Psychosis involves a loss of contact with reality. It is present in many conditions, including schizophrenia and bipolar disorder. Hallucinations and delusions are its most common symptoms.

People with psychosis may experience disruptions in their thoughts and perceptions, causing them to see their world differently. It is a common symptom in many medical and neurologic conditions.

Psychosis can affect anyone. According to the National Alliance on Mental Health (NAMI), 100,000 young people in the United States experience psychosis every year. At the same time, up to 3 in 100 people will have an episode in their lifetime.

In this article, learn more about psychosis, including what causes it and the treatment options available.

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Psychosis affects a person’s thoughts and perceptions. It alters how they process information, making it difficult to determine what is real from what is not.

People with psychosis may hear, see, smell, taste, or feel things that are not there. They can also hold strong beliefs or bizarre ideas, such as that someone is out to get them or that someone is monitoring their activities when these are not the case.

Psychosis feels or appears real to a person. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) states that a person may not be aware that they have psychosis. It can be overwhelming and confusing.

Sometimes, the symptoms can cause the person to harm themselves. In rare cases, they may hurt another person.

Psychosis is one of the key symptoms of schizophrenia and other psychotic disorders. According to the DSM-5, it also co-occurs with many mood and substance use disorders.

Depending on the cause, psychosis can appear quickly or cause slow, gradual changes in a person’s thoughts and perceptions. It can also be mild or severe.

In some cases, it may be mild when it first appears but become more intense over time. While psychosis includes a range of symptoms, it often involves one of two significant experiences.

The below sections explore the early signs of psychosis and two common symptoms in more detail.

Early signs

Early or first-episode psychosis (FEP) is the period when a person first begins to experience psychosis. The symptoms can be difficult to distinguish from typical behavior. These include:

  • a significant drop in job performance or school grade
  • difficulty concentrating or thinking clearly
  • uneasiness or suspiciousness around others
  • lacking emotions or having strong, inappropriate ones
  • social withdrawal
  • sudden decline in self-care or personal hygiene

The DSM-5 states that psychosis involves abnormalities in one of the following categories or domains:

  • Hallucinations: Experiences a person perceives to be real despite the lack of stimulus to cause them.
  • Delusions: False beliefs that a person holds despite a lack of evidence or proof.
  • Disorganized thought: Having thoughts that are not logical, unrelated, or loosely connected. A person’s thought process may drift away from the topic. Their speech may make no sense to others.
  • Catatonia: The person may become unresponsive or oppose stimuli (negativism) or present with unintentional movements or activities that lack purpose (catatonic excitement).
  • Disorganized behavior: Unpredictable or inappropriate emotional responses that are not in line with the situation.
  • Negative symptoms: A decline in emotions, words, movements, or motivation (anhedonia).

Hallucinations

Hallucinations may cause a person to see, hear, feel, taste, or smell something that is not there. Of these, auditory hallucinations appear to be the most common.

A person with auditory hallucinations hears things and believes them to be real when they do not exist.

A person may hear incoherent sounds or distinct voices. They can perceive them to come through the ears, anywhere external to them, or in their mind.

Hearing voices may be very distressing, especially when they are commanding, derogatory, haunting, or threatening. It can affect a person’s actions and cause them to harm themselves or others. It may also cause a person to attempt suicide.

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.

Click here for more links and local resources.

Delusions

A person may also experience delusions during a psychotic episode. The most commonly encountered types of delusions include:

  • Erotomanic delusions: The belief that another person is in love with them.
  • Delusions of grandeur: A strong belief that the person has a special power or authority.
  • Thought broadcasting: The belief that the person is broadcasting their thoughts and that others can perceive them.

A person may also experience:

The length of a person’s psychosis varies depending on the type of psychosis.

Substance or medication-induced psychosis tends to resolve shortly after the substance clears from a person’s system. But psychosis triggered by amphetamines, phencyclidine (PCP), and cocaine may last for several weeks.

Meanwhile, a brief psychotic disorder usually lasts for less than a month. According to the DSM-5, psychotic symptoms need to be present in people with schizophrenia for a significant portion of time during 1 month or longer.

Psychosis is not an illness in and of itself. It is often a symptom of another condition. To determine what may be causing the psychosis, a doctor will perform a thorough history.

This includes understanding the person’s personal, family, medical, cultural, social, and religious history. They will also ask about the person’s psychotic symptoms, including their course, duration, and severity.

The doctor will conduct a physical examination, including a mental and neurological exam.

If the signs and symptoms suggest an underlying medical condition, a doctor may request tests, including:

The doctor may also consider testing for HIV and syphilis. Brain imaging is often not necessary except when the person presents with a new, severe headache, a history of recent significant head trauma, or focal neurological deficits.

They may also do tests to rule out other factors, including:

If the signs indicate a psychiatric cause, the doctor will refer to criteria from the DSM-5 to make a diagnosis.

Psychosis can happen due to several factors. It may be a symptom of a mental condition. Psychotic disorders such as delusional disorder and schizotypical disorder share psychosis as a symptom.

Studies show that a combination of genetic and environmental factors can lead to psychosis. Certain environmental factors may increase a person’s risk for psychosis, including:

  • maternal infections and obstetric complications
  • maternal stress and malnutrition
  • child abuse
  • head injury during childhood
  • migration
  • drug misuse

Other causes of psychosis include:

  • brain changes
  • alcohol and substance misuse
  • general medical conditions
  • certain psychiatric and neurological conditions
  • certain prescription drugs
  • sex hormones
  • lack of sleep

Traumatic events such as war, sexual assault, or death can also trigger a psychotic episode.

The mechanisms by which psychosis occurs are not entirely clear, but many studies point to imbalances in the brain’s chemicals.

The positive symptoms of psychosis are associated with excess dopamine activity (a neurotransmitter related to mood), as well as a decrease in the activity of receptors for glutamate (another neurotransmitter).

Some studies also point to imbalances in the activity of gamma-aminobutyric acid (GABA) and acetylcholine.

Anyone experiencing psychosis should receive urgent medical attention. Treatment can provide both short- and long-term help.

Antipsychotic drugs

Antipsychotic drugs are the primary treatment for people with psychotic illnesses.

Antipsychotics can reduce psychosis symptoms in people with psychiatric disorders, such as schizophrenia. However, they do not treat or cure the underlying condition.

Examples of these medications include:

  • haloperidol (Haldol)
  • chlorpromazine (Thorazine)
  • clozapine (Clozaril)

A person can only use these drugs under supervision from a doctor as they can have adverse effects.

Learn more about antipsychotic drugs for schizophrenia here.

The doctor will also treat any underlying conditions responsible for the psychosis. Where possible, family support can also help.

Acute and maintenance phases of schizophrenia

In schizophrenia, there are two phases of antipsychotic treatment:

Acute phase

During the acute phase of schizophrenia, a person may need to stay in a hospital to receive care.

Sometimes, a doctor will prescribe rapid tranquilization. They will give the person a fast-acting medication that relaxes them to ensure they do not harm themselves or others.

Maintenance phase

In the maintenance phase, a person does not stay in the hospital, but healthcare professionals will prescribe antipsychotic drugs to help prevent further episodes. Stopping the medication can lead to relapses.

Psychotherapy interventions, including cognitive behavioral therapy (CBT) and supportive counseling, can also help people with schizophrenia and other psychotic disorders.

Learn more about the stages of schizophrenia and treatment here.

Apart from schizophrenia, other psychotic disorders can cause psychosis. According to the DSM-5, these include:

  • Schizoaffective disorder: This disorder is similar to schizophrenia but includes periods of mood disturbances.
  • Brief psychotic disorder: Symptoms occur in response to a stressful life event, last less than 1 month, and do not return.
  • Delusional disorder: The person strongly believes in something irrational and often bizarre with no factual basis.
  • Bipolar psychosis: Some people with bipolar disorder experience psychosis during a very high or very low mood.
  • Severe depression: Also known as major depressive disorder with psychotic features.
  • Postpartum (postnatal) psychosis: This type of psychosis can present after giving birth.
  • Substance-induced psychosis: The misuse of alcohol, some recreational drugs, and certain prescription drugs can cause this.

Psychosis can also result from other disorders, such as:

Psychosis is a collection of symptoms that makes a person out of touch with reality. Hallucinations and delusions often accompany it.

A person may experience psychosis for various reasons, including underlying mental health conditions, trauma, and infections.

While having a psychotic episode is distressing, treatment can help manage the symptoms.

If a person has concerns about someone experiencing psychosis, they should take them to the emergency room, if possible, or call 911.