Psychosis: An unsettling symptom
Psychosis is a symptom, not an illness, and it is more common than many people think. In the U.S., approximately 100,000 young people experience psychosis each year. As many as 3 in 100 people will have an episode at some point in their lives.
Most people think of psychosis as a break with reality. In a way it is. Psychosis is characterized as disruptions to a person’s thoughts and perceptions that make it difficult for them to recognize what is real and what isn’t. These disruptions are often experienced as seeing, hearing, and believing things that aren’t real or having strange, persistent thoughts, behaviors, and emotions. While everyone’s experience is different, most people say psychosis is frightening and confusing.
Psychosis often begins in young adulthood when a person is in their late teens to mid-20s. However, people can experience a psychotic episode at any age, and as a part of many disorders and illnesses, including Parkinson's disease, Alzheimer’s disease, and related dementias.
There is no one cause of psychosis. Psychosis appears to result from a complex combination of family history, 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 any disorder.
Symptoms
Psychosis includes a range of symptoms but usually involves one of these two major experiences:
Hallucinations - Seeing, hearing, or feeling things that aren’t there, such as the following:
Hearing voices (auditory hallucinations)
Strange sensations or unexplainable feelings
Seeing glimpses of objects or people that are not there or distortions
Delusions - Strong beliefs that are not consistent with the person’s culture, are unlikely to be true, and may seem irrational to others, such as the following:
Believing external forces are controlling thoughts, feelings, and behaviors
Believing that trivial remarks, events, or objects have personal meaning or significance
Thinking they have special powers, are on a special mission, or even that they are God
Warning signs
A person will often show changes in their behavior before psychosis develops. Behavioral warning signs for psychosis include:
Suspiciousness, paranoid ideas, or uneasiness with others
Trouble thinking clearly and logically
Withdrawing socially and spending a lot more time alone
Unusual or overly intense ideas, strange feelings, or a lack of feelings
Decline in self-care or personal hygiene
Disruption of sleep, including difficulty falling asleep and reduced sleep time
Difficulty telling reality from fantasy
Confused speech or trouble communicating
Sudden drop in grades or job performance
Alongside these symptoms, a person with psychosis may also experience more general changes in behavior that include:
Emotional disruption
Anxiety
Lack of motivation
Difficulty functioning overall
A person experiencing a psychotic episode may behave in confusing and unpredictable ways and may harm themselves or become threatening or violent toward others. The risk of violence and suicide decreases with treatment, so it is important to seek help. When persistent changes like these are noticed in a friend or family member and they begin to intensify, reach out to a healthcare provider.
Usually, a person has gradual, non-specific changes in thoughts and perceptions, but doesn't understand what's going on. Early warning signs can be difficult to distinguish from typical teen or young adult behavior. While such signs should not be cause for alarm, they may indicate the need to get an assessment from a doctor.
Encouraging people to seek help for early psychosis is important. Families are often the first to see early signs and the first to suggest treatment. However, a person's willingness to accept help is often complicated by delusions, fears, stigma, and feeling unsettled.
In this case, families can find the situation extremely difficult, but there are engagement strategies to help encourage a person to seek help.
Such warning signs often point to a person’s deteriorating health, and a physical and neurological evaluation can help find the problem. If the psychosis is a symptom of a mental health condition, early action helps to keep lives on track.
Studies have shown that it is common for a person to have psychotic symptoms for more than a year before receiving treatment. Reducing this duration of untreated psychosis is critical because early treatment often means better recovery. A qualified psychologist, psychiatrist or social worker can make a diagnosis and help develop a treatment plan.
Treatment
Early treatment of psychosis, especially during the first episode, leads to the best outcomes.
Treatment of psychosis usually includes antipsychotic medication. There are different types of antipsychotic medications, and they have different side effects, so it is important to work with a healthcare provider to determine the most effective medication with the fewest side effects.
It is important to find a mental health professional who is trained in psychosis treatment and who makes the person feel comfortable. With early diagnosis and appropriate treatment, it is possible to recover from psychosis. Some people who receive early treatment never have another psychotic episode. For other people, recovery means the ability to lead a fulfilling and productive life, even if psychotic symptoms sometimes return.
People with psychosis should be involved in their treatment planning and consulted in making decisions about their care. Their needs and goals should drive the treatment programs, which will help them stay engaged throughout the recovery process.
Coordinated specialty care (CSC)
Coordinated specialty care is a recovery-oriented, team approach to treating early psychosis that promotes easy access to care and shared decision-making among specialists, the person experiencing psychosis, and family members.
This approach consists of multiple components:
Individual or group psychotherapy is tailored to a person’s recovery goals. Cognitive and behavioral therapies focus on developing the knowledge and skills necessary to build resilience and cope with aspects of psychosis while maintaining and achieving personal goals.
Family support and education programs teach family members about psychosis as well as coping, communication, and problem-solving skills. Family members who are informed and involved are more prepared to help loved ones through the recovery process.
Medication management (also called pharmacotherapy) means tailoring medication to a person’s specific needs by selecting the appropriate type and dose of medication to help reduce psychosis symptoms. Like all medications, antipsychotic medications have risks and benefits. People should talk with their healthcare provider about side effects, medication costs, and dosage preferences (daily pill or monthly injection).
Supported employment and education services focus on return to work or school, using the support of a coach to help people achieve their goals.
Case management provides opportunities for people with psychosis to work with a case manager to address practical problems and improve access to needed support services.
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