What Is Psychosis?
Psychosis 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. It can be triggered by a mental illness, a physical injury or illness, substance abuse, or extreme stress or trauma.
Psychotic disorders, like schizophrenia, involve psychosis that usually affects you for the first time in the late teen years or early adulthood. 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.
These episodes stem from something else, like drug use or a medical condition. Whatever the reason, they tend to disappear in a short time, and they often stay away if you treat the condition that caused them.
Who gets psychosis?
Young people are especially likely to get it, but doctors don’t know why. It most often starts when you're in your teens to late 20s. But it can also affect older people and, rarely, children.
How common is psychosis?
It's hard to know exactly how common psychosis is. Studies have shown that it affects from 15 to 100 out of every 100,000 people each year.
Psychosis vs. schizophrenia
Psychosis is a symptom of schizophrenia, a complicated mental illness that also has other symptoms. Psychosis can also be a symptom of other conditions, such as serious depression.
Psychosis vs. neurosis
Doctors used to use the term "neurosis" to describe what they now call anxiety disorders. Symptoms of these disorders may include obsessive thoughts, irrational fears, or compulsive behaviors. But unlike psychosis, they don't involve losing touch with reality.
Symptoms of Psychosis
Psychosis doesn’t start suddenly. It usually follows a pattern.
Warning signs before psychosis
It starts with gradual changes in the way you think about and understand the world. You or your friends or 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
- 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
What does a psychotic episode look like?
Usually you’ll notice all of the above psychosis symptoms, including:
Hallucinations. These could be:
- 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.
- Olfactory hallucinations: You smell odors no one else can.
- Gustatory hallucinations: You taste things when there's nothing in your mouth.
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.
You might have persecutory delusions, in which you think a person or group of people wants to harm you. Or you could have grandiose delusions, in which you believe you are all-powerful or in a position of authority. Religious delusions, sometimes called spiritual psychosis, center on spiritual or religious themes.
Unstable thought patterns could cause outward symptoms, like:
- Suddenly losing your train of thought, in conversation or while doing a task
- Speaking quickly
- Talking constantly
Can you be aware of your own psychosis?
Often, people with psychosis don't know it. Your hallucinations and delusions may seem very real to you.
3 Stages of Psychosis
Experts say there are three stages of psychotic episodes. What each stage looks like and how long it lasts will vary from person to person.
In this stage, you have mild changes in your thoughts and moods that tend to come on gradually. They might include:
- Trouble sleeping
- Loss of concentration and motivation
- Avoiding friends and family members
- Suspiciousness and strange beliefs
This is when you have typical symptoms of psychosis, like:
- Behavior and personality changes
These changes may be apparent to others around you.
While some of your symptoms may remain for a while, they eventually go away, allowing you to return your usual daily routines. Most people recover if they get the right treatment. You may never have another psychotic episode.
Along with secondary psychosis and psychosis due to a mental illness, you might hear about these types:
This is a rare but serious type of postpartum depression that can happen from a few days to a few weeks after you give birth. It's more likely to affect those who already have a condition like schizophrenia or bipolar disorder. Doctors aren't sure what causes it, but they think sleep loss, hormone changes, and your genes could play a role.
Along with hallucinations and delusions, you could have mood changes like sadness and/or joy. If you or someone you know has these symptoms, seek medical help right away.
About half of people with bipolar disorder sometimes have delusions and/or hallucinations, usually when they're in a state of mania (a period of high energy and mood). Treatments include antipsychotic drugs and electroconvulsive therapy (ECT), which involves passing mild electric currents through the brain.
Postictal psychosis (PIP)
Myxedematous psychosis (also called myxedema psychosis)
You can get this when your thyroid gland doesn't work well, a condition known as hypothyroidism. Because of the way thyroid hormone affects your brain, you may have hallucinations, delusions, and changes to your sense of taste or smell if there's not enough in your body. Your doctor can test your level of thyroid-stimulating hormone (TSH) to confirm myxedema psychosis and rule out other conditions like schizophrenia.
Taking thyroid hormone can help balance your gland's activity and end the psychosis.
This is a complication of a condition called Wernicke encephalopathy, a brain disorder caused by a shortage of vitamin B1 that most often affects those who have alcohol use disorder.
Along with serious memory problems, it can cause disorientation and emotional changes. You may tell false or confused stories when you can't remember what really happened.
It's treated by restoring your levels of B1 along with good nutrition and hydration.
This extremely rare type of psychosis can appear at the beginning of your period, around ovulation, or during the few days before your period starts. It happens because out-of-balance hormones at different points in your cycle can affect thinking and moods. It may show up quickly and disappear just as fast. During the episodes, you may be confused about what's real, hallucinate, and believe things that aren't true.
Cognitive behavioral therapy (CBT) and antipsychotic drugs can help ward off symptoms, even with hormone levels that are hard to predict.
Causes of Psychosis
Doctors don’t know exactly what causes psychosis. Genes are thought to play a role, but they don't in every case.
What can trigger a psychotic episode?
In general, you develop psychosis due to a mental or physical condition, alcohol or drug use, or a traumatic event.
Psychological causes. Along with schizophrenia and bipolar disorder, serious stress, anxiety, or depression can trigger a psychotic episode. Serious sleep loss could also be a cause.
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.
Medical conditions. Besides epilepsy and thyroid problems, illnesses and injuries that can bring on psychosis include:
- Traumatic brain injuries
- Brain tumors
- Parkinson’s disease
- Alzheimer’s disease
- HIV and AIDS
- Multiple sclerosis
- Low blood sugar (hypoglycemia)
Drug-induced psychosis. Both drugs that depress the nervous system, like cannabis (marijuana), and stimulant drugs, like cocaine and amphetamines, can affect your brain activity in dramatic ways, so that what seems real to you doesn't match with the world. Some prescription medications can also lead to psychosis.
Most of the time, this goes away when you stop using the drug. But there’s a strong link between all these drugs and primary psychosis. More than 25% of those who are diagnosed with amphetamine-induced psychosis later have psychotic disorders. Cannabis is involved in roughly half of all cases.
Studies suggest that these drugs may not so much cause psychosis as uncover the condition when it’s already present among people with psychiatric conditions, such as schizophrenic disorders or a family history of psychosis.
If you've been using a drug for a while, you could also have psychotic symptoms when you suddenly stop taking it.
Drugs used to treat mental illness can lead to problems as well. Although it’s rare, if you've been taking an antipsychotic (such as chlorpromazine, fluphenazine, haloperidol, perphenazine, and others) for many months or years, you could develop a movement disorder call tardive dyskinesia because of the long-term effects of the medication on your brain.
And if you stop taking an antipsychotic medicine, you may get supersensitivity psychosis. Doctors think it happens because ongoing use of this type of drug changes how your brain responds to the chemical dopamine. The use of some antipsychotic medications, like aripiprazole (Abilify), carries a higher risk of psychosis.
Most drug-triggered symptoms will clear up after the drug leaves your system. But psychosis from cocaine, PCP (phencyclidine, or "angel dust"), and amphetamines could last for weeks. While you wait for the episode to pass, your doctor can ease the symptoms with an anti-anxiety drug such as lorazepam (Ativan) or maybe an antipsychotic.
Alcohol-induced psychosis. You can get delusions or hallucinations when you're intoxicated on alcohol, suddenly stop using alcohol, or have long-term alcoholism. Your doctor can treat you with antipsychotics or other medications. If you're able to stop using alcohol, your psychosis symptoms probably won't come back.
When to See a Doctor
If you have any psychosis symptoms or notice psychotic behavior in someone around you, contact a doctor or mental health professional right away. The sooner you get treatment, the more effective it's likely to be.
Keep in mind that those with psychosis often don't recognize that they're having symptoms.
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. They may do drug screening tests as well as blood tests to look for physical causes. Doctors diagnose mental illnesses after ruling out other things that could be causing psychotic symptoms.
There aren't any tests your doctor can use to diagnosis psychosis. Instead, they'll ask you several questions, such as:
- If any mental health conditions run in your family
- Whether you take any medications or use illegal drugs
- What kind of moods you've had lately
- How well you're able to do your usual activities
- If you've had hallucinations or delusions, what they were like
When you have psychosis, you may not be able to care for yourself or do the things you normally do. Some people develop substance use disorders when they use drugs or alcohol to try to deal with their symptoms.
It’s important to get treated early, after the first episode of psychosis. That will help keep the symptoms from affecting your relationships, job, or schoolwork. It may also help you avoid more problems down the road.
Your doctor may recommend coordinated specialty care (CSC). This is a team approach to treating schizophrenia when the first symptoms appear. The family is involved as much as possible.
The psychosis treatment 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.
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.
When you have psychosis, you have a hard time understanding what's real and what's not. Many things can cause it, including physical and mental illnesses and substance abuse. Treatment, especially when you get it early in the process, can be very effective.