Psychosis is a psychological condition in which a person loses touch with reality. Psychosis isn’t an illness of its own; rather, it’s a syndrome made of symptoms of an underlying disorder. The symptoms of psychosis and the conditions causing it both require treatment.
Psychosis isn’t uncommon. About 3 percent of all Americans will experience at least one psychotic episode in their lifetimes. An episode of psychosis can be caused by a medical disorder, mental illness, drug abuse, or toxic chemicals. Psychosis can be acute, a single event, or can be chronic, coming and going for years. Psychosis is always a serious condition that disrupts a person’s ability to live a satisfying life.
These are some of the most common early warning signs that psychosis is developing.
- You’re sure you’re being spied on or followed.
- You think there might be a conspiracy to harm you.
- Your thoughts seem disjointed and it’s harder to form a clear thought.
- Your daily, familiar environment feels threatening or strange.
- You’ve felt like your thoughts were not your own, or that your thoughts were being controlled.
- You’ve been going off-topic and rambling to an unusual degree when trying to speak with others.
- You hear distant hissing, clapping, or whispering that’s not due to your environment or a disorder like tinnitus.
- You’re hearing voices or seeing things you can’t be sure are real.
- You question whether or not you’re real.
- You feel unusually mistrustful of people you normally feel comfortable with.
Some of the early warning signs of psychosis are the same as those of other psychological disorders. People experiencing psychosis for the first time usually know something’s wrong, but many won’t seek help for fear of being stigmatized or judged.
First-episode psychosis, also called early psychosis, is a person’s first episode of feeling disconnected, or losing touch with reality. Some of the early warning signs of psychosis include:
- Withdrawal from family and friends
- An unusual drop in grades or work performance
- Marked decline in personal hygiene
- Withdrawal from others, unusual self-isolating behavior
- Seeing or hearing things that aren’t real (hallucinations)
- Strong belief in bizarre things that are untrue (a belief the individual is being watched or spied on is common)
- Increased paranoia, fear that others mean to harm them
- Strong, inappropriate emotions or having no feelings at all
The hallmark symptoms of psychosis are hallucinations and delusions. Hallucinations involve hearing, feeling, or seeing things that aren’t present. These hallucinations are usually negative; that is, they seem harmful, hurtful, or dangerous.
- Auditory hallucinations often involve hearing voices. These “voices” may denigrate or insult the person, or even give the person instructions to carry out actions.
- Visual hallucinations may look extremely detailed and fully formed or might only look like colored dots or spheres.
Delusions are powerfully held beliefs or ideas that are patently false and irrational. A person suffering from a delusion will insist that it is true even when presented with overwhelming evidence that it is not. Common delusions in psychosis are:
- Paranoid or persecutory. A person believes others are planning to harm them, plotting against them, or conspiring against them. Delusions of betrayal by a loved one are also common.
- Thought control. The individual believes an outside entity is controlling their thoughts, even their behaviors, or that others can hear their thoughts.
- Grandiosity. Delusions of grandeur involve a person thinking they’re uniquely chosen for a mission, supremely unique, on a mission from God, or even believing they are god themselves.
Psychosis deeply affects the way a person interprets information from the environment. In time, it distorts our internal narratives, which are the stories we tell ourselves that helps us frame the world and our place in it.
Causes of Psychosis
Psychosis is sometimes a part of disorders like depression and bipolar disorder. Extreme trauma can also lead to psychosis, which is common to a class of psychological disorders, fittingly called the psychotic disorders.
Exposure to toxic chemicals can lead to psychosis, as can drug abuse, but psychosis is most commonly found in schizophrenia and related disorders. In fact, psychosis is a distinguishing feature of schizophrenia.
Treatment of Psychosis
The acute phase of psychosis must be treated first. A person can’t get any benefit from other modes of treatment when they are actively psychotic. Medication therapy is ideal for stabilizing acute psychosis.
Over the last twenty years many new antipsychotics have been developed that are more effective and have fewer side-effects than the antipsychotics of the 20th century. These include:
- Vraylar (cariprazine)
- Latuda (lurasidone)
- Risperdal (risperidone)
- Zyprexa (olanzapine)
- Seroquel (quetiapine)
- Invega (2009)
Treating psychosis as close to its onset as possible is the best approach to recovery. As is the case for many psychological disorders, a combination of medication and psychotherapy is the most effective treatment approach that produces long-term remission of psychosis.
Psychotherapy for Psychosis
Cognitive Behavioral Therapy (CBT) is a useful type of therapy that examines how a person’s thoughts and feelings about situations molds our reactions and behaviors. A form of CBT, CBT for psychosis (CBTp) has been developed to help people de-escalate the fear and anxiety that comes from hallucinations.
The goal of CBTp isn’t to teach a person how to determine what’s real or not—after all, if a person were able to determine that, they wouldn’t be psychotic. CBTp helps people identify hallucinations as part of their disorder and not something to be acted on or feared.
An Effective Depression Treatment: TMS Therapy
Newer and highly effective treatments for psychological disorders are becoming available. One such treatment for depression and depression related anxiety is TMS Therapy, also known as, Transcranial Magnetic Stimulation (TMS). This form of treatment uses magnetic fields to precisely stimulate areas of the brain that are responsible for a person’s mood. TMS is FDA-approved for the treatment of Major Depression Disorder, produces no systemic side effects and is a medication-free treatment. TMS is eligible for coverage by most major health insurers, such as Medicare and Tri-Care.
This blog post is meant to be educational in nature and does not replace the advice of a medical professional. See full disclaimer.
Loewy, Rachel L., et al. (2011). Psychosis risk screening with the Prodromal Questionnaire—Brief Version (PQ-B). Schizophrenia research 12(1) pp. 42-46.
Miller, C. (2019, September 30). How does cbt help people with psychosis? Retrieved July 25, 2021, from https://childmind.org/article/cbt-help-people-psychosis/
The National Alliance on Mental Health: Psychosis. (2021, July 14). Retrieved July 14, 2021, from https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Psychosis
World Health Organization: Schizophrenia. (2019, October 4). Retrieved July 24, 2021, from https://www.who.int/news-room/fact-sheets/detail/schizophrenia