Psychosis

Psychosis is characterized by an impaired relationship with reality. And it is a symptom of serious mental disorders. People who are psychotic may have either hallucinations or delusions.

Hallucinations are sensory experiences that occur within the absence of an actual stimulus. For example, a person having an auditory hallucination may hear their mother yelling at them when their mother isn’t around. Or someone having a visual hallucination may see something, like a person in front of them, who isn’t actually there.

The person experiencing psychosis may also have thoughts that are contrary to actual evidence. These thoughts are known as delusions. Some people with psychosis may also experience loss of motivation and social withdrawal.

These experiences can be frightening. They may also cause people who are experiencing psychosis to hurt themselves or others. It is important to see a doctor right away if you or someone you know is experiencing symptoms of psychosis.

• Symptoms of psychosis include:
  • difficulty concentrating
  • depressed mood
  • sleeping too much or not enough
  • anxiety
  • suspiciousness
  • withdrawal from family and friends
  • delusions
  • hallucinations
  • disorganized speech, such as switching topics erratically
  • depression
  • anxiety
  • suicidal thoughts or actions

Delusions and hallucinations are two very different symptoms that are both often experienced by people with psychosis. Delusions and hallucinations seem real to the person who is experiencing them.

Delusions

A delusion is a false belief or impression that is firmly held even though it is contradicted by reality and what is commonly considered true. There are delusions of paranoia, grandiose delusions, and somatic delusions.

People who are experiencing a delusion of paranoia might think that they are being followed when they are not, or that secret messages are being sent to them. Someone with a grandiose delusion will have an exaggerated sense of importance. Somatic delusion is when a person believes they have a terminal illness when in reality they are healthy.

Hallucinations

A hallucination is a sensory perception in the absence of outside stimuli. That means seeing, hearing, feeling, or smelling something that isn’t present. A person who is hallucinating might see things that don’t exist or hear people talking when they are alone.

Causes of psychosis

Each case of psychosis is different, and the exact cause is not always clear. There are, however, certain illnesses that cause psychosis. There are also triggers like drug use, lack of sleep, and other environmental factors. In addition, certain situations can lead to specific types of psychosis to develop.

Illnesses

Illnesses that can cause psychosis include:

• brain diseases such as Parkinson’s disease, Huntington’s disease, and some chromosomal disorders
• brain tumors or cysts

Also some types of dementia may cause psychosis, such as:  

• Alzheimer’s disease
• HIV, syphilis, and other infections that attack the brain
• some types of epilepsy
• stroke

Risk factors for developing psychosis

It’s not currently possible to precisely identify who is likely to develop psychosis. However, research has shown that genetics may play a role.

People are more likely to develop a psychotic disorder if they have a close family member, such as a parent or sibling who has a psychotic disorder.

Children born with the genetic mutation known as 22q11.2 deletion syndrome are at risk for developing a psychotic disorder, especially schizophrenia.

Types of psychosis

Some kinds of psychosis are brought on by specific conditions or circumstances that include the following:

Brief psychotic disorder

Brief psychotic disorder, sometimes called brief reactive psychosis, can occur during periods of extreme personal stress like the death of a family member. Someone experiencing brief reactive psychosis will generally recover in a few days to a few weeks, depending on the source of the stress.  

Drug- or alcohol-related psychosis

Psychosis can be triggered by the use of alcohol and illegal drugs, including stimulants such as methamphetamine and cocaine. Hallucinogenic drugs like LSD often cause users to see things that are not really there, but this effect is temporary. Some prescription drugs like steroids and stimulants can also cause symptoms of psychosis

People who are addicted to alcohol and certain drugs can experience psychotic symptoms if they suddenly stop drinking or taking the drug to which they are addicted.

Organic psychosis

A head injury or an illness or infection that affects the brain can cause symptoms of psychosis.

Psychotic disorders

Psychotic disorders can be triggered by stress, drug or alcohol use, injury, or illness. They can also appear on their own. The following types of disorders may have psychotic symptoms:

Bipolar disorder

When someone has bipolar disorder, their moods swing from very high to very low. When their mood is high and positive, they may have symptoms of psychosis. They may feel extremely good and believe they have special powers.

When their mood is depressed, the individual may have psychotic symptoms that make them feel angry, sad, or frightened. These symptoms include thinking someone is trying to harm them.

Delusional disorder

A person experiencing delusional disorder strongly believes in things that are not real.

Psychotic depression

This is major depression with psychotic symptoms.

Schizophrenia

Schizophrenia is a lifelong disease that is generally accompanied by psychotic symptoms.

How is psychosis diagnosed?

Psychosis is diagnosed through a psychiatric evaluation. That means a doctor will watch the person’s behavior and ask questions about what they are experiencing. Medical tests and X-rays may be used to determine whether there is an underlying illness causing the symptoms.

Diagnosing psychosis in children and teenagers

Many of the symptoms of psychosis in adults are not symptoms of psychosis in young people. For example, small children often have imaginary friends with whom they talk. This just represents imaginative play, which is completely normal for children.

But if you are worried about psychosis in a child or adolescent, describe their behavior to GP and Health Professional.

Treatment of psychosis

How is psychosis treated?

Treatments usually involve medication, education about the illness, counselling, family support and practical support (such as helping you get back to school or work). Avoiding drugs, reducing stress and learning ways to cope with stress can help prevent the symptoms from returning in the future.

Rapid tranquilization

Sometimes people experiencing psychosis can become agitated and be at risk of hurting themselves or others. In these cases, it may be necessary to calm them down quickly. This method is called rapid tranquilization. A doctor or emergency response personnel will administer a fast acting shot or liquid medicine to quickly relax the patient.

Drugs and medication

Symptoms of psychosis can be controlled with medications called antipsychotics. These medicines reduce hallucinations and delusions and help people think more clearly. The type of medicine that is prescribed will depend on the symptoms.

In many cases, people only need to take antipsychotics for a short time to get their symptoms under control. People with schizophrenia may have to stay on medications for life.

Cognitive behavioral therapy and other therapy treatments.

Cognitive behavioral therapy means meeting regularly to talk with a mental health counselor with the goal of changing thinking and behaviors. This approach has been shown to be effective in helping people make permanent changes and more effectively manage their illness. It is often most helpful for psychotic symptoms that don’t completely resolve with medications.
CRT (single modality intervention)
CRT is an identified procedure that is specifically focused on basic cognitive processes, such as attention, working memory or executive functioning, and having the specific intention of bringing about an improvement in the level of performance on that specified cognitive function or other functions, including daily living, social or vocational skills (NICE 2009 update p. 276).

How do I help someone else cope with psychosis?

Try to be calm and supportive as it can be frightening and confusing to experience psychosis. If you are worried about a friend or family member, seek help from your GP or local mental health service, and encourage the young person to get professional treatment as early as possible.

Practical help can assist a person to stay safe and feel secure. This might mean helping them to pay bills or rent, or getting them to medical appointments.

If someone is suggesting they will harm themselves, call your mental health service or hospital to arrange urgent specialist attention. Remember the person may be responding to things that are real to them but do not make sense to you. There are support groups for family and friends of people with psychosis.

Complications and outlook of psychosis

Psychosis does not have many medical complications. However, if left untreated, it can be challenging for people experiencing psychosis to take good care of themselves. That could cause other illnesses to go untreated.

Most people who experience psychosis will recover with proper treatment. Even in severe cases, medication and therapy can help.
Psychosis causes people to misinterpret or confuse what is going on around them. For example, they may have hallucinations (in which they see or hear things that are not existent) or delusions (fixed false beliefs). A first episode of psychosis is most likely to happen in late adolescence or in the early adult years. It is often frightening for the person and misunderstood by others, but psychosis can be treated and most people make a full recovery. Without treatment, psychosis can seriously disrupt your life and development, so it’s important to get early help.

What are the symptoms of psychosis?

Confused thinking: Everyday thoughts can become confused, making sentences unclear or hard to understand. You might have difficulty concentrating, following a conversation or remembering things. Thoughts can seem to speed up or slow down.

False beliefs (delusions): You strongly believe something is real, but it’s not. For example, you may believe the way that cars are parked outside the house shows you are being watched by the police.

Hallucinations: You can see, hear, feel, smell or taste something that is not actually there.

Changed feelings: How you feel can change for no obvious reason. You might feel strange and cut off from the world, with everything moving in slow motion. Mood swings are common, and you might feel unusually excited or depressed. You may seem to feel less emotion, or show less emotion to those around you.

Changed behaviour: You may be extremely active or have difficulty getting the energy to do things, laugh when things don’t seem funny, or become angry or upset without any cause.

What are the types of psychosis?

Psychosis can occur in a number of mental illnesses. Some possibilities include:

Drug-induced psychosis: Using or withdrawing from drugs, especially cannabis and amphetamines, can cause psychotic symptoms that last for short or long periods

Brief reactive psychosis: Psychotic symptoms appear suddenly after a major stress in the person’s life. Recovery is often quick

Schizophrenia: An illness in which the symptoms have continued for at least six months. Many people with schizophrenia lead happy and fulfilling lives, and many make a full recovery

Bipolar disorder: People can experience psychotic symptoms as part of this disorder

Psychotic depression: Psychotic symptoms can occur in people with very severe depression

What causes psychosis?

Like lots of illnesses, psychosis is probably caused by a combination of your genes (inherited from your parents) and the things you are exposed to in your life (your environment, which might include stress, drug use or severe social changes).