Psychosis

What do you think of when you hear the word “psychotic?” 

Some people are scared of psychosis because of the way it’s shown on TV or in the movies. In real life, though, psychosis is a serious condition—but it is treatable.

Psychosis is often described as a “loss of reality” or a “break from reality” because it makes you experience or believe things that aren’t real. It can change the way you think, act, feel or sense things. 

Who does it affect?

About three out of every 100 people will experience an episode of psychosis in their lifetime. Psychosis affects men and women equally and occurs across all cultures and socioeconomic groups. Psychosis usually first appears in a person’s late teens or early twenties.

Risk of psychosis seems to run in families, and people seem to be more vulnerable if a family member has a psychotic disorder like schizophrenia or a personality disorder like paranoid personality disorder. 

Mental illness: Schizophrenia is the most common cause of psychosis. Other psychotic disorders include schizoaffective disorder. People with severe mood disorders like depression or bipolar disorder may also experience psychosis. 

Substance use: Some substances cause psychosis. Cocaine, amphetamines (speed), marijuana, PCP, hallucinogens and sedatives can cause psychosis when you use those substances. Alcohol, sedatives and hypnotics (sleep medication) can cause psychosis when you suddenly stop using them. Most regular methamphetamine (meth) users experience psychosis at some point.

Other health problems: Certain physical injuries, diseases or health conditions such as brain injury or lupus can cause psychosis. 

Stress: Intense stress can cause psychosis. In this particular cause, there may be no other conditions or diseases involved. This kind of psychosis lasts for less than one month. Stress can also trigger symptoms in people who are particularly at risk for psychotic disorders. 

Signs & Symptoms

While psychosis looks different from person to person, it always causes changes in your abilities and personality. The symptoms of psychosis generally depend on the cause of psychosis, so different people may have very different symptoms. Someone living with schizophrenia may experience many positive and negative symptoms while someone living with a brain injury may only experience hallucinations or delusions. The most important thing to remember is that all symptoms are treatable

• Because it is so different in each person, you may experience some or all of the symptoms below. 
• I’m hearing voices that other people don’t hear 
• My thoughts take a long time to form, come too fast together, or don’t form at all 
• I’m convinced I’m being followed 
• I’m having trouble remembering things, concentrating and making decisions 
• I act differently or I have a hard time completing basic tasks 
• I don’t feel like talking much anymore, or people say they can’t understand what I’m saying 
• I get confused easily 

If you are experiencing any of these symptoms it’s important that you talk to your doctor. These symptoms could also be signs of other mental or physical health problems, and your doctor can help figure out what is causing them. 

What causes psychosis?

There is no one cause of psychosis. Psychosis appears to result from a complex combination of genetic risk, differences in brain development, and exposure to stressors or trauma. Psychosis may be a symptom of a mental illness, such as schizophrenia, bipolar disorder, or severe depression. However, a person can experience psychosis and never be diagnosed with schizophrenia or any other disorder.

For older adults, psychosis symptoms can be part of a physical or mental illness that emerges later in life. Psychosis can also be a symptom of some diseases of older age, including Parkinson’s disease, Alzheimer’s disease, and related dementias.

Other possible causes of psychosis include sleep deprivation, certain prescription medications, and the misuse of alcohol or drugs. A mental illness, such as schizophrenia, is typically diagnosed by excluding these other causes.

A qualified mental health professional (such as a psychologist, psychiatrist, or social worker) can provide a thorough assessment and accurate diagnosis. 

Diagnosis & Treatment

Psychosis is much easier to treat if it’s treated early. People who receive treatment during their first episode of psychosis often recover faster, experience fewer related problems like depression, spend less time in the hospital and have fewer school, work or social problems. With treatment, many people never experience psychosis again after they recover from their first episode. Treatment for psychosis usually includes medication and counselling. Some people need to stay in the hospital for assessment or treatment. 

Medications: Most people with psychosis can be treated with medications called antipsychotics. Antipsychotics have improved in the last few years. They are more effective and have fewer side-effects than they used to. These newer antipsychotics are also called ‘atypical antipsychotics.’ Other medication like antidepressants or mood stabilizers may help mood problems that go along with psychosis.

Counselling: Supportive counselling can offer emotional support. Cognitive-behavioural therapy (CBT) is a promising type of counselling for psychosis. It teaches how behaviours and thoughts affect mood. Family therapy may help the entire family cope with a family member’s psychosis. 

Education: Education is a very import part of a psychosis treatment plan and it should include patients and their families. Helpful psychosis education explains what psychosis is and what we know about it, treatment options and coping skills, how to avoid relapse and how to access services. 

Stress management: Stress can worsen symptoms, make it harder to function and even trigger a relapse, so it’s important to learn positive ways to deal with stress. This might include learning problem-solving skills, coping skills and relaxation skills. 

Self-care: Self-care strategies like eating well, getting enough sleep and keeping in touch with family and friends can also help. 

Social and life skills support: Someone living with psychosis might need help with skills like finding a job and managing their finances. A professional like an occupational therapist or social worker can help with day-to-day living and connect people with community services or government programs. 

Resources

• Early Psychosis Intervention Nova Scotia
• Hope for Mental Health 
• Early Psychosis: An Information Guide
• Beyond Psychosis (video)
• Promoting Recovery from First Episode Psychosis (CAMH online store)
• A free tutorial on psychosis is available on the Mental Health 101 page.
• Schizophrenia: An Information Guide (PDF)
• Understanding Psychiatric Medications: Antipsychotics 
• When a Parent Has Experienced Psychosis: What Kids Want to Know
• Women and Psychosis: An Information Guide (PDF)

Sources: National Institute of Mental Health, CAMH, CMHA Northern BC