What Is Psychosis? The diagnosis explained

Medically reviewed by Michael MacIntyre, MD

Psychosis occurs when someone experiences a loss of contact with reality. This happens when a person’s thoughts and perceptions become distorted, making it hard to understand what is real and what is not. Psychosis is often described as a “break from reality” because psychosis can change how you think, act, see, feel, and hear things. When this occurs, it is called a “psychotic episode.”

Psychosis is not a mental health condition or disorder. Rather, it is a group of symptoms that may point to an underlying mental health condition. Psychosis can be very distressing and confusing for the person experiencing a loss of contact with reality and their loved ones. On average, about three in 100 people will experience a psychotic episode in their lifetime.

Causes

Researchers are still exploring what causes psychosis. Most theories point to a combination of genetic and environmental factors that play a role in the development of psychosis. What causes psychosis differs from person to person but can include:

• Genetics: Research has linked certain genes to an increased risk of mental health disorders and psychosis. People with a family history of psychotic disorders, such as schizophrenia or bipolar disorder, may be more likely to experience psychosis themselves.
• Trauma: Traumatic events such as physical, emotional, or sexual abuse, the death of a loved one, or natural disasters can increase the risk of psychosis and trigger symptoms.
• Stress: Chronic stress can alter the brain’s functioning and contribute to the development of psychosis, especially in people who are at an increased risk for psychosis.
• Substance use: The use of substances such as cannabis, cocaine, amphetamines, and hallucinogens may raise the risk of experiencing psychosis symptoms.
• Medical conditions: Brain tumors, stroke, HIV, dementia, certain types of epilepsy, Parkinson’s disease, and Huntington’s disease can sometimes cause psychosis.
• Mental health conditions: Psychosis can be a sign of certain mental health concerns, including schizophrenia, bipolar disorder, depression, and some personality disorders.
• Other factors: Lack of sleep and certain prescription medications, such as stimulants and steroids, may also trigger psychosis in some people.

Signs of Psychosis

While psychosis looks and feels different for everyone, an episode usually includes hallucinations, delusions, and odd or disorganized thoughts and behaviors. How long psychosis lasts and how often it occurs depends on the underlying cause of psychosis.

For people who don’t have an underlying mental health condition, psychosis may last a few days or weeks. Those with schizophrenia or another psychological disorder may have symptoms that persist for many months. Knowing the signs of psychosis can help you or a loved one get the help they need.

Early Warning Signs

Psychosis usually develops gradually, with non-specific changes such as mood swings or developing “odd” beliefs or behaviors over time. Most people experience their first psychotic episode during adolescence and early adulthood. In some cases, these early warning signs can be mistaken for typical teenage behavior.

Early psychosis warning signs can include:

• Changes in grades or job performance
• Social withdrawal
• Loss of motivation
• Trouble focusing and thinking clearly
• Paranoia or suspiciousness of others
• Changes in eating, sleeping, and hygiene patterns
• Difficulty telling the difference between fiction and reality
• Unusual ideas, feelings, and beliefs
• Intense, pervasive anxiety

Hallucinations

Hallucinations are experiences in which you sense things that aren’t there. Hallucinations are sensory-related and involve one or more of the five senses, including sight, taste, touch, smell, and hearing.

Examples of hallucinations include:

• Hearing voices that others can’t hear
• Seeing people, animals, or objects that are not there
• Feeling like someone has touched you when no one is there
• Smelling an unpleasant or strange odor no one else can smell
• Having a peculiar, unpleasant, or unexpected taste in your mouth

For a person going through a psychotic episode, these experiences can feel very real and convincing, even though they are not rooted in reality.

Delusions

Delusions are strong, unshakeable beliefs that feel real but are not. Delusions can take many forms but typically involve implausible, paranoid, or bold thoughts.

Examples of delusions include:

• Believing you are being followed or monitored or someone wants to harm you
• Feeling that outside forces are controlling your thoughts, feelings, and behaviors
• Thinking you have special powers or abilities or are an important religious or political figure (known as delusions of grandeur)

People experiencing delusions may resist evidence or arguments contradicting their beliefs, making engaging in daily activities or interacting with others challenging.

Diagnosis

Because psychosis is a group of symptoms and not a diagnosis, healthcare providers use a combination of a physical exam, medical history review, psychiatric evaluation, and laboratory tests to reach an accurate diagnosis. This helps determine whether a physical or mental health condition is causing psychosis.

To learn more about your symptoms, a healthcare provider will usually ask about the following:

• Personal and family medical history, including psychiatric disorders, head injury, or seizures
• Medications you are taking
• Whether you use substances (e.g., cannabis or hallucinogens) or drink alcohol
• Your symptoms, including if and how often you experience hallucinations or delusions
• How your symptoms are affecting your daily life

Additionally, your healthcare provider may order diagnostic tests, such as blood tests or brain scans (e.g., MRI), to look for and rule out medical conditions that can cause psychosis. It’s also common for a primary care provider to work in tandem with a mental health professional for psychiatric testing.

Treatment

Psychosis treatment usually includes a combination of medication, psychotherapy, and support. Your care may be managed by a team of healthcare professionals and specialists who work with you to develop a personalized treatment plan based on your needs. A care team for psychosis typically includes a primary care provider (to monitor overall health), a psychiatrist (to prescribe medication), and a psychologist (to provide therapy).

Your treatment plan can vary depending on what’s causing your psychosis. Common treatment options may include:

• Medication: Antipsychotic medications work by regulating dopamine (the “feel-good” chemical in your brain) levels to help reduce symptoms of psychosis. Depending on the cause, some people may only need antipsychotic drugs until symptoms of psychosis subside, while others with certain mental health conditions (e.g., schizophrenia) may need these medicines long-term.
• Psychotherapy: Several types of psychotherapy, such as cognitive behavioral therapy (CBT), can help you understand your psychosis and identify harmful thought patterns and feelings that may contribute to psychosis. Psychotherapy can help you learn coping strategies and communication skills to help you replace unhelpful thoughts with healthier, more balanced thoughts.
• Support services: Support is essential to managing many mental health conditions. Your care team may offer case management, family support and education, educational and vocational support, and peer support. These services provide practical assistance and emotional support to help improve your overall quality of life.
• Treatment for underlying condition(s): If a physical or mental health condition is the cause of your psychosis, your treatment plan will also involve managing this condition. Depending on the underlying condition, you may need to take other medications, try certain therapies, or incorporate certain lifestyle changes or interventions.

A Quick Review

Psychosis occurs when a person’s thoughts and feelings are not based in reality. Hallucinations, delusions, and changes in thoughts, perceptions, and behaviors are key characteristics of a psychotic episode. Symptoms develop slowly over time, but the first episode typically happens during late adolescence and early adulthood.

Certain genetic and environmental factors can increase the risk of psychosis, including a family history of mental health disorders, trauma, substance use, and chronic stress. Several health conditions like schizophrenia, bipolar disorder, stroke, and dementia may also cause psychotic episodes to occur.

Psychosis can be frustrating and confusing to experience. However, treatment can help reduce symptoms. A healthcare provider may offer treatment options such as medications, psychotherapy, and social support. With the proper treatment and support, most people who experience psychosis can live fulfilling lives.

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Read the original article on Health.