What is Psychosis?
When you lose touch with reality and see, hear, or believe things that aren’t real, doctors call that psychosis. You may have delusions. That means you hold on to untrue or strange beliefs. You might also have hallucinations. That’s when you imagine you hear or see something that doesn’t exist.
Psychosis is a symptom, not an illness. A mental or physical illness or extreme stress or trauma can cause it.
Psychotic disorders, like schizophrenia, are mental illnesses that involve psychosis that usually happens for the first time in the late teen years or early adulthood. Young people are especially vulnerable for reasons doctors don’t fully understand. Even before the first episode psychosis (FEP), they may also show subtle signs of behavioral changes. This is called the prodromal period and could last days, weeks or even months.
Symptoms of Psychosis
The classic signs and symptoms of psychosis are:
- Hallucinations: Hearing, seeing, or feeling things that do not exist
- Delusions: false beliefs, especially based on fear or suspicion of things that are not real
- Disorganization: In thought, speech, or behavior
- Disordered thinking: Jumping between unrelated topics, making strange connections between thoughts
- Catatonia: Unresponsiveness
- Difficulty concentrating
Depending on the cause, psychosis can come on quickly or slowly. The same is the case in schizophrenia, although symptoms may have a slow onset and begin with milder psychosis, some people may experience a rapid transition back to psychosis if they stop taking their medication.
The milder, initial symptoms of psychosis might include:
- Feelings of suspicion
- General anxiety
- Distorted perceptions
- Obsessive thinking
- Sleep problems
Hallucinations can affect any of the senses (sight, sound, smell, taste, and touch) in the person with psychosis, but in about two-thirds of patients with schizophrenia, hallucinations are auditory - hearing things and believing them to be real when they do not exist.
The following auditory hallucinations are common:
- Hearing several voices talking, often negatively, about the patient
- A voice giving a commentary on what the patient is doing
- A voice repeating what the patient is thinking
How is Psychosis Treated?
In this section, we discuss the treatments for psychosis and some methods of prevention.
Antipsychotics: Treatment with antipsychotics is the most common therapy for people with a psychotic illness.
Antipsychotics are effective at reducing psychosis symptoms in psychiatric disorders such as schizophrenia, but they do not themselves treat or cure underlying psychotic illnesses.
So-called second-generation antipsychotics are most commonly used by doctors to treat psychosis. While their use is widespread in the United States, this is controversial. The World Health Organization (WHO) does not recommend them, except clozapine (branded Clozaril and FazaClo in the U.S.), which may be used under special supervision if there has been no response to other antipsychotic medicines.
Acute and maintenance phases of schizophrenia: Antipsychotic treatment of schizophrenia is in two phases - the acute phase to treat initial psychotic episodes and a lifelong phase of maintenance therapy.
During the acute phase, a stay in hospital is often needed. Sometimes a technique called rapid tranquilization is used. A fast-acting medication that relaxes the patient will be used to ensure that they do not harm themselves or others.
In the maintenance phase, treatment of schizophrenia is in the community and antipsychotics help to prevent further psychotic episodes, although relapses often occur, sometimes due to a failure to take the medications. Lifelong treatment of schizophrenia may involve other interventions and support, including the role of the family in care.
Psychotherapy can also be useful in treating cognitive and residual symptoms of schizophrenia and other psychotic disorders.
WHEN TO SEE A MENTAL HEALTH PROFESSIONAL
If the problems in your life are stopping you from functioning well or feeling good, professional help can make a big difference. And if you're having trouble, know that you are not alone: One in four adults in this country have a mental health problem in any given year.
Of course, you don't have to be in crisis to seek help. Why wait until you're really suffering? Even if you're not sure whether you would benefit from help, it can't hurt to explore the possibility.
A mental health professional can help you:
- Come up with plans for solving problems
- Feel stronger in the face of challenges
- Change behaviors that hold you back
- Look at ways of thinking that affect how you feel
- Heal pains from your past
- Figure out your goals
- Build self-confidence
Treatment for a mental health issue can include medication and psychotherapy. In some cases, the two work well together.
What, exactly, is psychotherapy? It's a general term that means talking about your problems with a mental health professional. It can take lots of forms, including individual, group, couples and family sessions. Often, people see their therapists once a week for 50 minutes. Depending on your situation, treatment can be fairly short or longer-term.
Some people worry that getting help is a sign of weakness. If you do, consider that it can be a sign of great strength to take steps toward getting your life back on track.
WHEN TO GET EMERGENCY HELP
If you think you may hurt yourself or attempt suicide call 911 or your local emergency number immediately.
Also consider these options if you're having suicidal thoughts:
- Call your mental health specialist.
- Call a suicide hotline number — in the U.S., call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255).
- Seek help from your primary doctor or other health care provider.
- Reach out to a close friend or loved one.
- Contact a minister, spiritual leader or someone else in your faith community.
If a loved one or friend is in danger of attempting suicide or has made an attempt:
- Make sure someone stays with that person.
- Call 911 or your local emergency number immediately.
- Or, if you can do so safely, take the person to the nearest hospital emergency room.