Psychosis is a symptom, not an illness, that involves a disconnection from reality. Often, psychosis takes the form of hallucinations, delusions (beliefs not based in reality), and disorganized thinking (difficulty thinking clearly).
Psychosis can be a symptom of a mental illness, such as;
or can result from situations such as drug use, extreme stress, or significant sleep deprivation.
Psychosis affects approximately 3% of the population at some point in their lives. It can occur at any age and is more prevalent in people with a family history of psychotic disorders. It affects men and women equally.
Some people only experience a few episodes of psychosis, or a brief episode that lasts for a few days or weeks. When psychosis occurs due to a psychotic illness, such as schizophrenia, the onset is usually around late adolescence/early adulthood.
Symptoms of Psychosis
1. Hallucinations
A hallucination is when someone perceives things that are not present. Hallucinations can be:
- Auditory - hearing things that are not present such as voices, music, or footsteps
- Visual - seeing things that are not present such as people, objects, animals, shapes, or lights
- Olfactory - smelling things that are not present such as a bad smell
- Tactile - feeling things that are not present such as feeling something brushing up against your skin
- Gustatory - tasting something that is not present such as an unpleasant or metallic taste
- Presence - sensing that someone is close by when no one is present
- Proprioceptive - sensing that your body is moving when it is not such as a feeling of floating
There are also two hallucinations that occur in the context of sleep:
- Hypnopompic - experiencing hallucinations when waking from sleep. This can occur in sleep disorders but for most people is considered normal
- Hypnagogic - experiencing hallucinations when falling asleep, also considered normal for most people. These are typically visual.
2. Delusions
Delusions are false beliefs that are not based in reality and considered bizarre or unusual. Types of delusions include:
- Paranoid delusion such as the belief that one is being watched or singled out for something bad. A common example is the Truman Show Effect, when someone beliefs that their life is a staged reality show or that they are being watched on cameras
- Grandiose delusion such as the belief that one is an important religious figure, famous person, or a person in leadership, or the belief that one has special powers that others do not
- Depressive delusion such as the belief that one has committed a serious crime. This can be part of OCD
- Reference delusion such as the belief that one is receiving important messages or codes via TV shows, music, advertising etc.
- Control delusion such as the belief that ones thoughts are being controlled or manipulated by real or supernatural others
- Somatic delusion such as the belief that something is wrong with part or all of ones body such as through infestation or infection
3. Disorganised Thinking and Speech
Disorganised thinking and speech (also known as Formal Thought Disorder) is when someones ability to sustain coherent conversation, via speech or writing, is significantly impaired.
While delusions refer to the content of thoughts, formal thought disorder refers to the organization and the expression of thoughts (not the thoughts themselves).
Symptoms of formal thought disorder include:
- Racing thoughts - thoughts moving very fast
- Flight of ideas - where one moves rapidly from one idea to the next to the point that others cannot see the connections between each thought or topic
- Tangentiality - difficulty maintaining a topic or coming to a point
- Incoherence - speaking in a way that does not make sense to others (popularly described as “word salad”)
- Thought blocking - such as having complete mind blanks mid sentence
- Clanging - choosing words based on their sound, such as rhyming, rather than their meaning leading to speech to not make sense to others
- Alogia - significant poverty of speech (lack of talking)
- Echolalia - repeating noises and words
What Causes Psychosis?
The exact cause of psychosis is not yet fully understood, but it is believed to result from a combination of genetic, biological, and environmental factors. Some contributing factors include:
- Genetic predisposition - individuals with a family history of psychotic disorders are at a significantly higher risk of developing psychosis
- Brain chemistry - imbalances in neurotransmitters, such as dopamine and glutamate, may contribute to the development of psychosis
- Substance use - the use of certain drugs such as marijuana, LSD, and amphetamines can trigger psychotic episodes in some individuals
- Stress and trauma - severe stress or traumatic events can increase the risk of developing psychosis
- Physical illness - certain medical conditions such as brain tumors, infections, or autoimmune disorders can cause psychotic symptoms
Psychosis Assessment and Diagnosis
Diagnosing psychosis involves a comprehensive assessment by a mental health professional, which may include:
- Clinical interview - gathering information about the individual's symptoms, medical history, family history, and substance use
- Mental status examination - assessing the individual's appearance, behaviour, speech, thought processes, and mood
- Neuropsychological testing - evaluating cognitive functioning, such as memory, attention, and problem-solving skills
- Medical tests - ruling out any underlying medical conditions that may be causing the psychotic symptoms (such as mercury poisoning)
Psychosis Treatment Options and Strategies
Treatment for psychosis typically involves a combination of medication, therapy, and psychosocial interventions. Some common treatment options include:
- Antipsychotic medication - the single most effective treatment for psychosis is antipsychotic medication. These medications help to reduce the severity of psychotic symptoms by regulating neurotransmitters in the brain
- Psychotherapy - supportive therapy and Cognitive Behavioural therapy (CBT) can help individuals cope with the symptoms of psychosis
- Psychosocial interventions such as supported employment, social skills training, and assertive community treatment
- Hospitalisation - in some cases, hospitalization may be necessary to ensure the safety of the individual and provide intensive treatment
Tips for Managing Psychosis
- Seek professional help - early intervention is crucial for the successful management of psychosis. If you or a loved one is experiencing symptoms of psychosis, consult a mental health professional as soon as possible
- Adhere to treatment - follow the prescribed treatment plan, including taking medications as directed and attending therapy sessions regularly
- Build a support network - connect with family, friends, and support groups to share experiences and receive encouragement
- Maintain a healthy lifestyle - engage in regular physical activity, eat an adequate well balanced diet, and establish a consistent sleep schedule to promote overall well-being
- Avoid substance use - refrain from using drugs or alcohol, as they can exacerbate psychotic symptoms or interfere with treatment
