Psychosis involves a loss of contact with reality and can feature hallucinations and delusions. It is a symptom of schizophrenia and bipolar disorder, but there are many other causes.

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

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Psychosis affects how a person thinks and their perceptions. Their senses may seem to detect things that do not exist, and they may find it difficult to determine what is real and true.

People with psychosis may:

  • hear voices
  • see people or items that are not there
  • smell odors that other people cannot detect

They may also believe that they are in trouble, someone is chasing them, or they are very important when these situations are not the case.

A person may not be aware that they have psychosis because the delusions feel real to them. Psychosis 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.

The signs and symptoms of psychosis include:

  • Hallucinations: The person hears, sees, smells, tastes, or feels things that do not exist.
  • Delusions: The individual believes things that are false, and they may have unfounded fears or suspicions.
  • Disorganized thinking, speech, and behavior: The person may jump between unrelated topics in speech and thought, making connections that appear illogical to other people. Their speech may make no sense to others.
  • Catatonia: The person may become unresponsive.
  • Unusual psychomotor behavior: The person makes unintentional movements, such as pacing, tapping, and fidgeting.

The person may also experience:

  • mood changes
  • difficulty focusing
  • sleep problems

Depending on the cause, psychosis can appear quickly or slowly. It can also be mild or severe. In some cases, it may be mild when it first appears but become more intense over time.

Early signs

The mild, early symptoms of psychosis might include:

  • general anxiety
  • depression
  • social isolation
  • problems focusing
  • mild or moderate disturbances in language, energy levels, and thinking
  • difficulty taking initiative
  • lower tolerance to stress
  • sleep problems
  • neglecting self-care
  • feelings of suspicion
  • thoughts and ideas that seem strange to others

Hallucinations can affect any of the senses — sight, sound, smell, taste, and touch — in the person with psychosis.

Hearing voices

Auditory hallucinations appear to be the most common types of hallucinations for people with schizophrenia. The person hears things and believes them to be real when they do not exist.

Often, the person hears voices. There may be one or many voices, and they will sound exactly like real voices.

The voices may:

  • be recognizable, nonspecific, or of someone who has died
  • sound either clear or like mumbling in the background
  • give instructions or criticize the person
  • be intermittent or constant

Hearing voices can be very confusing, and it can affect a person’s actions. It can lead to the individual harming themselves or, less often, others.

Treatment can manage or prevent psychosis, but it can return if the person stops taking their medication.

There may also be a risk of 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 National Suicide Prevention Lifeline is available 24 hours per day at 800-273-8255. During a crisis, people who are hard of hearing can call 800-799-4889.

Click here for more links and local resources.

Delusions during psychosis

During a psychotic episode, a person may experience delusions.

Paranoid delusions can cause a person to be suspicious of individuals or organizations, believing them to be plotting to cause the person harm.

Delusions of grandeur involve a strong belief that the person has a special power or authority. For instance, they may believe that they are a political leader.

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

Early diagnosis

Schizophrenia and bipolar disorder usually appear in a person’s teenage years or during early adulthood. Early treatment can improve long-term outcomes, but it can take time for healthcare professionals to provide an accurate diagnosis.

Psychiatrists recommend considering the possibility of a psychotic disorder in a young person if they show signs of:

  • increased social withdrawal
  • changes in mood
  • reduced focus or performance at school or work
  • distress or agitation without being able to explain why

There is no biological test for psychosis, but laboratory tests can rule out other medical problems that might explain the symptoms.

Diagnostic tests

To diagnose psychosis, a doctor will carry out a clinical examination and ask various questions.

They will ask about:

  • the person’s experiences, thoughts, and daily activities
  • any family history of psychiatric illness
  • any medical and recreational drug use
  • any other symptoms

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

  • the use of drugs or other substances
  • a head injury
  • other medical conditions, such as multiple sclerosis (MS) or a brain tumor

Possible tests include:

  • blood tests
  • urinalysis
  • an electroencephalogram (EEG), which records brain activity

If the signs indicate a psychiatric cause, the doctor will refer to criteria from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) to make a diagnosis.

The exact causes of psychosis are not well-understood but might involve:

  • Genetic factors: Research shows that schizophrenia and bipolar disorder may share a common genetic cause.
  • Hormones: Some people experience postpartum psychosis after giving birth. Due to this, and the fact that the early signs of psychosis often occur first in adolescents, some experts have suggested that hormonal factors may play a role in those with a genetic susceptibility.
  • Brain changes: Tests have found differences in brain chemicals — specifically, the activity of the neurotransmitter dopamine — in people who experience psychosis.

A lack of sleep may also trigger psychosis.

Psychosis can be disruptive, but treatment is available to help people manage it.

Antipsychotic drugs

Antipsychotic drugs are the main form of treatment for people with a psychotic illness.

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.

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

The person may need to stay in the hospital.

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

Maintenance phase

The person does not stay in the hospital but uses antipsychotic drugs to help prevent further episodes. Stopping the medication can lead to relapses.

Psychotherapy can also help treat cognitive issues and other symptoms of schizophrenia and other psychotic disorders.

Apart from schizophrenia, various other disorders and factors can cause psychosis. The different types 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 a month, and do not return.
  • Delusional disorder: The person has a strong belief in something irrational and often bizarre with no factual basis.
  • Bipolar psychosis: Some people with bipolar disorder experience psychosis, either 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 one of the key symptoms of schizophrenia, but it has other causes.

It can make the individual and those around them anxious, but treatment is available to help manage psychosis in those who are at risk.

It is essential to follow the treatment plan for schizophrenia and other mental health conditions to prevent a relapse of symptoms, such as psychosis.

If anyone has concerns that a person may be experiencing psychosis, they should take them to the emergency room, if possible, or call 911.