An episode of psychosis is when a person has a break from reality and often involves seeing, hearing and believing things that aren’t real. Approximately 3 in 100 people will experience an episode of psychosis during their lives. Young adults are placed at an increased risk to experience an episode of psychosis because of hormonal changes in the brain that occur during puberty, but a psychotic episode can occur at any age.
Psychosis is not an illness, but a symptom. A psychotic episode can be the result of a mental or physical illness, substance use, trauma or extreme stress.
Symptoms of a psychotic episode can include incoherent speech and disorganized behavior, such as unpredictable anger, but psychosis typically involves one of two major experiences:
Hallucinations are seeing, hearing or physically feeling things that aren’t actually there. For example:
- Voices telling you to commit acts of violence or self-harm
- Feeling like something is crawling under your skin
- Seeing someone take the shape of something he is not, such as a demon
Delusions are strong beliefs that are unlikely to be true and may seem irrational to others. For example:
- Believing external forces are controlling your thoughts, feelings and behavior
- Believing that trivial remarks, events or objects have personal meaning or significance
- Thinking you have special powers, are on a special mission or even that you are God
Early Warning Signs
Most people think of psychosis as a sudden break from reality, but there are often warning signs that precede an episode of psychosis. Knowing what to look for provides the best opportunity for early intervention. Some indications are:
- A worrisome drop in grades or job performance
- Trouble thinking clearly or concentrating
- Suspiciousness or uneasiness with others
- A decline in self-care or personal hygiene
- Spending a lot more time alone than usual
- Strong, inappropriate emotions or having no feelings at all
Several factors can contribute to psychosis:
- Genetics. Many genes are associated with the development of psychosis, but just because a person has a gene doesn’t mean they will experience psychosis. Studies are still being conducted to determine the exact genes that cause psychosis.
- Trauma. A traumatic event such as a death, war or sexual assault can trigger a psychotic episode. The type of trauma—as well as a person’s age—also affect whether a traumatic event will result in psychosis.
- Substance use. The use marijuana, LSD, amphetamines and other substances can increase the risk of psychosis in people who are already vulnerable.
- Physical illness or injury. Traumatic brain injuries, brain tumors, strokes, HIV and some brain diseases such as Parkinson’s, Alzheimer’s and dementia can sometimes cause psychosis.
Psychosis is a symptom, not an illness. A diagnosis identifies an illness, and symptoms are components of an illness. Health care providers draw on information from medical and family history along with a physical examination to make a diagnosis. If causes such as a brain tumor, infection or epilepsy are ruled out, a mental illness might be the cause.
Identifying and treating psychosis as early as possible leads to the best outcomes. Early intervention is always the best approach to treating a mental health condition, because there is a chance of preventing the illness from progressing.
There are many specialized centers that focus exclusively on psychosis and crisis treatment in youth. The American Psychiatric Association, your state chapter of the APA, primary care doctor, insurance carrier and the state or county mental health authority are other resources that can help find you help.
Therapy is essential to treating psychosis. Some more common therapies include:
- Cognitive behavioral therapy (CBT), which teaches people to observe and then change ineffective patterns of thinking. For psychosis, CBT teaches someone to critically evaluate their experience to determine whether or not the experience is real or not.
- Supportive psychotherapy teaches a person to cope with the experience of developing and living with psychosis. The therapist attempts to reinforce a person's healthy ways of thinking and reduce internal conflict.
- Cognitive enhancement therapy (CET), which seeks to build brain capacity through the use of computer exercises and group work. Increasing cognitive functions, such as the ability to organize thoughts, is the ultimate goal.
- Family psychoeducation and support, which helps individuals who are living with psychosis and their families work on bonding, collaborating, problem solving and learning from each other. NAMI’s Family-to-Family program is available across the nation and has been shown to improve family functioning and outcomes in key measures. Family-to-Family is an evidence-based practice where the positive results were still seen 9 months after taking the class.
Once a diagnosed has been made, a health care provider may work to select a medication that can help to reduce these symptoms. Antipsychotics fall into two classes:
- First generation, or typical, antipsychotics. These medications can cause movement problems that can be short (dystonia) or long term (called tardive dyskinesia), and also muscle stiffness. Other side effects can also occur.
- Second generation, or atypical, antipsychotics. These medications are called atypical because they are less likely to block dopamine and cause movement disorders. They do, however, increase the risk of weight gain and diabetes. Changes in nutrition and exercise, and possibly medication intervention, can help address these side effects.
The literature on the utility and effectiveness of the use of antispychotics early in the course of psychosis and emerging schizophrenia is evolving. Check with a doctor to see progress on the research studies in this important and evolving area.
Complementary Health Approaches
In one small study, omega-3 fatty acids, commonly found in fish oil, were found to decrease the risk of developing psychosis in young adults and teens who demonstrated early symptoms. Researchers believe that omega-3s may help by replenishing neurons and connections in the brain.
For acute safety issues, people experiencing psychosis may need to be hospitalized during an episode, and may sometimes require sedation in order to be evaluated. Hospital staff will run tests to rule out any other potential causes for a psychotic episode, such as drugs and alcohol or another illness. Based on what they find, they will suggest a course of treatment. This can include medication, outpatient therapy or an extended inpatient stay.
Different cultures have different needs, so working with a professional who is sensitive to cultural interpretations of illness can help improve recovery outcomes. For example, visual or auditory hallucinations with a religious content, such as hearing God’s voice, may be viewed as a normal part of religious experience.