What is psychosis?
The word psychosis describes conditions that affect the mind, in which people have trouble distinguishing between what is real and what is not. When this occurs, it is called a psychotic episode.
Psychosis usually first appears in a person’s late teens or early twenties. Approximately three out of 100 people will experience an episode of psychosis in their lifetime. Psychosis occurs across all cultures, ethnicities, gender identities, abilities and socioeconomic groups.
Psychosis is treatable and many people with the condition go on to lead full, meaningful lives.
What is early psychosis?
Early psychosis is the first time a person experiences a psychotic episode. It is often very frightening, confusing and distressing, particularly because it is an unfamiliar experience. Unfortunately, there are also many negative stereotypes and misconceptions associated with psychosis that can add to the person’s distress.
Although an episode of early psychosis can be distressing for the person and for their family and friends, recovery is possible.
There are many treatment options for psychosis. Many people recover from early psychosis and never experience another psychotic episode. For those who continue to experience episodes or symptoms, treatment and support can promote recovery.
Symptoms of psychosis
Psychosis affects the way a person thinks, feels and behaves.
The experience of psychosis varies greatly from person to person. Symptoms can come on suddenly or develop very gradually.
The symptoms of psychosis are often categorized as either “positive” or “negative.” People may also experience cognitive difficulties and other symptoms. Family members and friends may notice specific symptoms or they may sense a change in their relationship with the person.
Positive symptoms
Positive symptoms are those that add to or distort the person’s usual functioning. There are various types of positive symptoms.
Delusions
Delusions are firmly held false beliefs that are out of keeping
with the person’s cultural environment. The person may be truly convinced of a belief that is not shared by others, and even the most logical argument cannot change their mind. Common delusions include:
- being followed by others
- being monitored by cameras
- having special abilities or powers
- receiving hidden messages through certain songs or comments
- having one’s thoughts controlled by an outside force.
Hallucinations
During psychosis, a person may hear, see, smell, taste or feel something that is not actually there. For example, they may hear voices or noises that no one else hears, see things that are not there, or experience unusual physical sensations. These changes in perception are called hallucinations.
Disorganized speech, thoughts or behaviour
Disorganized speech might involve switching rapidly from one subject to the next, or being so garbled that speech is difficult to understand.
A person experiencing psychosis may have changes in their thinking patterns and may find it hard to concentrate and follow a conversation. Their thoughts may speed up, slow down or become jumbled, or their thoughts may not connect in a way that makes sense.
Behaviour also may be disorganized. For example, the person may have difficulties performing regular activities of daily living, such as cooking or self-care. They may display inappropriate behaviours or emotions, such as laughing while talking about a tragic event.
Negative symptoms
Negative symptoms involve a decrease in or loss of normal function.ing. These symptoms are often not as obvious as positive symptoms. They may include:
- restricted emotional and facial expression
- restricted speech, with loss of words or difficulty remembering words
- difficulty with generating ideas or thoughts
- reduced ability to begin tasks
- reduced social interaction
- decreased motivation.
Other symptoms
Other symptoms or difficulties often occur alongside psychotic symptoms. They include:
- cognitive symptoms, such as difficulties with attention, concentration, memory and executive function (e.g., planning, organizing and carrying out tasks)
- mood changes—the person may be unusually excited, depressed or anxious, or have highly changeable moods
- suicidal thoughts or behaviours
- substance use problems
- sleep disturbances
- difficulty completing activities of daily living and tasks that were once manageable.
Some people experiencing a psychotic episode may feel very depressed or confused. They may think that life is not worth living or that suicide is the only option. People experiencing suicidal thoughts may make plans to hurt themselves. If a person is having suicidal thoughts, it is important to encourage them to connect with a health care professional or crisis service for support. It may also be a good idea for family members and friends to seek support and assistance to cope in such situations.
Remember, with treatment and support, symptoms of psychosis can become more manageable.
Phases of psychosis
Psychosis has three phases. However, not all people who experi.ence a psychotic episode will have clear symptoms of all three phases—each person’s experience will differ.
Prodromal phase
The prodromal phase usually lasts several months, though the duration can vary. This first phase of psychosis involves symptoms that may not be obvious, such as changes in feelings, thoughts, perceptions and behaviours.
Some common prodromal symptoms are:
- reduced concentration and attention, disorganized thoughts
- reduced motivation, changes in energy level, less interest in usual activities
- social withdrawal
- sleep disturbance
- suspiciousness
- irritability, anxiety, depressed mood
- absence from school or work, or deterioration in performance
- intense focus on ideas that may seem odd or disturbing to others.
These symptoms are very general, and may not necessarily be a sign of psychosis. For example, they could represent typical adolescent behaviour. Family members and friends can track these changes over time—if they persist, this may suggest a prodromal phase.
Acute phase
In the acute, or active, phase, the person typically experiences positive psychotic symptoms, such as hallucinations, delusions and disorganized thinking. Some negative symptoms may also emerge. This phase is the easiest to recognize and diagnose, and so it is when most people begin treatment. The earlier treatment starts, the greater the chance of recovery.
Recovery phase
In the recovery, or residual, phase, active symptoms become less intense, though some may not disappear altogether. After recovery from early psychosis, some people never experience a relapse (another episode). To reduce the risk of relapse, it is very important to continue medication and other treatments as recommended by the physician and clinical team.
The recovery process—how long it takes and how much improve.ment there is—varies from person to person. Once the active symptoms of psychosis have responded to treatment, the person may still need help with issues such as depression, anxiety, decreased self-esteem, social problems and school or work difficulties.
Family members and friends may also need help with coping and navigating supports for the person experiencing psychosis.
It is helpful for them to be involved in the person’s recovery and safety plans. In urgent situations, such as when there is potential harm to the person experiencing psychosis, family members or friends should bring them to the nearest emergency department so they can get care.
Types of psychosis
There are a number of mental illnesses that can include psychosis as a symptom. In the early phases of a psychotic episode, it is usually difficult to diagnose the exact type of psychotic disorder that is happening. This is because the factors that determine a specific diagnosis are often unclear during the psychotic episode.
It is important to recognize and understand symptoms, and to communicate them to the treatment team. Any concerns or questions about diagnosis should be discussed with a mental health professional. A thorough medical assessment may be needed to rule out any physical illness that may be the cause of the psychosis
Schizophrenia
The term schizophrenia refers to a diagnosis in which a person experiences some psychotic symptoms for at least six months, with a significant decline in their ability to function. The symptoms and length of the illness vary from person to person.
Schizophreniform disorder
This type of psychosis is the same as schizophrenia except that
the symptoms last for at least one month and no more than six months. The illness may completely resolve, or it may persist and progress to other psychiatric diagnoses, such as schizophrenia, bipolar disorder or schizoaffective disorder.
Bipolar disorder
With bipolar disorder, the symptoms of psychosis relate more to a mood disturbance than to a thought disturbance. The person will experience elevated mood (mania) and sometimes depression, which may persist or fluctuate in intensity. When psychotic symptoms arise, they often reflect the person’s mood. For example, someone who is depressed may hear voices that put them down. Someone who is experiencing an elevated mood may believe they are special and capable of doing amazing things.
Schizoaffective disorder
A person with schizoaffective disorder will experience a combination of schizophrenia symptoms (e.g., hallucinations, delusions) and mood disorder symptoms (e.g., depression, mania) at some point in the illness.
Depression with psychotic features
Sometimes a person will experience a severe depression with symptoms of psychosis, without the mania associated with bipolar disorder. This type of depression is referred to as a psychotic depression or depression with psychotic features.
Substance-induced psychosis
The use of substances such as marijuana, cocaine, ecstasy, ketamine, LSD, amphetamines and alcohol can sometimes cause psychotic symptoms. In substance-induced psychosis, the symptoms of psychosis can spontaneously resolve once the effects of the substance wear off, but other times they may require medical treatment.
Organic psychosis
Symptoms of psychosis may appear as a result of a physical illness or head injury. A thorough medical examination is needed to rule out or confirm this type of psychosis. This examination may involve tests or investigations such as a brain scan.
Brief psychotic disorder
Sometimes symptoms of psychosis come on suddenly and, in some cases, are triggered by a major stress in the person’s life, such as a death in the family. This type of psychosis lasts less than a month.
Delusional disorder
This type of psychosis features very strong and fixed beliefs in things that are not true. For example, a person may believe they have made an important discovery, despite there being no credible evidence to support this belief. Changes in perception, such as hallucinations, are not seen in this illness. Delusional disorder does not usually affect a person’s ability to function.
It may be difficult to make a diagnosis in the early stages of psychosis. Often, patterns of symptoms must be assessed over many months, and determining a diagnosis may take time. This means that initially it may be more helpful to focus on the symptoms and how they affect the person’s functioning rather than focusing on a particular diagnosis. Remember that everyone’s experience of psychosis is different—the course and the outcome will vary from person to person.