Psychosis is an abnormal condition of the mind that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations. Other symptoms may include incoherent speech and behavior that is inappropriate for the situation. There may also be sleep problems, social withdrawal, lack of motivation, and difficulties carrying out daily activities.
Psychosis is a condition that affects the way your brain processes information. It causes you to lose touch with reality. You might see, hear, or believe things that aren’t real. Psychosis is a symptom, not an illness. A mental or physical illness, substance abuse, or extreme stress or trauma can cause it.
Psychotic disorders, like schizophrenia, involve psychosis that usually affects you for the first time in the late teen years or early adulthood. Young people are especially likely to get it, but doctors don’t know why.
Even before what doctors call the first episode of psychosis (FEP), you may show slight changes in the way you act or think. This is called the prodromal period and could last days, weeks, months, or even years.
Sometimes you can lose touch with reality even when you don’t have a primary psychotic illness such as schizophrenia or bipolar disorder. When this happens, it’s called secondary psychosis.
These episodes stem from something else, like drug use or a medical condition. Whatever the reason, they tend to disappear in a short time, and they often stay away if you treat the condition that caused them.
Psychosis doesn’t suddenly start. It usually follows this pattern:
Warning signs before psychosis: It starts with gradual changes in the way you think about and understand the world. You or your family members may notice:
Signs of early psychosis: You may:
Symptoms of a psychotic episode: Usually you’ll notice all of the above plus:
Doctors don’t know exactly what causes psychosis, but some known risk factors include:
Psychosis can also be a symptom of a mental illness, like schizophrenia or bipolar disorder.
Both drugs that depress the nervous system, like cannabis (marijuana), and stimulant drugs, like cocaine and amphetamines, can affect your brain activity in dramatic ways, so that what seems real to you doesn’t match with the world.
Most of the time, this goes away when you stop use of the drug. But there’s a strong link between all these drugs and primary psychosis. More than 25% of those who are diagnosed with amphetamine-induced psychosis later have psychotic disorders. Cannabis is involved in roughly half of all cases.
Studies suggest that these drugs may not so much cause psychosis as uncover the condition when it’s already present among people with psychiatric conditions, such as schizophrenic disorders or a family history of psychosis.
Drugs used to treat mental illness can lead to problems as well. Although it’s rare, if you’ve been taking an antipsychotic (such as chlorpromazine, fluphenazine, haloperidol, perphenazine, and others) for many months or years, you could develop a movement disorder call tardive dyskinesia because of the long-term effects of the medication on your brain.
And if you stop taking an antipsychotic medicine, you may get supersensitivity psychosis. Doctors think it happens because ongoing use of this type of drug changes how your brain responds to the chemical dopamine.
Most drug-triggered symptoms will clear up after the drug leaves your system. But psychosis from cocaine, PCP (aka angel dust), and amphetamines could last for weeks. While you wait for the episode to pass, your doctor can ease the symptoms with an anti-anxiety drug such as lorazepam (Ativan) or maybe an antipsychotic.
Postictal psychosis (PIP) happens in some people with epilepsy who’ve had a number of seizures in a row. It’s more likely when you’ve had a seizure disorder for a long time or you’ve had mental illness in the past.
Antipsychotic drugs like olanzapine and risperidone can stop symptoms and may help prevent future episodes.
Myxedematous psychosis may happen when your thyroid gland doesn’t work well, known as hypothyroidism. Because of the way thyroid hormone affects your brain, you may have hallucinations, delusions, and changes to your sense of taste or smell if there’s not enough in your body. Your doctor can test your level of thyroid-stimulating hormone (TSH) to confirm myxedema psychosis and rule out other conditions like schizophrenia.
Taking thyroid hormone can help balance your gland’s activity and end the psychosis.
Although it’s extremely rare, some women have menstrual psychosis. Out-of-balance hormones at different points in your cycle can affect thinking and moods. This type of psychosis can appear at the beginning, around ovulation, or during the few days before your period starts.
Menstrual psychosis can show up quickly and can disappear just as fast. During the episodes, you may be confused about what’s real, hallucinate, and believe things that aren’t true.
Cognitive behavioral therapy (CBT) and antipsychotic drugs can help ward off your symptoms, even with hormone levels that are hard to predict.
You can see a psychologist, psychiatrist, or a social worker. They’ll find out what might have caused your symptoms and look for related conditions. Doctors diagnose mental illnesses after ruling out other things that could be causing psychotic symptoms.
It’s important to get treated early, after the first episode of psychosis. That will help keep the symptoms from affecting your relationships, work, or school. It may also help you avoid more problems down the road.
Your doctor may recommend coordinated specialty care (CSC). This is a team approach to treating schizophrenia when the first symptoms appear. It combines medicine and therapy with social services and work and education support. The family is involved as much as possible.
What your doctor recommends will depend on the cause of your psychosis.
Your doctor will prescribe antipsychotic drugs — in pills, liquids, or shots — to ease your symptoms. They’ll also suggest you avoid using drugs and alcohol.
You might need to get treated in a hospital if you’re at risk of harming yourself or others, or if you can’t control your behavior or do your daily activities. The doctor will check your symptoms, look for causes, and suggest the best treatment for you.
Counseling, along with medicines, can also help manage psychosis.