Psychosis is a symptom but is not a diagnosis in itself. Psychosis can be caused by different mental health conditions, such as schizophrenia or bipolar disorder, by physical illness or by other causes, such as bereavement or lack of sleep.
What is psychosis?
Psychosis means that you interpret reality abnormally and in a very different way from other people around you. This is like losing touch with reality. .
The most common types of psychosis are hallucinations and delusions. You might also experience problems with thinking and speech.
What are the causes of psychosis?
Psychosis can be a symptom of lots of different mental health problems, including:
- Severe depression.
- Bipolar disorder.
- Alzheimer's disease.
- Paranoid personality disorder.
- Psychosis after childbirth (postpartum psychosis).
Psychosis can also occur in the absence of any underlying mental health condition. Other causes of psychosis include:
- Physical illness or injury - eg, with a high fever or following a head injury.
- Conditions affecting the brain - eg:
- Parkinson's disease or a brain tumour.
- When taking street drugs like LSD, amfetamines, phencyclidine (PCP) and cannabis.
- Alcohol misuse.
- Nitrogen narcosis when diving at depth.
- Side-effect of some prescribed medicines (eg, steroids) or when you stop taking a medicine for a mental health condition.
- Lack of sleep.
- Bereavement - if you have recently lost someone close to you, you may think you see them or hear them talking to you.
- Abuse or trauma - you are more likely to experience psychosis if you have experienced abuse or a very traumatic event.
The main symptoms of psychosis are:
- Hallucinations. This means you hear, see, feel, smell or taste things that aren't really there. A common hallucination is hearing voices.
- Delusions. A delusion may occur when you have a strong belief that isn't real or shared by others. A common delusion is wrongly believing that there is a conspiracy to cause you or others harm.
- Disorganised thinking and speech.
How often a psychotic episode occurs and how long it lasts are very variable and will depend on the underlying cause. You might experience psychosis once, have occasional short episodes, or have frequent and prolonged episodes of psychosis.
Psychosis can feel positive. Seeing the faces of loved ones or hearing their voices may be very comforting. However, psychosis can also be very negative and distressing, affecting your behaviour and disrupting your life. Hallucinations or delusions can make you feel very tired, overwhelmed, anxious, scared, threatened or confused. Delusions about certain people or organisations may make it hard for you to trust them.
People around you may be very dismissive of your experiences and this may make you feel very frustrated.
Hallucinations may include:
- Seeing things that other people don't see.
- Experiencing tastes, smells and sensations, such as feeling insects crawling on your skin when there are no insects there.
- Hearing voices that other people don't hear.
Lots of people have beliefs that many other people don't share. But a delusion is a false belief that no one else shares. You still believe it even if it doesn't make any sense.
Some delusions are positive. You might believe you are very rich, powerful or important. This is sometimes called delusions of grandeur.
Delusions may also be very negative and frightening. You might feel that something or someone is trying to harm you. This is sometimes called having paranoid delusions.
Disorganised thinking and speech
Hallucinations and delusions can make your thoughts and emotions feel confused and disorganised. Disorganised thinking ('thought disorder') can also be a type of psychosis.
- Racing thoughts: thoughts go through your head very fast.
- Flight of ideas: your thoughts move very quickly from one idea to the next.
- Speaking very quickly with other people finding it hard to understand you.
- Your speech sounds jumbled and doesn't make sense to other people.
- Finding it difficult to keep your attention on one thing.
What are the treatments for psychosis?
You should see your doctor immediately if you're experiencing symptoms of psychosis. You will usually be referred to a mental health specialist for further assessment and treatment. A very severe psychotic episode may mean you need to be admitted to hospital for treatment.
If you're concerned about someone who seems to be having a psychotic episode, you should contact their doctor or their mental health team or call an ambulance.
Support from others with psychosis. It often helps to share experiences with other people who experience psychosis. You may be able to find a local support group or a national support group, such as Mind in the UK ...
Recognise your triggers. It might be helpful to keep a diary to help you understand what triggers your psychosis or makes it worse. Learn to recognise any warning signs.
Avoid triggers. Once you have identified any triggers, you can try to take steps to avoid them. If you learn to recognise warning signs, you can take action early to try to prevent the psychosis from becoming any worse. Family and friends may also be able to recognise any warning signs.
Learn to relax. Manage stress and try some relaxation techniques when you feel stressed, anxious or busy.
Look after yourself. Try to get enough sleep. Eating regularly and keeping to a healthy diet can improve your mood and energy levels.
Exercise. Exercise can really help the way you feel.
Create a crisis plan. When you're feeling well you should talk to close friends and family about what would help you, including who should be contacted for professional help.
Treatment for psychosis involves using a combination of:
- Talking therapies such as cognitive behavioural therapy (CBT) can help you understand your experiences and develop strategies to deal with them.
- Medication. Most people with psychosis will be offered an antipsychotic medicine. You may need other medicines for any mental health condition that is causing the psychosis.
- Family therapy. Family therapy may be very helpful if you are going through any difficulties as a family.
- Arts therapies can help you express how you are feeling, especially if you find it difficult to talk about your experiences.
- Social support. This may include education, employment, or accommodation.
What are the complications of psychosis?
- People with psychosis are more likely to have drug or alcohol problems. Some people use drugs, alcohol or both as a way of managing their psychotic symptoms. However, this can make the psychotic symptoms worse and cause other problems.
- Self-harm and suicide. People with psychosis have increased risk of self-harm and suicide.
What is the outcome?
The outcome (prognosis) is very variable and will depend on any underlying cause. If needed, medication is usually effective but may be needed long-term.
Further reading and references
; NICE Clinical Guideline (Feb 2014)
; NICE Clinical Guideline (January 2013, updated Oct 2016)
; Recognition and Differential Diagnosis of Psychosis in Primary Care. Am Fam Physician. 2015 Jun 1591(12):856-63.
; NICE CKS, February 2015 (UK access only)
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