Psychosis: Types, Symptoms, & Treatments

What Is Psychosis?

Psychosis is a set of mental health symptoms that affect the ability to differentiate reality from false beliefs and ideas. Psychosis can impair functioning in various aspects of life as individuals struggle with delusions, hallucinations, and impaired insight.

Psychotic symptoms typically occur alongside a diagnosable mental health disorder, like schizophrenia or brief psychotic disorder. These experiences can become dangerous and harmful to the individual and others, and most episodes require immediate care and attention.

How Common Is Psychosis?

Statistics estimate that 1.5-3.5% of individuals will experience a psychotic disorder in their lifetime. A larger number will experience at least one psychotic episode, possibly due to bipolar psychosis, depression, or neurological or medical conditions.¹

Schizophrenia Vs. Psychosis

Schizophrenia is a diagnosable mental health disorder, but psychosis is a set of symptoms. However, these two experiences are closely interwoven because psychosis is a key feature of schizophrenia.²

Psychosis Vs. Neurosis

While professionals rarely use “neurosis” in modern practice, the term describes “emotional” conditions. These could include anxiety, depression, obsessive-compulsive behaviors, and phobias. Neurosis is generally less severe than psychosis.

Signs of Psychosis

Early warning signs of psychosis can be challenging to differentiate from other mental health symptoms, particularly those of a mood disorder like depression. For example, sudden behavioral and social changes could be signs of a psychotic break. However, more apparent manifestations may develop when untreated symptoms worsen and begin impacting self-care, mental clarity, and academics.

Early signs of psychosis may include:

• Sudden drop in work or school performance
• Flat affect
• Emotionality or mood swings
• Difficulty concentrating
• Appearing suspicious of others
• Declined self-care
• Social withdrawal
• Hallucinations
• Disorganized thoughts or speaking incoherently

Psychosis Symptoms

Symptoms of psychosis can present differently depending on the specific mental diagnosis. In every case, psychotic episode symptoms can profoundly impact the ability to function adequately in work, school, relationships, and other aspects of life.

Symptoms of psychosis include:

Delusions

Delusions are false beliefs that persist despite conflicting evidence. Delusions always involve false beliefs but can be either bizarre or non-bizarre. Non-bizarre delusions reflect situations that can actually happen. Conversely, bizarre delusions involve unrealistic ideas or concepts.

Types of delusions in psychosis include:

• Persecutory: People with persecutory delusions develop ideas that others, groups, agencies, or institutions are working to harm or injure them.
• Referential: Referential delusions occur when someone believes that actions or remarks by others or occurrences in the world directly relate to them.
• Grandiose: Grandiose delusions involve ideas of wealth, fame, or extraordinary skills beyond what the person possesses or could ever hope to achieve.
• Erotomanic: Erotomanic delusions occur when someone falsely believes someone else is in love with them.
• Somatic: Somatic delusions involve false beliefs about bodily functions and overall health.
• Nihilistic: People with nihilistic delusions are convinced without evidence that some major catastrophe is about to occur. They may engage in various conspiracy theories to support their claims.

Hallucinations

Hallucinations are false perceptions that occur outside of reality. Hallucinations in psychosis are powerful, convincing sensory experiences that occur while fully awake and are otherwise difficult to ignore.

Auditory hallucinations are the most common, especially in schizophrenia.² People with auditory hallucinations can hear voices that can be nothing more than gibberish. Other times, “command voices” may tell them what to do or say.

Psychotic hallucinations generally coincide with a pattern of delusional thinking. While delusions can exist without hallucinations, the opposite is rarely true. Because these experiences can be so vivid and persistent, their development can deepen a more elaborate and entangled cycle of delusion.

Types of hallucinations in psychosis include:

• Auditory: Auditory hallucinations refer to hearing things outside reality, such as music, noises, or conversations.
• Tactile: Tactile hallucinations are when a person feels something touching or tickling their skin without an external source.
• Visual: People experiencing visual hallucinations see people, movements, or objects.
• Olfactory: Olfactory hallucinations involve the sense of smell.
• Gustatory: Those with gustatory hallucinations taste pleasant, unpleasant, or neutral things without an external source.

Disorganized Thinking or Speech

Another specific psychotic feature is the presentation of disorganized thinking. This symptom can develop as the psychosis worsens, making basic communication more challenging. People with this symptom may switch from one topic to another. They may follow a disjointed path through many unrelated topics, becoming less able to answer simple questions. Individuals may become incomprehensible and present persistent muttering or “word salad.”

Grossly Disorganized or Abnormal Motor Behavior

Grossly disorganized or abnormal behavior is a diagnostic criterion describing strange, inappropriate, or bizarre movements. For example, a person may exhibit otherwise abnormal facial expressions, gestures, or postures.

Negative Symptoms

“Negative” refers to reduced and diminished behavior presentation and functioning. These symptoms include a gross lack of emotional expression and motivation. Speech patterns may appear flat, without inflection. Anhedonia, the absence of pleasure in usual activities, may also present in psychosis.

Catatonia

Catatonia is when a person becomes immobile, rigid, or unresponsive, and many may appear motionless, rigid, or like a statue. They may become mute or unresponsive to anything around them. Some people develop a condition called “waxy flexibility.” Another person may move their limbs to a certain position where they stay until moved again.³

Stages of Psychosis

Several psychosis stages can occur before and after a person shows signs of acutely psychotic behavior. Early intervention can help prevent future episodes or worsening symptoms, so identifying the warning signs can offer the best chance of recovery.

Prodrome

Prodrome refers to the period right before a psychotic episode begins. A person may show early warning signs like social withdrawal, changes in thinking, or difficulty sleeping. Not everyone who experiences prodrome develops psychosis.

Acute

Acute psychosis refers to an active psychotic episode or break. Psychotic break symptoms can cause a complete disconnect from reality, and individuals may require immediate mental health care and intervention.

Recovery

Recovery from a psychotic episode includes regaining stability and returning to a healthy baseline. Following through with treatments like medication, therapy, and support groups is essential to prevent or minimize future breaks. Individuals may also consider creating a crisis plan, including warning signs, resources, and support.

Types of Psychotic Disorders

Psychotic disorders vary in terms of their severity and cause. Psychosis can appear in a short-term episode, result from substance abuse, or be a symptom of a chronic mental health disorder. Psychosis can also be a rare and dangerous postpartum complication.

Brief Psychotic Disorder

Brief psychotic disorder is the sudden appearance of any psychotic symptom. Someone may experience this condition when entering a temporary and quick psychotic state, often after an overwhelmingly stressful event. Symptoms typically resolve, and functioning returns to normal.

Substance-Induced Psychosis

Drug-induced psychosis applies when hallucinations or delusions follow drug, alcohol, or cannabis use. Certain medications can also induce psychotic symptoms in some people. In some cases, substance-induced psychoses could be catalysts for underlying mental disorders.

Bipolar Psychosis

Those with bipolar disorder can experience severe episodes of mania that include hallucinations or delusions. Psychosis symptoms may also present during depressive episodes. These psychotic features often resolve once the mood episode ends and the person returns to a more balanced state.

Postpartum Psychosis

Postpartum onset begins during pregnancy or after childbirth and is directly related to hormonal changes. These symptoms may be the first instance of psychosis for many women who develop a postpartum psychotic disorder or postpartum bipolar disorder. This condition can go overlooked, so any mood and behavior changes suggesting psychosis require immediate medical and psychological attention.

Postictal Psychosis

Postictal psychosis refers to psychotic features that occur following a seizure. The symptoms are similar to any other psychotic disorder, often including hallucinations, delusions, and disorganized thinking.

Myxedematous Psychosis

Myxedematous psychosis is a rare and serious condition in which a person experiences psychosis due to hypothyroidism.⁴

Korsakoff Psychosis

Korsakoff psychosis is a serious condition associated with Wernicke encephalopathy. This disorder is closely related to alcoholism and alcohol withdrawal. One striking feature is that patients often fabricate convincing stories about events they can not recall.⁵

What Causes Psychosis?

What triggers psychosis depends on various factors, such as an underlying mental illness, environmental factors, and stress. For example, traumatic experiences can influence brief psychotic disorder episodes. A detailed personal and family history aids in assessments and accurate diagnosis. Regardless of causes or triggers, no one should feel at fault for a psychotic disorder, whether diagnosed or supporting a diagnosed loved one.

Below are possible causes of psychosis:

• Severe depression: A severe form of depression can include psychotic features like hallucinations or delusions.
• Schizophrenia: Psychosis is one of the diagnostic criteria for schizophrenia. A schizophrenia psychotic episode is similar to any other episode, but individuals are more likely to exhibit grossly disorganized motor behavior.
• Trauma: A traumatic event can result in a brief, short-term episode of psychosis.
• Stress: High stress can worsen many mental health conditions, including psychosis. Stress alone generally does not cause a psychotic episode but can exacerbate existing conditions.
• Substance use: Certain substances, like drugs and alcohol, can trigger a psychotic episode.
• Head injury: A severe head injury or traumatic brain injury (TBI) can sometimes lead to psychosis following the trauma.
• Medication side effects: Some medications, including steroids, antiepileptic, and antimalarial drugs, can induce psychosis with hallucinations and delusions.⁶
• Sleep deprivation: Sleep deprivation can trigger psychotic symptoms, especially in individuals with pre-existing psychotic conditions.
• Genetic factors: Some psychotic disorders, like schizophrenia, are known to have a genetic component.
• Medical conditions: Certain medical conditions, like brain tumors, stroke, epilepsy, and dementia, can trigger psychotic symptoms.

How Long Does Psychosis Last?

The duration of psychosis varies widely depending on the condition and associated risk factors. Some people may experience a single, brief psychotic episode lasting just a few days. Others may suffer from chronic, lifelong disorders that make coping with psychosis an ongoing struggle.

Complications

Psychotic episodes can result in severe or life-threatening consequences, such as self-harm, accidental injury, or suicidal thoughts. Unfortunately, chronic symptoms can impair functioning, leaving many unable to maintain employment or stable housing. These challenges can lead to homelessness, legal problems, and relationship conflicts.

Below are possible complications associated with psychotic episodes:

• Self-harm
• Suicidal ideation
• Substance misuse
• Job loss
• Unstable housing
• Poor social skills
• Harm to others due to delusions or hallucinations
• Legal problems
• Permanent disability

How Is Psychosis Diagnosed?

A mental health professional can diagnose psychosis and related conditions. A thorough diagnostic interview often reviews family history, substance use, medical concerns, and symptoms. The clinician may also administer a mental status exam (MSW) to assess for thought disorders, mood, affect, and the presence or absence of suicidal or homicidal ideation. The provider will use diagnostic criteria for psychosis and rule out any other potential causes.

Treatments for Psychosis

Treatment for psychosis usually involves a collaborative approach among various mental health providers and services that address different areas of dysfunction. People can also benefit from rehabilitation or inpatient services to improve functioning and ensure ongoing health and safety.

Medications for Psychosis

Psychosis treatment typically requires antipsychotic medications to help improve functioning.⁷ Both typical and atypical antipsychotics can aid in reducing and managing positive symptoms, particularly hallucinations and disorganized thinking.

Sometimes, people with psychotic symptoms fear that medications might control them, and many may push back against professional advice. They may also have valid concerns about possible side effects, such as tiredness or sluggishness.

Psychiatrists who treat psychosis are familiar with side effects and understand how to approach dosage requirements and changes to find the best treatment approach. They may prescribe other psychiatric medications alongside antipsychotics to improve related symptoms, including depression and anxiety.

Psychotherapy for Psychosis

Medications are necessary to reduce and manage psychotic symptoms, but psychotherapy is equally essential. Therapy for psychosis can help improve trust, even when internal forces pose resistance.

Therapists specializing in psychosis help clients face delusional thoughts and perceptual distortions without judgment or reproach. Instead of telling them, “Those voices in your head aren’t real,” communication begins with, “I’d like to know more about the voices and how you feel about them.”

Mental health professionals often delve into psychotic experiences to understand associated fears and unfulfilled desires. Therapists can help individuals explore hidden, repressed, or blunted thoughts and emotions to develop trust as an antidote to paranoia. Patients can then face reality with less anxiety and a greater sense of planning and organization.

Below are therapy options for psychosis:

• Cognitive behavioral therapy (CBT): CBT can help individuals challenge and confront negative thoughts. Therapists can also teach coping skills for psychotic symptoms.
• Acceptance and commitment therapy (ACT): ACT focuses on learning to recognize thoughts and allowing them to exist. Doing so can help clients regain power over their thoughts to make healthier decisions.
• Family therapy: Family therapy can benefit families when a member experiences psychosis. These symptoms can be frightening and confusing for the whole family, so mutual counseling aims to improve communication, teach coping skills, and provide psychoeducation.
• Crisis intervention: Crisis services are necessary to help individuals gain safety and stability when experiencing an acute psychotic episode.

Inpatient & Hospitalization

Acute psychosis can be serious and often requires a period of hospitalization or inpatient mental health treatment. These facilities offer access to medical care, therapy, and monitoring to achieve stabilization and safety.

Coping With Psychosis

Living with psychosis can be frightening, especially when symptoms are recurring. However, coping skills and lifestyle changes can help reduce the frequency of episodes and impact on your life. For instance, avoid substances and implement other healthy activities, such as exercise, nutritious foods, and social support. These choices can make a difference in your overall well-being.

Below are tips for coping with psychosis:

• Avoid substance use: Substance abuse can induce or exacerbate a psychotic episode. Even limiting alcohol or drug use can be a healthy step.
• Maintain a healthy lifestyle: Staying physically active, eating well, and spending time in nature can help you feel mentally and physically stronger, providing the best possible chance for treatment success.
• Lean on loved ones for support: Your support network is invaluable when struggling with mental health. Connect with those you can lean on while navigating treatment and symptoms.
• Follow your treatment plan: Professionals care about your well-being, so follow your medication, therapy, and support plan. Never stop medication cold turkey–always consult your provider if you have any concerns.
• Seek local resources: Seek supportive resources in your community, like groups, transportation help, housing, food assistance, or case management. These services can provide much-needed guidance and access to care when dealing with psychosis.
• Maintain self-care: Taking good care of yourself, including getting adequate sleep and establishing a healthy daily routine, can help improve mental health and reduce the onset of psychotic symptoms.

Final Thoughts

Psychosis is a scary and often serious condition that can be brief or chronic, depending on the cause and underlying factors. With early identification of symptoms and proper treatment, an individual can learn to cope with psychosis and reduce the impact on their life.