Ever felt like you’re losing touch with reality? Hearing voices or seeing things that aren’t really there? You’re not alone. Psychosis is a mental health condition that affects millions of people.
The good news is, that psychosis is treatable and many people recover fully or are able to manage their symptoms well with proper treatment and support. This comprehensive guide will walk you through everything you need to know about psychosis.
“The psychotic drowns in the same waters in which the mystic swims with delight.”
― Joseph Campbell, Psychology of the Future: Lessons from Modern Consciousness Research
We’ll explore what psychosis really means, the different types and symptoms, what causes it, how it’s diagnosed, and the latest treatment options that can help you or your loved one start on the path to recovery. By the end, you’ll have a solid understanding of this complex condition and feel empowered to seek help. Recovery is absolutely possible, so let’s dive in.
Causes — Genetics, Brain Chemistry Imbalances, Environmental Factors.
Genetics plays a role in psychosis, as it tends to run in families. If a close relative experiences psychosis, your risk increases. Brain chemistry imbalances, especially in dopamine and glutamate, may also contribute.
Environmental factors can trigger psychotic episodes in susceptible individuals. Severe stress, trauma, or sleep deprivation can set off psychosis or worsen symptoms.
“Schizophrenia cannot be understood without understanding despair.”
― R.D. Laing
Recreational drug use, especially cannabis, amphetamines, and cocaine, can induce psychotic symptoms. These mind-altering substances interfere with neurotransmitters like dopamine that help regulate mood and perception. For some, drug-induced psychosis becomes permanent.
Infections, autoimmune disorders, prenatal or birth complications, and metabolic disorders are other possible causes or contributors. A combination of genetic vulnerability and environmental influences often lead to the development of psychotic disorders.
The underlying mechanisms behind psychosis are complex. A personalized treatment plan that addresses all possible causes — biological, psychological, and social — gives the best chance of recovery or remission. Gaining insight into triggers that exacerbate symptoms empowers you to better manage this condition.
Types — Schizophrenia, Schizoaffective Disorder, Schizophreniform, Etc.
There are several types of psychosis, including:
- Schizophrenia: A chronic mental health condition causing distorted thoughts, hallucinations, and impaired cognitive abilities. Symptoms usually appear in early adulthood and include hearing voices, paranoid delusions, and disorganized speech or behavior.
- Schizoaffective disorder: Characterized by symptoms of schizophrenia, such as delusions and hallucinations, along with symptoms of a mood disorder like mania or depression. Mood episodes also occur independently of psychotic symptoms.
- Schizophreniform disorder: Resembles schizophrenia but symptoms last less than six months. If symptoms continue for more than six months, the diagnosis may change to schizophrenia.
- Brief psychotic disorder: Sudden onset of psychotic symptoms like delusions, hallucinations, or disorganized speech and behavior that lasts less than one month. Usually in response to a stressful life event.
- Substance-induced psychotic disorder: Temporary psychotic reaction caused by alcohol, drugs, medications, or toxins that lasts as long as the substance’s effects or up to one month after stopping use of the substance.
Positive Symptoms — Delusions, Hallucinations, Racing Thoughts.
Positive symptoms refer to experiences that people with psychosis struggle with, such as delusions, hallucinations, and racing thoughts.
Delusions are false beliefs that are firmly held despite evidence that contradicts them. Persecutory delusions, where you believe you are being spied on, harmed, or plotted against are common. Grandiose delusions involve believing you have a special power or importance.
Hallucinations involve seeing, hearing, smelling, tasting or feeling things that aren’t really there. Auditory hallucinations, like hearing voices, are most common. The voices may comment on your behavior, have conversations with each other, or give commands. Visual hallucinations involve seeing things like people, animals or objects that aren’t really present.
Racing thoughts refer to a rapid, uncontrollable stream of thoughts that jump quickly from topic to topic in a fragmented, illogical manner. Your mind feels very active and crowded, making it hard to focus or concentrate.
These disorganized, speedy thoughts can contribute to feelings of anxiety, irritability, and difficulty sleeping.
Managing positive symptoms typically involves medication and therapy. Antipsychotic medications can help reduce or eliminate delusions and hallucinations.
“A transference neurosis corresponds to a conflict between ego and id, a narcissistic neurosis corresponds to that between between ego and super-ego, and a psychosis to that between ego and outer world.”
― Sigmund Freud, General Psychological Theory: Papers on Metapsychology
Cognitive behavioral therapy helps you develop coping strategies to better deal with distressing thoughts and experiences. Education about your condition and developing a strong support system are also helpful.
Negative Symptoms — Flattened Affect, Reduced Speech, Apathy.
Negative symptoms refer to reductions or absences of normal behaviors, emotions, and cognitions. These include:
This means having little or no emotional expression. Your face may appear expressionless, and your speech monotonous. It can make social interaction difficult and reduce motivation or pleasure from activities.
Some people experience decreased speech, speaking very little or only in short phrases. This is known as alogia and can make communication challenging.
A lack of motivation, enthusiasm, or interest in social interaction or day-to-day activities. Apathy reduces initiative and passion and makes it hard to accomplish goals or engage in hobbies.
“Am I racially kin to this man? Baynes wondered. So closely so that for all intents and purposes it is the same? Then it is in me, too, the psychotic streak. A psychotic world we live in. The madmen are in power. How long have we known this? Faced this? And — how many of us do know it?”
― Philip K. Dick, The Man in the High Castle
The negative symptoms of psychosis can significantly impact the quality of life. Treatment options include medications, psychotherapy, social skills training, and occupational therapy. While negative symptoms tend to be persistent, some improvement is often possible with comprehensive treatment and support.
Cognitive Symptoms — Difficulty Concentrating, Memory Issues.
Cognitive symptoms like difficulty concentrating and memory problems are common psychosis. Your ability to focus, process information, and recall details may be impaired.
It can be hard to focus your attention on tasks, conversations, or reading. Your mind may feel scattered or cluttered, making it a struggle to stay on topic or complete things. Simple chores and activities that used to be easy now require immense effort and persistence.
You may notice your memory isn’t as sharp as it used to be. It’s common to forget important details like appointments, conversations or where you left your keys.
Your short-term memory in particular may be affected, causing you to repeat questions or lose your train of thought. Long-term memories can also start to fade, though usually not as dramatically.
Don’t be too hard on yourself if you’re experiencing cognitive difficulties. It’s a symptom of your condition, not a reflection of your intelligence or worth.
“He didn’t know what beget what, but he quickly learned that people with money to hide were powerful, and powerful people were violent. It was reliable math: as the amount of money being conveyed increased, so too did the level of paranoia; the psychotic behavior of his clients increasing with every figure added to the sum.”
― T. Mountebank, Sister Sable
Be patient with yourself and try using memory aids like to-do lists, calendars, timers, and reminders to help minimize the impact on your day-to-day life.
Let your doctor know right away if your symptoms worsen or become severely debilitating. Treatment like therapy or medication adjustments may help improve your cognitive abilities and quality of life.
Duration — Episodes May Last Weeks To Months.
Psychotic episodes can last for varying periods of time, from a few weeks to several months. The duration depends on several factors, including:
- The underlying cause of the psychosis. Conditions like schizophrenia and bipolar disorder typically involve episodes that last longer, often 6 months or more. Brief psychotic disorder usually resolves within a month.
- How quickly treatment is started. Antipsychotic medications and psychotherapy can help shorten the length and severity of psychotic episodes. The sooner treatment begins, the sooner symptoms may start to improve.
- Individual differences. Each person experiences psychosis in their own way. Some may recover more quickly than others, even with similar treatment. Genetics, lifestyle, environment, and other influences all play a role.
- Compliance with treatment. Following the recommended treatment plan, including taking all medications as prescribed and attending therapy or counseling sessions, helps ensure the best outcome. Noncompliance often leads to prolonged or repeated episodes.
While the initial psychotic episode may feel endless, the good news is that with proper diagnosis and treatment, most people are able to recover and go on to live healthy, productive lives.
“We can postulate that there must be diseases founded on a conflict between ego and super-ego. Analysis gives us the right to infer that melancholia is the model of this group, and then we should put in a claim for the name of “narcissistic psychoneuroses” for these disorders.”
― Sigmund Freud, General Psychological Theory: Papers on Metapsychology
But treatment is a lifelong effort — sticking with medications and psychotherapy helps prevent future relapses. With the right treatment and support, psychotic episodes can be managed safely and, in many cases, avoided altogether.
Risk Factors — Family History, Drug Use, Stress Trauma.
A family history of psychosis or schizophrenia is one of the biggest risk factors. If you have a first-degree relative (parent, sibling, child) with psychosis, your risk increases significantly. Genetics account for about 80% of the risk for schizophrenia.
Using drugs like cannabis, cocaine, methamphetamine, or hallucinogens like LSD or magic mushrooms, especially during adolescence, can increase the risk of developing psychosis. These drugs may trigger the initial psychotic episode or exacerbate symptoms in people already prone to psychosis.
Severe stress or trauma
Undergoing a severely stressful life event like physical or sexual abuse, a traumatic accident, a natural disaster, or a combat experience can trigger the onset of psychotic symptoms in vulnerable individuals. The stress and trauma cause changes in the brain that may lead to psychosis in those predisposed to it.
In summary, the major risk factors for developing psychosis include:
- Close family member with psychosis or schizophrenia
- Using drugs like cannabis, cocaine, or meth during adolescence
- Suffering severe stress, trauma, or abuse
Paying attention to these risks and minimizing them when possible can help reduce your vulnerability to psychosis. However, sometimes psychosis arises with no obvious risk factors or explanation. The key is to get treatment as soon as symptoms appear to prevent severe consequences.
Brain Abnormalities — Structural And Chemical Differences Seen On Scans.
Brain scans of people with psychosis often show structural and chemical differences compared to people without psychosis. Studies using MRI and CT scans have found that people with schizophrenia, for example, tend to have enlarged ventricles (fluid-filled spaces) in the brain and less cortical gray matter (the outer layer of brain cells).
“…I have sometimes imagined my own sanity as resting on the surface of a membrane, a thin and fragile membrane that can easily be ripped open, plunging me into the abyss of madness, where I join the tumbling souls whose membranes have likewise been pieced over the ages. Sometimes, when my thoughts are especially fevered, I can visualize the agent of this piercing. It is a watchful presence at the edge of things, silent and dripping, a stranger in a raincoat… When we fall into such psychosis, there are no other membranes below to catch and protect us. And the horror and helplessness of the fall are intensified by an uncaring world.”
― Ron Powers, No One Cares About Crazy People: The Chaos and Heartbreak of Mental Health in America
PET and SPECT scans measuring brain activity and blood flow have shown decreased activity in the frontal and temporal lobes of the brain. These areas are involved in memory, planning, judgment, and social behavior.
Some research also points to excess dopamine activity in the mesolimbic pathway of the brain, which is involved in reward and pleasure.
While these findings point to real biological differences, it’s important to note that not all people with psychosis show these abnormalities. Brain structure and function are also influenced by environmental and genetic factors, so psychosis arises from a complex interplay between nature and nurture.
More research is still needed to fully understand the neurological underpinnings of psychotic disorders. But by identifying differences, scientists get closer to developing better treatments that target the specific biological mechanisms involved.
Many new medications for schizophrenia and bipolar disorder, for example, work by impacting the brain’s dopamine and glutamate systems.
As brain scan technology improves, researchers will continue to gain new insights into how the structure and function of the brain may contribute to psychosis. Coupled with genetic studies, this can help unlock the mysteries behind these serious but often misunderstood mental health conditions.
Anosognosia — Lack Of Insight Into The Condition.
Anosognosia refers to a lack of insight or awareness into one’s own condition. People experiencing psychosis and delusional beliefs often do not realize their thoughts or perceptions are distorted or irrational.
They may not recognize the severity or implications of their condition. This lack of insight can interfere with treatment and recovery.
- Anosognosia is common in people with schizophrenia, bipolar disorder, and other psychotic disorders where delusional thoughts are present. Despite clear symptoms, the person continues to feel their experiences and beliefs are normal and accurate. They may deny anything is wrong at all.
- Treatment providers should approach someone with anosognosia gently and avoid direct confrontation. Arguing or trying to logically convince the person their delusions or hallucinations aren’t real often does not work and can damage rapport and trust.
- As treatment progresses and symptoms start to improve, insight usually increases. Antipsychotic medications and cognitive behavioral therapy can be particularly helpful for developing awareness of the condition. Education about the disorder and its expected symptoms is also important.
- Family and friends should also avoid confrontation and criticism. Expressing concern, listening without judgment, and providing empathy and support can help motivate the person to stick with treatment. Gently encouraging medication compliance and appointment attendance may be needed.
- Anosognosia makes living with and overcoming psychosis especially difficult. However, with comprehensive treatment and a strong support system, significant improvements in symptoms and insight are possible. Progress may be slow, but ongoing patience and understanding will make a difference.
Role Of Dopamine — Receptor Dysfunction Links To Symptoms.
Dopamine is a key neurotransmitter in the brain that helps regulate movement and emotional responses. For those with psychosis, the dopamine system is dysfunctional, impacting the mesolimbic pathway in particular.
This pathway connects the ventral tegmental area in the midbrain to the nucleus accumbens and other limbic system structures.
“The truth, and the threat it poses, can be too overwhelming to bear, and for many women in the aftermath of the sexual revolution, the truth was that their experiences were being dismissed by the men in their lives. Although many of the women in the films of this period are clearly meant to be schizophrenic, sociopathic or downright psychotic, the underlying implication (and there always is one in horror films) is that these ‘illnesses’ come in at the break between the woman’s experience and the man’s experience of the same situation- and what is ‘true’ or ‘right’ is often whatever the man says it is.”
― Kier-la Janisse, House of Psychotic Women: An Autobiographical Topography of Female Neurosis in Horror and Exploitation Films
In people without psychosis, dopamine release in the mesolimbic pathway reinforces rewarding experiences and helps regulate emotional salience — how much importance we assign to external stimuli.
For those with psychosis, excess dopamine activity in this pathway leads to hallucinations, delusions, and disordered thinking. Antipsychotic medications work by blocking D2 dopamine receptors in the mesolimbic pathway and other dopamine pathways to help alleviate these symptoms.
The dopamine hypothesis of schizophrenia proposes that excess dopamine in the mesolimbic pathway, especially at D2 receptors, leads to psychosis. Support for this includes:
- PET scans show increased dopamine release in the striatum of unmedicated people with schizophrenia.
- Antipsychotics that block D2 receptors reduce symptoms.
- Dopamine agonists like amphetamines can induce psychosis in healthy people and worsen symptoms for those with schizophrenia.
While dopamine clearly plays a role, psychosis is a complex disorder with many interacting causes. Other neurotransmitters, genetics, trauma, stress, and structural brain changes are also involved.
A comprehensive understanding of psychosis must consider all these factors and how they influence the dopamine system. Treatment and management should take an integrated, personalized approach to each individual.
Neurocognitive Deficits — Problems With Memory, Attention, Problem-solving.
Neurocognitive deficits refer to problems with memory, attention, problem-solving, and other thinking skills. These issues can make daily life difficult for someone with psychosis.
Memory issues may include trouble learning and retaining new information. You might forget important details or events. To help, focus on one task at a time, write reminders, and stick to a routine.
Attention difficulties can make it hard to focus or shift focus. You may get easily distracted or overwhelmed. Try relaxation techniques like meditation or deep breathing to improve concentration. Limit distractions and break big tasks into small steps.
Problem-solving challenges may involve trouble planning, making decisions, or thinking logically. Take your time, write down options, and evaluate the pros and cons. Ask others for input. Start with easier problems to build confidence.
Other thinking skills impacted could be processing speed, cognitive flexibility, and abstract reasoning. Be patient with yourself. Set small, achievable goals and celebrate victories.
Make lifestyle changes to maximize cognitive health like exercising, limiting alcohol or substance use, and engaging in social interaction.
With treatment and support, many people with psychosis can improve neurocognitive functioning over time. However some deficits may remain, requiring ongoing coping strategies and skills retraining.
Talk to your doctor about cognitive remediation therapy or occupational therapy. They can help retrain your brain and make the most of your abilities.
Social Cognition Challenges — Difficulty Recognizing Emotions, Mental States.
Social cognition refers to the mental processes involved in perceiving, understanding, and generating responses to the intentions, dispositions, and behaviors of others. For those with psychosis, social cognition can be challenging in many ways.
Difficulty Recognizing Emotions and Mental States
You may have trouble identifying emotions in others through facial expressions, tone of voice, and gestures. This can make social interactions confusing and anxiety-provoking. Some tips to help improve:
- Observe how others express emotions in various situations. Look for patterns and cues that signal different feelings. Practice identifying emotions in photos, videos, and in everyday life.
- Ask others directly how they’re feeling. Don’t assume you know based on appearances alone. Say something like, “You seem (emotion). Am I reading you correctly?” This can help confirm your perceptions and make you a better observer over time.
- Explain your own emotional state to others openly and honestly. This models the behavior you want to see in return and helps ensure your intentions and feelings are understood.
- Seek counseling or social skills training. Speaking to a professional therapist or coach can help strengthen your ability to recognize emotions and navigate challenging social situations.
With practice and conscious effort, recognizing emotions in others can become easier. But don’t be too hard on yourself if you continue to struggle at times.
Many people experience difficulties in this area, with or without psychosis. The key is learning coping strategies, asking for help when you need it, and surrounding yourself with people who understand and support you.
Vulnerability-stress Model — Predisposition Triggered By Stressors.
The vulnerability-stress model proposes that psychosis develops in susceptible individuals when they experience severe stress. Some people may be predisposed to psychosis due to genetics, brain abnormalities, or early childhood trauma. However, psychosis does not usually emerge unless precipitated by environmental stressors.
Stressful life events that could trigger the onset or relapse of psychosis include:
- Traumatic experiences like physical or sexual abuse
- Social stress from isolation or discrimination
- Family stress from poor relationships or communication
- Work or school stress from inability to cope with responsibilities
- Substance abuse of drugs like cannabis, cocaine or methamphetamine
- Medical issues such as head injuries or seizures
These stressors do not directly cause psychosis but can provoke symptoms in vulnerable persons. The severity, frequency, and duration of stressors, as well as lack of social support, increase the risk.
Managing stress and avoiding potential triggers may help prevent or minimize psychotic episodes.
The vulnerability-stress model highlights the complex interplay between biological, psychological, and social factors in the development of psychosis.
A comprehensive approach that addresses both vulnerability and stress may be most effective for treatment and prevention. Reducing stress, learning coping strategies, and making lifestyle changes can complement medical interventions. Support from family and community also plays an important role in resilience and recovery.
Negative Social Stigma — Misunderstanding Leads To Discrimination.
The negative social stigma surrounding psychosis often arises from misunderstanding and fear of the unknown. People may make insensitive comments or discriminate against those with psychosis due to ignorance about the condition.
Misunderstanding the Condition
Many people wrongly assume that psychosis means someone is “crazy” or dangerous. In reality, psychosis is a symptom of an underlying condition like schizophrenia or bipolar disorder and does not define a person’s character or worth. Promoting education and awareness about what psychosis really means can help reduce prejudice.
Those with psychosis deserve the same rights, respect, and opportunities as anyone else. While psychosis may present certain challenges, many people are able to live full and meaningful lives with proper treatment and support.
However, discrimination can be an additional barrier to well-being for people already dealing with the difficulties of the condition itself.
Calling out insensitive remarks, advocating for inclusiveness, and making an effort to understand psychosis can all help create a more compassionate society for those affected.
Though stigma may persist, together we can work to overcome ignorance and ensure people with psychosis feel respected and valued.
Suicide Risk — Psychotic Depression Increases Risk Of Self-harm.
Psychotic depression greatly increases the risk of suicide or self-harm. The delusions and hallucinations that characterize psychosis can involve themes of self-harm, danger, or worthlessness that fuel suicidal thoughts. The deep despair of major depression also amplifies the desire to end one’s life.
Some warning signs of suicide risk to watch for include:
- Talking about death, dying, or suicide
- Feeling hopeless or worthless
- Showing extreme mood changes
- Withdrawing from family and friends
- Giving away prized possessions
- Writing a will or suicide note
If you observe these signs in yourself or a loved one with psychotic depression, seek emergency medical help right away.
Do not leave the person alone, and call emergency services or a suicide hotline for support and next steps. Hospitalization may be necessary to ensure safety and stabilize the condition.
Treatment focuses on managing both the psychotic and depressive symptoms. Antipsychotic and antidepressant medications, along with psychotherapy, are typically used in combination.
Close monitoring, especially early in treatment or when changing medications, is important to assess suicide risk and medication side effects.
With proper treatment and support, the suicide risk can be reduced. However, due to the chronic nature of psychotic depression, vigilance for recurring signs of suicidal thoughts or self-harm must be ongoing. By staying on guard for these warning signs, lives can be saved.
Treatments — Antipsychotic Medications, Psychotherapy, Social Support.
The three most common treatments for psychosis are:
These medications work by changing the way certain chemicals in the brain interact. There are two main groups: typical and atypical antipsychotics. Atypical antipsychotics, like risperidone and clozapine, are often preferred due to fewer side effects. It can take trial and error to find the right drug and dosage for you. Common side effects include drowsiness, dizziness, weight gain, and tremors.
Talk therapy, especially cognitive behavioral therapy (CBT) and family therapy can be very helpful for managing psychosis. CBT helps challenge delusional thoughts and replace them with more realistic ones. Family therapy provides education and support. Therapy may be one-on-one or in a group setting.
Having a strong support system will aid recovery. Connecting to others with similar experiences can help reduce isolation and provide empathy. Support groups are available both online and in person.
Let close family and friends know how they can support you, whether it’s helping out with chores or just spending time together. Their support and understanding will help you stay on track with treatments and work towards remission.
The combination of medication, psychotherapy, and social support offers the best chance of managing psychotic symptoms.
Ongoing treatment and monitoring are often needed to prevent relapse, improve quality of life, and allow you to live independently. With the right treatment plan, many people are able to gain control over their symptoms and live full, productive lives.
Cognitive Behavioral Therapy — Manages Symptoms and increases Coping Skills.
Cognitive behavioral therapy (CBT) is a practical approach to managing psychotic symptoms and coping with challenges. CBT helps you identify negative or unrealistic thoughts and replace them with more positive, realistic ones. It also teaches coping strategies to better handle stress and psychotic episodes.
Some key aspects of CBT for psychosis include:
- Challenging delusional beliefs by considering alternative explanations and looking for evidence that contradicts delusional ideas. This can help reduce distress and conviction in delusional beliefs over time.
- Learning to cope with hallucinations by ignoring voices or sounds that aren’t really there and avoiding arguing with them. Practicing relaxation techniques like deep breathing to decrease anxiety.
- Developing a relapse prevention plan to identify early warning signs of psychosis and determine strategies to avoid or minimize relapse. Having a plan in place can help reduce hospitalization rates.
- Acquiring coping strategies like distraction, problem-solving, and social support to manage stress and symptoms. Building a strong support system is vital for recovery and maintaining wellness.
- Setting small, achievable goals and rewarding yourself for your progress. Making continuous progress, no matter how small, fosters a sense of empowerment and hope.
CBT is often used in combination with medications and other therapies. While symptoms may not disappear completely, CBT can be very effective at reducing severity and distress, allowing you to live a higher quality of life with greater independence and functioning. CBT gives you the skills and tools to better manage your condition over the long run.
So there you have it, a comprehensive overview of psychosis and its related conditions. Psychosis can be an extremely frightening and traumatic experience.
But the good news is, with proper diagnosis and treatment, many people go on to live healthy and productive lives. The key is getting the right help as early as possible. Don’t delay if you or someone you know is exhibiting symptoms.
Talk to a medical professional, contact local support groups, and start building your support network. You don’t have to go through this alone.
While psychosis may be a lifelong condition, with a commitment to treatment and self-care, people can gain control over their symptoms and find meaning and purpose. There is always hope, so keep your head up!