actions
      • Small events or comments have huge meaning
      • You have special powers, are on a special mission, or actually are a god

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Causes of Psychosis

Doctors don’t know exactly what causes psychosis, but some known risk factors include:

  • Genetics: You can have the genes for it, but that doesn’t always mean you’ll get psychosis.
  • Drugs: Triggers include some prescription medications and abuse of alcohol or drugs like marijuana, LSD, and amphetamines.
  • Trauma: The death of a loved one, a sexual assault, or war can lead to psychosis. The type of trauma and the age you were when it happened also play a role.
  • Injuries and illnesses: Traumatic brain injuries, brain tumors, strokes, Parkinson’s disease, Alzheimer’s disease, dementia, and HIV can all bring on psychosis.

Psychosis can also be a symptom of a mental illness, like schizophrenia or bipolar disorder.

Diagnosis

You can see a psychologist, psychiatrist, or a social worker. They’ll find out what might have caused your symptoms and look for related conditions. Doctors diagnose mental illnesses after ruling out other things that could be causing psychotic symptoms.

Medical Treatment for Psychosis

It’s important to get treated early, after the first episode of psychosis. That will help keep the symptoms from affecting your relationships, work, or school. It may also help you avoid more problems down the road.

You doctor may recommend coordinated specialty care (CSC). This is a team approach to treating schizophrenia when the first symptoms appear. It combines medicine and therapy with social services and work and education support. The family is involved as much as possible.

What your doctor recommends will depend on the cause of your psychosis.

Your doctor will prescribe antipsychotic drugs -- in pills, liquids, or shots -- to ease your symptoms. They’ll also suggest you avoid using drugs and alcohol.

You might need to get treated in a hospital if you’re at risk of harming yourself or others, or if you can't control your behavior or do your daily activities. The doctor will check your symptoms, look for causes, and suggest the best treatment for you.

Some clinics and programs offer help just for young people.

Psychotherapy

Counseling, along with medicines, can also help manage psychosis.

  • Cognitive behavioral therapy (CBT) can help you recognize when you have psychotic episodes. It also helps you figure out whether what you see and hear is real or imagined. This kind of therapy also stresses the importance of antipsychotic medications and sticking with your treatment.
  • Supportive psychotherapy helps you learn to live with and manage psychosis. It also teaches healthy ways of thinking.
  • Cognitive enhancement therapy (CET) uses computer exercises and group work to help you think and understand better.
  • Family psychoeducation and support involves your loved ones. It helps you bond and improves the way you solve problems together.
  • Coordinated specialty care (CSC) creates a team approach in treating psychosis when it’s first diagnosed. CSC combines medication and psychotherapy with social services and work and education support.

WebMD Medical Reference Reviewed by Joseph Goldberg, MD on July 13, 2019

Sources

SOURCES:

National Alliance on Mental Illness: “Psychosis,” “Early Psychosis and Psychosis.”

U.S. National Library of Medicine Medline Plus: “Psychotic Disorders.”

National Institute of Mental Health: “Recovery After an Initial Schizophrenia Episode (RAISE) Questions & Answers,” “What is Psychosis?”

Compton, M. and Broussard, B. The First Episode of Psychosis: A Guide for Patients and Their Families, published online 2009.

Cleveland Clinic: “Diseases and Conditions: Schizophrenia.”

National Institute of Mental Health: “What is Psychosis?”

Center for Cognition & Recovery: “What is Cognitive Enhancement Therapy?”

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