Psychosis is an experience rather than a diagnosis. It describes times when a person’s sense of what is real differs from the people around them. Often, psychosis involves hallucinations, delusions (strongly held beliefs that others don’t share), and disorganised thinking (difficulty thinking clearly).
Psychosis can be part of a number of mental health conditions, such as:
or it can happen in response to drug use, extreme stress, or significant sleep deprivation.
Around 3% of people experience psychosis at some point in their lives. It can happen at any age and is more common in people with a family history of psychosis.
Some people only experience a few episodes of psychosis, or a brief episode that lasts for a few days or weeks. When psychosis is part of a condition such as schizophrenia, it usually first appears in late adolescence or early adulthood.
What Psychosis Can Look Like
1. Hallucinations
A hallucination is when someone perceives things that are not present. Hallucinations can be:
- Auditory - hearing things that are not present such as voices, music, or footsteps
- Visual - seeing things that are not present such as people, objects, animals, shapes, or lights
- Olfactory - smelling things that are not present such as a bad smell
- Tactile - feeling things that are not present such as feeling something brushing up against your skin
- Gustatory - tasting something that is not present such as an unpleasant or metallic taste
- Presence - sensing that someone is close by when no one is present
- Proprioceptive - sensing that your body is moving when it is not such as a feeling of floating
There are also two hallucinations that occur in the context of sleep:
- Hypnopompic - experiencing hallucinations when waking from sleep. This can happen with some sleep conditions, but for most people it is a common experience
- Hypnagogic - experiencing hallucinations when falling asleep, also a common experience for most people. These are typically visual.
2. Delusions
Delusions are strongly held beliefs that others don’t share and that don’t shift with evidence. Types of delusions include:
- Paranoid delusion such as the belief that one is being watched or singled out for something bad. A common example is the Truman Show delusion, when someone believes that their life is a staged reality show or that they are being watched on cameras
- Grandiose delusion such as the belief that one is an important religious figure, famous person, or a person in leadership, or the belief that one has special powers that others do not
- Depressive delusion such as the belief that one has committed a serious crime
- Reference delusion such as the belief that one is receiving important messages or codes via TV shows, music, advertising etc.
- Control delusion such as the belief that one’s thoughts are being controlled or manipulated by real or supernatural others
- Somatic delusion such as the belief that something is wrong with part or all of one’s body such as through infestation or infection
3. Disorganised Thinking and Speech
Disorganised thinking and speech (also known as Formal Thought Disorder) is when it becomes much harder for someone to hold a conversation that others can follow, in speech or writing.
While delusions refer to the content of thoughts, formal thought disorder refers to the organisation and the expression of thoughts (not the thoughts themselves).
Formal thought disorder can include:
- Racing thoughts - thoughts moving very fast
- Flight of ideas - where one moves rapidly from one idea to the next to the point that others cannot see the connections between each thought or topic
- Tangentiality - difficulty maintaining a topic or coming to a point
- Incoherence - speaking in a way that does not make sense to others
- Thought blocking - such as having complete mind blanks mid sentence
- Clanging - choosing words based on their sound, such as rhyming, rather than their meaning, so that speech doesn’t make sense to others
- Alogia - speaking much less than usual
- Echolalia - repeating noises and words
What Causes Psychosis?
The exact cause of psychosis is not yet fully understood, but it is thought to involve a combination of genetic, biological, and environmental factors. Some contributing factors include:
- Genetics - people with a family history of psychosis are considerably more likely to experience it
- Brain chemistry - changes in how certain brain chemicals work may play a part
- Substance use - certain drugs such as marijuana, LSD, and amphetamines can trigger psychosis in some people
- Stress and trauma - severe stress or traumatic events can make psychosis more likely
- Physical health - certain medical conditions such as brain tumours, infections, or autoimmune disorders can cause psychosis
Psychosis Assessment and Diagnosis
Assessing psychosis involves a comprehensive assessment by a mental health professional, which may include:
- Clinical interview - gathering information about the person's experiences, medical history, family history, and substance use
- Mental status examination - assessing the person's appearance, behaviour, speech, thought processes, and mood
- Neuropsychological testing - evaluating cognitive functioning, such as memory, attention, and problem-solving skills
- Medical tests - ruling out any underlying medical conditions that may be causing the psychosis (such as mercury poisoning)
Support and Treatment Options for Psychosis
Support for psychosis usually involves a combination of medication, therapy, and psychosocial support. Common options include:
- Antipsychotic medication - psychiatrists usually recommend antipsychotic medication, and it helps many people. These medications can reduce the intensity of psychotic experiences by acting on chemical messengers in the brain
- Psychotherapy - supportive therapy and Cognitive Behavioural Therapy (CBT) can help people cope with psychosis and its impact on their life
- Psychosocial support such as supported employment, social skills training, and assertive community treatment
- Hospital care - in some cases, a hospital stay may be needed to keep the person safe and provide more intensive treatment
Tips for Looking After Yourself
- Reach out for professional support - getting help early can make a big difference. If you or someone you love is experiencing psychosis, contact a mental health professional as soon as possible
- Stay connected with your care team - work out a plan together, including how you take medication and attend therapy sessions
- Build a support network - connect with family, friends, and support groups to share experiences and receive encouragement
- Look after your body - move in ways you enjoy, eat regularly and enough, and keep a consistent sleep routine to support your overall wellbeing
- Avoid alcohol and other drugs - they can make psychosis worse or interfere with medication
