Psychosis
Psychosis is the term for a collection of symptoms that happen when a person has trouble telling the difference between what’s real and what’s not. This disconnection from reality can happen for several reasons, including many different mental and physical conditions. It’s usually treatable with medication and other techniques.
Psychosis is disconnection from reality. People may have false beliefs or experience things that aren’t real. Psychosis isn’t a condition. It’s a term that describes a collection of symptoms.
Two important types of psychosis include:
- Hallucinations. These are when parts of your brain mistakenly act like they would if your senses (vision, hearing, touch, smell and taste) picked up on something actually happening. An example of a hallucination is hearing voices that aren’t there (auditory hallucination).
- Delusions. These are false beliefs that someone holds onto very strongly, even when others don’t believe them or there’s plenty of evidence that a belief isn’t true. For example, people with delusions of control believe someone is controlling their thoughts or actions remotely.
Psychosis is a common symptom of many mental health conditions. The America Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) has an entire category devoted to these conditions.
This category, “Schizophrenia Spectrum and Other Psychotic Disorders,” includes the following conditions:
- Schizophrenia.
- Brief psychotic disorder.
- Delusional disorder.
- Schizoaffective disorder.
- Schizophreniform disorder.
- Schizotypal (personality) disorder.
- Substance/medication-induced psychotic disorder.
- Psychotic disorder due to another medical condition.
Psychosis can also happen with certain types of mood disorders. Those include:
- Bipolar disorder.
- Major depression and related conditions.
Medical conditions that can cause psychosis
Psychosis can also happen because of a wide range of other conditions that affect your brain and body. These include:
- Alzheimer’s disease and other types of dementia.
- Hormone-related conditions like Addison’s disease and Cushing’s disease, and when your thyroid gland is too active or not active enough.
- Infections of your brain or spinal cord (encephalitis or meningitis).
- Lupus.
- Lyme disease.
- Multiple sclerosis.
- Postpartum psychosis (a rare, severe mental health emergency related to postpartum depression).
- Stroke and other neurological (brain-related) conditions.
- Vitamin B1 (thiamine) and vitamin B12 deficiencies.
Other causes of psychosis
Psychosis, or symptoms that look very much like it, can also happen under other circumstances. The causes will seem more like triggers in some cases because psychosis develops quickly. In others, it may be a slow process. Some of the circumstances or factors that can cause psychosis include:
- Misuse of alcohol, prescription medications or recreational drugs (the disorder mentioned above is when this lasts for a longer period).
- Severe head injuries (concussions and traumatic brain injuries).
- Traumatic experiences (past or present).
- Unusually high levels of stress or anxiety.
The treatment of psychosis depends mainly on the underlying cause. In those cases, treating the underlying cause is often the only treatment needed.
For psychosis that needs direct treatment, there are several approaches.
- Medications. Antipsychotic drugs are the most common type of medications to treat psychosis, but other medications, such as antidepressants or lithium, may also help.
- Cognitive behavioral therapy (CBT). This type of psychotherapy can help with certain mental health conditions that can cause psychosis or make it worse.
- Inpatient treatment. For severe cases of psychosis, especially when a person may poses a danger to themselves or others, inpatient treatment in a hospital or specialist facility is sometimes necessary.
- Support programs or care. Many people experience psychosis because of other conditions such as alcohol or substance use disorders and personality disorders. Treating these disorders or helping people with social, work and family programs can sometimes reduce the impact of psychosis and related conditions. These programs can also make it easier for people to manage psychosis and their underlying condition.
Psychosis is unpredictable. There are many genetic and lifestyle risk factors, but there’s no way to consistently predict if people will experience these symptoms.
There are some things people can do to make them less likely to develop these symptoms or conditions that involve it.
- Avoid recreational marijuana use earlier in life. Researchers have linked psychosis with heavy marijuana use during teenage years and early adulthood. However, there’s disagreement on whether or not marijuana use is a direct cause or if it’s just a contributing factor.
- Wear safety equipment. Head injuries can result in brain damage that causes psychosis or similar symptoms.
- Don’t ignore infections. Untreated infections, especially those that affect your eyes and ears, can spread to your brain and cause psychosis.
- Eat a balanced diet and maintain a healthy weight. Many conditions related to your circulatory and heart health, especially stroke, can cause psychosis and related conditions. Preventing stroke and similar conditions can help reduce your risk of developing psychosis.
When should I seek treatment from a doctor or healthcare provider?
Psychosis can sometimes happen with severe or even life-threatening conditions like stroke. It’s not a symptom you should try to self-diagnose or treat on your own. A person with psychotic symptoms needs a trained, qualified medical provider to examine them, make the diagnosis and recommend treatment.
Managing psychosis
A common symptom that happens along with conditions that cause psychosis is anosognosia, which means “lack of insight.” This is more than just denial. It means the person literally can’t recognize or understand the signs or symptoms of their condition.
If your healthcare provider diagnoses you with psychosis, it’s very important to follow their treatment recommendations. That can feel difficult, especially if you don’t think anything is wrong with you.
If you feel this way, it’s important to talk to your healthcare provider and loved ones about it. It may feel scary, upsetting or frustrating to discuss it, but it’s still something you should try to do. Building those relationships, as well as communicating with and trusting your healthcare provider and the people who care about you can make a big difference in how you feel and recover.
References
- American Psychological Association Dictionary of Psychology (https://dictionary.apa.org/). Accessed 5/15/2022.
- National Health Service (UK). Overview – Psychosis (https://www.nhs.uk/mental-health/conditions/psychosis/overview/). Accessed 5/15/2022.
- National Institutes of Health, National Library of Medicine. Psychotic disorders (https://medlineplus.gov/psychoticdisorders.html). Accessed 5/15/2022.
- Pandurangi AK. Assessment and Management of Psychosis. In: McKean SC, Ross JJ, Dressler DD, Scheurer DB. eds. Principles and Practice of Hospital Medicine, 2e. McGraw Hill; 2017. Accessed 5/15/2022.
- Pokorna O, Samelson-Jones E. Psychosis. In: Feldman MD, Christensen JF, Satterfield JM, Laponis R. eds. Behavioral Medicine: A Guide for Clinical Practice, 5e. McGraw Hill; 2019. Accessed 5/15/2022.
- Schizophrenia Spectrum and Other Psychotic Disorders (https://journals-sagepub-com.ccmain.ohionet.org/doi/pdf/10.1177/0020764018801690). Diagnostic and Statistical Manual of Mental Disorders, 5e-TR. March 2022. Accessed 5/15/2022.
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