Psychosis

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What is psychosis?

Psychosis is not a condition itself but a sign of certain types of mental illnesses or, in some cases, a physical illness. Psychosis, or psychotic episodes, can be a one-time occurrence, or someone may experience several depending on the cause. According to the National Alliance on Mental Illness (NAMI), about three in every 100 people in the United States experience at least one episode of psychosis during their lifetime.

A psychotic episode occurs when someone loses touch with or breaks from reality, either by believing things that are not true (delusion) or experiencing sensations that are not real (hallucinations). These can affect any sense, but when they are audio (heard), they can be perceived as hearing voices.

Anyone can have a psychotic episode, but some people are more likely than others to experience at least one. Risk factors, such as family history, increase that risk. First episodes of psychosis happen most often among people in their late teens or early 20s.

Someone who has a psychotic episode should be evaluated by a healthcare professional as soon as possible in order to learn why the psychosis occurred. Not investigating the cause could result in more episodes and worsening of the illness that caused it, and, depending on the illness, could become life-threatening.

Seek immediate care (call 911) if someone having a psychotic episode is at risk of self-harm or harming others, or if the psychosis is accompanied by symptoms including sudden muscle weakness, difficulty breathing, changes in vision, chest pain, or loss of consciousness.

What are the symptoms of psychosis?

Unlike the pain from a broken bone or a fever from an infection, there are symptoms that can occur before a psychotic episode. It is rare that a first episode appears without any early warning signs. Anyone can experience any of these signs alone, but if they occur in combination with others, it could be an early warning of psychosis.

The most common early warning signs of a psychotic episode include:

  • Appearing to have no feelings or emotions at all
  • Avoiding being with other people, withdrawing
  • Being suspicious of others
  • Difficulty communicating
  • Difficulty keeping on track, concentrating 
  • Difficulty separating fantasy from reality
  • Forgetting to perform personal hygiene, wearing dirty clothes, not cleaning the home
  • Loss of desire to spend time doing activities previously enjoyed
  • Strong outbursts of emotion
  • Sudden or unexpected drop in performance in school or at work

Symptoms that occur during psychosis

When someone is having a psychotic episode, the two primary symptoms are:

  • Hallucinations. Hallucinations are experiences perceived by someone but not by others, such as hearing voices (auditory), seeing things (visual), feeling something on the skin (tactile), smelling an odor (olfactory), or tasting something (gustatory).
  • Delusions. Delusions are false beliefs, when a person believes very strongly in something that is not observed by others. This can include paranoia, when people believe they are being watched or followed, but there is no evidence this is true.

If someone you know is showing possible signs of psychosis, it is important to seek medical help as soon as possible. Early recognition and diagnosis of the cause may help prevent worsening of the condition.

What causes psychosis?

Psychosis can be a symptom of a mental illness or the result of an underlying physical condition. It can be a one-time only event or it can be continuous, depending on the cause.

Mental illness causes of psychosis

Mental illnesses that can cause psychosis include:

  • Delusional disorder
  • Postpartum depression

Other causes of psychosis

Psychosis can have causes outside of mental illness, some of which may be temporary but can also become chronic.

Other causes of psychosis include:

  • Alcohol abuse
  • Brain tumor
  • Drug abuse, including use of hallucinogens, narcotics, cocaine and methamphetamine
  • Emotional trauma, such as after the death of a loved one or a natural disaster, that can result in a temporary diagnosis known as brief psychotic disorder
  • Migraines
  • Natural supplements, such as St. John’s Wort
  • Neurological conditions, such as Parkinson’s disease
  • Physical trauma, such as a blow to the head
  • Poisoning, particularly through exposure to heavy metals 
  • Prescription medications, including opioids (narcotics), antihistamines, benzodiazepines, and thyroid medications
  • Stroke, which can result in brain damage

Talk to your doctor if you have concerns about any prescription medications you take and any associated risk of psychosis or other side effects.

What are the risk factors for psychosis?

Several factors could increase the risk of developing psychosis. Not all people with risk factors will have a psychotic episode.

Some risk factors for psychosis include:

  • Age between 15 and 25 years
  • Cannabis and other substance use
  • Difficulty functioning at age-appropriate levels
  • Difficulty with social relationships and in social situations
  • Disruptive childhood
  • Family history of psychosis

Reducing your risk of psychosis

You may be able to lower your risk of having a psychotic episode by seeking help if you recognize any of the risk factors or if you are experiencing the early warning signs.

Speak with your healthcare professional about why you are concerned, about risk factors, and what you have been experiencing.

How do doctors diagnose psychosis?

Diagnosing psychosis may take some time as your doctor reviews your medical history and, possibly, gathers information from family members, friends, or coworkers.

To diagnose your condition, your doctor will ask you several questions related to your symptoms including:

  • Do you hear, see, or otherwise experience sensations that no one else seems to?
  • Do you feel like you’re not in control of your thoughts?
  • Are you having difficulty communicating and expressing yourself?
  • Do you feel like you possess any special talents or gifts that others aren’t aware of?
  • Do you feel that people are talking about you?
  • Are you mistrustful or fearful of others?

Your doctor will likely ask if you take any medications or use recreational drugs, if you have a family history of mental illness, and if you are experiencing any other symptoms you may not have mentioned.

You may undergo tests to rule out physical causes of psychosis, including:

  • Blood tests, to check thyroid function, levels of minerals (such as calcium and vitamin B12), or for infections, such as syphilis or HIV
  • Imaging tests, including MRI or CT, to identify brain damage or the presence of a brain tumor
  • Urine tests, to screen for drugs or substances that may trigger psychosis

What are the treatments for psychosis?

Early recognition and treatment are essential in trying to prevent future episodes. Aside from managing the psychotic episode, treatment also focuses on what caused it. If there is concern that someone is at risk of self-harm or hurting others, doctors may recommend in-patient treatment at a hospital.

Antipsychotic drugs

Doctors may prescribe antipsychotic drugs to help ease the present episode, including.

  • Chlorpromazine
  • Clozapine
  • Haloperidol
  • Loxapine
  • Olanzapine 
  • Quetiapine 
  • Risperidone

Tardive dyskinesia is an uncommon but serious side effect of some antipsychotic medications. Symptoms of tardive dyskinesia involve repeated and involuntary facial or finger movements, but can also involve the legs, arms, or torso. Talk with your doctor if you notice movements, such as finger twitching, rapidly blinking eyes, grimacing, lip movements, sticking out your tongue, or other repeating uncontrollable movement while taking antipsychotic medications.

Other treatments for psychosis

Non-pharmaceutical options for treatment of psychosis include:

  • Family psychoeducation and support
  • Social services
  • Talk therapy

If the cause is a physical condition, such as stroke, tumor, or infection, the medical team will treat the underlying issue, which in turn should relieve symptoms and episodes of psychosis.

Lifestyle changes to manage psychosis

Lifestyle changes will not cure illnesses that can cause psychosis, but they can reduce the risk of episodes.

Steps to manage and reduce risk of psychotic episodes include:

  • Avoid alcohol and recreational drugs, which can trigger psychosis.
  • Immediately report any psychotic symptoms to your doctor or pharmacist, particularly if episodes begin after starting a new medication.
  • Seek counseling if you begin to feel like you are losing control of your thoughts, are having difficulty communicating, or need help dealing with traumatic issues from the past.

How does psychosis affect quality of life?

Living with psychosis can be challenging. Family and peer support is important, so confiding in loved ones can help you cope and manage the tough periods. Support groups with others who have experienced similar issues can also be helpful.

Because strangers may react negatively to someone exhibiting signs of psychosis, working with a therapist may help provide coping mechanisms to help lessen the chances of negative stranger interactions. Family members may also struggle to accept someone who has psychotic episodes, so referring them for education and counseling can be beneficial to everyone.

Psychotic episodes may make it difficult to sleep, eat, or perform many of the regular activities of daily living. If this is occurring, speak with your doctor for help managing these issues and finding effective treatment options.

What are the potential complications of psychosis?

The most concerning complication related to psychosis is self-harm. People who are in a psychotic episode may have suicidal or other violent thoughts. If you are concerned about someone who is in this situation, call 911 for emergency medical help.

People with psychosis can also experience social isolation that results in complications, such as the inability to hold down a job, attend school, or have meaningful relationships. In some cases, actions taken by a person during a psychotic episode can result in legal prosecution or even incarceration.

If psychosis is caused by an untreated medical issue, such as an infection, tumor, or substance addiction, progression of the condition can result in more frequent and more severe symptoms.

Does psychosis shorten life expectancy?

People who have one-time episodes that last less than one month do have a good prognosis after they receive proper treatment. However, people who experience longer-term psychosis, even for the first time, do have a shorter life expectancy than those who do not, particularly if they do not receive treatment.

In order to improve life expectancy and quality of life, it is vital that people experiencing psychosis seek help and follow their treatment plans. Living with psychotic episodes is possible, with the right support and treatment.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Jun 24
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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