Psychosis

Psychosis is not an illness in itself but a set of symptoms that can occur in several conditions. During a psychotic episode, the brain has difficulty distinguishing between what is happening internally and what is happening in the outside world. A person may hear voices, become convinced of things that others find impossible or have thinking that becomes confused and hard to follow.

Psychosis can occur once, come and go, or be part of a longer-term condition such as schizophrenia, schizoaffective disorder or bipolar disorder. First episode psychosis most often appears in late adolescence or early adulthood, but it can happen at any age.

People sometimes use the phrase "psychotic break" to describe a sudden onset of psychosis. Despite stereotypes, most people with psychosis are not violent and are far more likely to be vulnerable or frightened than dangerous.

The main symptoms of psychosis include:

• Hallucinations: hearing voices, seeing things, or feeling, smelling or tasting things that are not there
• Delusions: fixed beliefs that are not shared by others, such as being followed, watched, controlled or having special powers
• Disorganized thinking and speech: jumping between topics or speaking in a way that is hard to understand
• Unusual behavior, agitation or withdrawal
• Reduced emotional expression, motivation or interest in daily life

Before a first episode, there are often early warning signs, such as withdrawing from friends, a drop in performance at school or work, trouble sleeping, suspiciousness, unusual thoughts or feeling that things have changed in a strange way. Recognizing these early signs and getting help can make a real difference.

Psychosis usually results from a combination of vulnerability and stress. Contributing factors include:

• Genetic predisposition and family history of psychosis
• Severe stress, trauma or major life changes
• Lack of sleep
• Substance use, especially cannabis, stimulants and hallucinogens
• Some medical conditions and medications

Drug-induced psychosis can occur during intoxication or withdrawal. Symptoms often fade as the substance leaves the body, but substance use can also trigger longer-lasting conditions in vulnerable people.

Postpartum psychosis is a rare but serious condition that can develop in the days or weeks after giving birth. It can include confusion, rapid mood changes, hallucinations and delusions, and it is a medical emergency requiring immediate help.

Psychosis also appears in schizophrenia, schizoaffective disorder, bipolar disorder and severe depression.

Early intervention is key. Many areas have specialized early psychosis or first episode psychosis services that offer coordinated care. Treatment usually combines:

• Antipsychotic medication prescribed and monitored by a psychiatrist
• Cognitive behavioral therapy for psychosis (CBTp), which helps people understand and cope with distressing experiences
• Family therapy and psychoeducation, which support loved ones and reduce stress at home
• Support with education, employment and housing
• Addressing substance use and physical health

Many people recover well from a first episode, and some never have another. Others continue to experience symptoms but learn to manage them and lead meaningful lives. Treatment plans are tailored to each person and reviewed over time.

A psychiatrist is usually central to assessing and treating psychosis, often working with clinical psychologists, nurses, social workers and occupational therapists in a team. A primary care doctor can be a first point of contact and help arrange specialist care.

An assessment will include questions about experiences, thoughts, mood, sleep, substance use, family history and physical health, and may include medical tests to rule out other causes. It is helpful if a trusted person can come along, with the person's consent.

If you are supporting someone, stay calm, listen without arguing about their beliefs and focus on how they are feeling. Encourage them to get help and offer to go with them.

Psychosis can sometimes involve serious risk. Seek urgent help if the person:

• Talks about suicide or harming themselves or others
• Is acting in ways that put themselves or others in danger
• Is very confused, agitated or unable to care for themselves
• Has recently given birth and shows sudden changes in behavior, confusion or hallucinations

In an emergency, call 911 in the US or your local emergency number. In the US, you can call or text 988 to reach the 988 Suicide & Crisis Lifeline. In the UK and Ireland, Samaritans can be reached on 116 123.