Psychosis

Overview

Psychosis is a state in which a person loses some contact with reality. It is not a diagnosis in itself but a set of symptoms that can occur in several conditions. During psychosis, a person may hear, see, or believe things that are not real, and their thinking and speech may become disorganized.

Psychosis can develop gradually or come on suddenly. It can be frightening for the person experiencing it and for those around them, but it is treatable, and many people recover well, especially when help is sought early. A first episode often occurs in the late teens or early twenties. Causes range from mental health conditions such as schizophrenia and bipolar disorder to drug use, severe stress, and physical illnesses, so a careful assessment is important.

Symptoms

Psychosis usually involves a combination of the following features, which can vary in intensity.

• Hallucinations: Hearing, seeing, smelling, or feeling things that are not there, most commonly hearing voices.
• Delusions: Strongly held false beliefs that are out of keeping with reality, such as feeling persecuted or having special powers.
• Disorganized thinking and speech: Jumbled thoughts, jumping between unrelated ideas, or speech that is hard to follow.
• Reduced insight: Difficulty recognizing that these experiences are not real.
• Changes in behavior and emotion: Withdrawal, agitation, suspiciousness, or flat emotional responses.

Early warning signs can be subtle, such as a drop in performance at school or work, social withdrawal, suspiciousness, and unusual ideas, before fuller symptoms appear.

Causes

Psychosis has many possible causes, and finding the cause guides treatment.

• Mental health conditions: Schizophrenia, schizoaffective disorder, severe bipolar disorder, and severe depression can all involve psychosis.
• Substance use: Drugs such as cannabis, stimulants, hallucinogens, and alcohol withdrawal can trigger psychosis.
• Medical conditions: Brain injury, infections, dementia, certain hormonal or metabolic problems, and some medications can cause it.
• Severe stress or trauma: Extreme stress, lack of sleep, and major life events can contribute, especially in vulnerable people.
• After childbirth: Rarely, severe psychosis can occur in the postpartum period and is a medical emergency.

Risk Factors

• A family history of psychosis, schizophrenia, or bipolar disorder
• Being a teenager or young adult (common age of first episode)
• Heavy use of cannabis or other drugs, especially in youth
• Significant stress, trauma, or sleep deprivation
• Certain medical and neurological conditions
• Recent childbirth (for postpartum psychosis)

Diagnosis

Assessment aims to confirm psychosis, find the cause, and rule out medical and drug-related triggers.

• Mental health evaluation: A detailed interview about symptoms, their timing, and their impact, often with input from family.
• Medical examination and tests: Blood tests, drug screening, and sometimes brain imaging to check for physical causes.
• Review of substances and medications: Identifying drugs or medicines that may be responsible.

Because some causes are medical emergencies, a first episode of psychosis should be evaluated promptly.

Treatment

Treatment is usually effective and works best when started early. It combines medication, psychological support, and addressing any underlying cause.

• Antipsychotic medication: Helps reduce hallucinations, delusions, and disordered thinking.
• Psychological therapies: Talking therapies such as cognitive behavioral therapy help a person cope, make sense of experiences, and stay well.
• Treating the underlying cause: Managing the related mental illness, stopping a triggering drug, or treating a medical condition.
• Support and rehabilitation: Family education, social and vocational support, and early-intervention services that focus on recovery.
• Hospital care: Sometimes needed for safety and to start treatment, especially in a severe first episode.

Self-Care and Support

• Seek help early; treating a first episode quickly improves recovery
• Avoid cannabis and other drugs that can trigger or worsen psychosis
• Protect sleep and manage stress, which can destabilize mental health
• Stay connected with mental health services and take medication as prescribed
• Build a support network of trusted family, friends, or peer groups
• Recognize personal early warning signs and have a plan to act on them

When to See a Doctor

Seek help promptly if you or someone you know develops hallucinations, strong false beliefs, or confused thinking, especially a first episode. Early treatment leads to better outcomes. Seek emergency care immediately, or call your local emergency number, if a person is at risk of harming themselves or others, has thoughts of suicide, is severely confused or unable to care for themselves, or if psychosis develops suddenly after childbirth, which is a medical emergency. If you or someone you know is in crisis, contact emergency services or a suicide and crisis helpline right away.

Related Topics

Frequently Asked Questions

References

1. National Institute of Mental Health (NIMH). Understanding Psychosis.
2. MedlinePlus, U.S. National Library of Medicine. Psychotic disorders.
3. Mayo Clinic. Psychosis (within Schizophrenia and related topics).
4. World Health Organization (WHO). Schizophrenia and psychosis.