All About Psychosis

Psychosis occurs when your mind can’t distinguish between what’s real and what isn’t.

It’s the primary symptom of mental health conditions known as psychotic disorders, but it may also occur as a secondary feature in other conditions, such as bipolar disorder.

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) considers psychosis a symptom of a mental health condition, not a diagnosis itself.

The DSM-5 categorizes it under “schizophrenia spectrum and other psychotic disorders.”

Psychosis may cause you to feel, taste, smell, hear or touch things that aren’t really there. It may also cause you to believe thoughts or have emotions that go against proven fact.

For some people, psychosis also involves catatonic behavior and significant cognitive impairment. This is not always the case, though.

Three stages of an episode of psychosis are recognized:

• Prodrome phase. The early warning signs of psychosis appear. You may start experiencing changes in behaviors and thoughts.
• Acute phase. During the acute phase of psychosis, reality-altering changes are active. You may be experiencing hallucinations or delusions – or both.
• Recovery. The recovery phase of psychosis occurs when your symptoms improve. This is often after treatment or when an underlying cause of psychosis has been addressed.

Psychosis can have many unique presentations. What you experience during each phase may be different from what someone else experiences.

There are many instances in which symptoms of psychosis may appear:

• psychotic disorders
• brief psychotic disorder
• postpartum psychosis
• psychotic disorder due to another medical condition
• substance/medication-induced psychosis
• unspecified/other schizophrenia spectrum and other psychotic disorder

Psychotic disorders

Several other mental health conditions have psychosis as a primary symptom. These are called psychotic disorders and include conditions such as schizophrenia.

Brief psychotic disorder

This disorder is often caused by extreme stress and lasts less than a month. It often resolves after treatment and with a full recovery.

Postpartum psychosis

Among instances of brief psychotic disorder is postpartum psychosis. You may experience brief psychosis at any time in life, but when it occurs during the first 4 weeks after giving birth, doctors refer to it as postpartum psychosis. This is different from postpartum depression.

Psychotic disorder due to another medical condition

You may experience psychosis brought on by another medical condition or injury. For example, after you’ve severely hit your head.

Substance/medication-induced psychotic disorder

Psychosis may be the result of certain medications or drugs, such as ketamine or cocaine.

Unspecified/other schizophrenia spectrum and other psychotic disorder

Doctors may use this diagnosis when psychosis symptoms are present but don’t meet the full criteria for any other disorder or mental health condition.

Symptoms of psychosis are typically organized into two main categories: positive and negative.

Positive symptoms are those that add to or distort usual functioning. These include:

• hallucinations
• delusions
• disorganized speech
• disorganized behavior

Negative symptoms are those that cause a loss of usual functioning and may include:

• withdrawn mood
• decreased motivation
• lack of emotional display
• decreased gestures
• lack of interest in other people, activities, or events
• personality changes

Other symptoms that may overlap with psychosis include:

• thoughts of suicide
• difficulty sleeping
• substance use
• anxiety
• depression

These symptoms, however, are not part of the formal criteria established by the DSM-5.

The exact cause of psychosis has not been yet established, though experts believe multiple factors are likely involved.

These include:

• hormonal changes in the brain
• traumatic events
• other mental health conditions
• physical injury or illness
• genetics
• substance use

Most episodes of psychosis don’t happen suddenly. When you experience your first episode, chances are there have been a number of slow, subtle signs leading up to that event.

Many of these early warning signs can be difficult to separate from everyday stress responses. You may not realize you’ve had a change in thinking or behavior if you’re experiencing thoughts of altered reality.

Early warning signs of psychosis may include:

• significant changes in school or job performance
• feelings of unease or suspicion around people
• strong or absent emotions
• a decline in personal hygiene
• difficulty concentrating
• social withdrawal
• unusual, persistent thoughts/beliefs
• seeing, hearing, or feeling things that aren’t there
• confused or disorganized speech

Identifying these signs of psychosis early, especially during the first episode, can help you achieve the best recovery outcomes.

Psychosis often occurs as a symptom of other mental health conditions.

It can be a symptom of conditions such as:

• schizophrenia
• schizophreniform disorder
• schizoaffective disorder
• delusional disorder

In addition to psychotic disorders, psychosis may appear as a feature of other mental health conditions, including:

• bipolar disorder
• major depressive disorder

Schizophrenia

Two or more of the following psychosis symptoms are present for at least 6 months and have a significant impact on daily life:

1. delusions
2. hallucinations
3. disorganized speech
4. grossly disorganized or catatonic behavior
5. negative symptoms

Schizophreniform disorder

This condition occurs when symptoms of psychosis are present for more than 1 month but less than 6 months.

Schizoaffective disorder

In schizoaffective disorder, there are symptoms of psychosis but also symptoms of mood disorders.

Delusional disorder

Symptoms of psychosis revolve around delusions or intense beliefs that go against what is proven to be true or accurate.

Bipolar disorder

In bipolar disorder, psychosis may present as more of a mood disturbance, as opposed to a thought disturbance.

Major depressive disorder

Major depression with psychotic features can present as hallucination or delusions often with negative depressive themes.

Psychosis is treatable. Depending on the type of psychosis, you may experience a full recovery.

Early treatment provides the best outcomes, and receiving care quickly can help reduce the chances symptoms will linger after treatment.

Left untreated, this condition may cause major disruptions in your routines and relationships.

Treatment for psychosis involves healthcare professionals who make up a coordinated specialty care (CSC) team.

When you experience a first-time psychosis episode, the CSC team will work with you to find a treatment routine involving:

• psychotherapy
• family support and education
• medication
• work assistance
• case management

In many cases, there’s no single cure for psychosis. Treatment can help resolve or manage symptoms based on the type of psychosis you’ve experienced.

Some episodes of psychosis may resolve quickly and completely, such as those caused by medications, drugs, injuries, or extreme stress.

Depending on the type, psychosis may return if underlying causes are not addressed or treatment stops.

Psychosis is a state where the mind can’t determine what’s real and what’s fantasy.

It can present in unique ways, but primarily involves hallucinations and delusions.

You may experience psychosis due to factors such as:

• stress
• underlying mental health conditions
• injuries
• medications
• biological processes

The earlier treatment begins, the better your chances of a successful outcome after psychosis. A specialized team of medical experts will help develop a plan that works for you.

Sometimes psychosis may coincide with thoughts of self-harm.

If you need to reach out for help, please consider these resources:

• American Psychiatric Association’s Find a Psychiatrist tool
• American Psychological Association’s Find a Psychologist tool
• Asian Mental Health Collective’s therapist directory
• Association of Black Psychologists’ Find a Psychologist tool
• National Alliance on Mental Illness Helplines and Support Tools
• National Institute of Mental Health’s Helpline Directory
• National Queer and Trans Therapists of Color Network
• Inclusive Therapists