Table of Contents

Understanding Psychosis: Symptoms, Causes, Types, and Treatment

psychosis

Clinically Reviewed by: Dr. Robin Campbell, LMFT, PHD

What is Psychosis?

Psychosis is a complex mental illness that significantly impacts a person’s thoughts and perceptions, leading to a disconnection from reality. Commonly manifested through psychosis symptoms such as auditory hallucinations and grandiose delusions, psychosis can severely disrupt daily life. This condition often emerges in young adults and can be precipitated by factors ranging from traumatic brain injuries and sexual assault to substance use disorders and traumatic events. Understanding the early warning signs of psychosis, particularly in the context of first episode psychosis, is crucial. This blog will explore what psychosis refers to, delve into the mechanisms by which psychosis develops, and highlight the importance of early treatment to manage psychosis effectively.

What is Psychosis?

Psychosis is a mental health condition characterized by a disconnection from reality. This can manifest in several ways, including:

  1. Hallucinations: Experiencing sensory perceptions that aren’t real, such as hearing voices or seeing things that others don’t.
  2. Delusions: Holding strong beliefs that are clearly contradicted by reality or rational argument, such as believing one has extraordinary powers or is under constant surveillance.
  3. Disorganized Thinking: Exhibiting thoughts that are fragmented or disconnected, making speech or reasoning difficult to follow.
  4. Altered Perception: Having a distorted understanding of what’s happening around oneself, which can affect interactions and behavior.

 

Psychosis can occur as part of various psychiatric disorders, like schizophrenia, bipolar disorder, or as a result of substance abuse or certain medical conditions. Treatment typically involves medication, psychotherapy, and support services, aimed at managing symptoms and improving quality of life.

 

Types of Psychosis

Psychosis can manifest in various forms, categorized broadly into several types based on the underlying cause or the condition they are associated with. Here’s a summary of the primary types of psychosis:

  1. Primary Psychotic Disorders:
    • Schizophrenia: Characterized by persistent symptoms like hallucinations, delusions, and disorganized thinking.
    • Schizoaffective Disorder: Features symptoms of schizophrenia along with mood disorder symptoms, such as depression or mania.
  2. Mood Disorder-Related Psychosis:
    • Bipolar Disorder with Psychotic Features: Occurs during extreme episodes of mania or depression where the individual might experience delusions or hallucinations.
    • Major Depressive Disorder with Psychotic Features: Psychosis occurs in conjunction with severe depressive episodes.
  3. Substance-Induced Psychosis:
    • Triggered by the use of or withdrawal from substances, including alcohol, drugs, and medications.
  4. Psychotic Disorders Due to a Medical Condition:
    • Caused by physical illnesses or brain injuries, such as brain tumors, HIV/AIDS, or Alzheimer’s disease.
  5. Brief Psychotic Disorder:
    • A short-term type of psychosis that can occur in response to extreme stress, and usually resolves within a month.
  6. Delusional Disorder:
    • Characterized by persistent delusions that are not accompanied by the full spectrum of psychotic symptoms typical of schizophrenia.

 

Each type of psychosis is distinct in its manifestations and the approach to treatment, which can involve a combination of medication, therapy, and support mechanisms tailored to the individual’s specific condition and symptoms.

 

What are the Causes of Psychosis?

The causes of psychosis are diverse and often involve a combination of genetic, biological, environmental, and psychological factors. Here are some of the key contributors:

  1. Genetic Factors: There’s a hereditary component to many psychotic disorders. Individuals with a family history of schizophrenia or bipolar disorder, for example, are at a higher risk.
  2. Brain Chemistry and Structure: Imbalances in neurotransmitters like dopamine and serotonin are often linked to psychosis. Abnormalities in brain structure, such as reduced gray matter, can also be associated with psychotic disorders.
  3. Substance Use: Alcohol, drugs (like marijuana, LSD, amphetamines), and certain medications can trigger psychosis, especially in individuals with a predisposition.
  4. Stress: Significant life stresses—such as trauma, abuse, or emotional loss—can trigger a psychotic episode, particularly in those who are vulnerable due to genetic or environmental factors.
  5. Physical Illnesses and Conditions: Various medical conditions can lead to psychosis, including neurological disorders like Parkinson’s disease, brain tumors, some forms of epilepsy, stroke, and even certain infectious diseases like HIV or syphilis.
  6. Psychiatric Disorders: Conditions such as schizophrenia, bipolar disorder, and severe depression are commonly associated with episodes of psychosis.
  7. Sleep Deprivation: Extreme lack of sleep can precipitate psychotic symptoms in some individuals.

 

Understanding the specific causes of an individual’s psychosis is crucial in tailoring treatment and management strategies to help mitigate symptoms and improve quality of life.

 

What are the Signs and Symptoms of Psychosis?

The signs and symptoms of psychosis involve a range of mental disruptions that affect thoughts, perceptions, and behaviors. Key symptoms include:

  1. Hallucinations: Experiencing sensations that are not real, such as hearing voices, seeing things, or feeling sensations that have no external source.
  2. Delusions: Strongly held false beliefs that are not influenced by logic or reality, such as believing one has extraordinary power, is being persecuted, or is under surveillance.
  3. Disorganized Thinking: Thoughts may be jumbled or illogical, making speech difficult to follow; sometimes speech may be garbled or nonsensical.
  4. Disorganized or Abnormal Motor Behavior: This can range from childlike silliness to unpredictable agitation. Behavior is not focused on a goal, so it’s hard to do tasks.
  5. Negative Symptoms: These include reduced ability or lack of ability to function normally. For example, a person may neglect personal hygiene or appear to lack emotion (doesn’t make eye contact, doesn’t change facial expressions, or speaks in a monotone).
  6. Cognitive Symptoms: These include problems with attention, memory, and the ability to plan and make decisions.

 

Effects of Psychosis

Psychosis can have profound effects on a person’s life, impacting various aspects of daily functioning, relationships, and overall well-being. Here are some of the key effects:

  1. Personal and Social Relationships: Symptoms like delusions and hallucinations can strain relationships with family and friends. Individuals might withdraw socially, mistrust others, or react inappropriately to social cues.
  2. Employment and Education: Cognitive impairments and unpredictable behaviors can make maintaining employment or academic achievements difficult. This often leads to financial problems and decreased life opportunities.
  3. Daily Functioning and Independence: Basic daily activities, such as personal hygiene, cooking, and managing finances, can become challenging. This may lead to increased dependency on others.
  4. Mental Health: People with psychosis are at a higher risk for co-occurring mental health disorders, such as depression, anxiety disorders, and substance abuse. These conditions can further complicate treatment and recovery.
  5. Physical Health: There is a higher prevalence of physical health issues among people with psychosis, such as cardiovascular disease, diabetes, and obesity, often due to a combination of lifestyle factors and medication side effects.
  6. Increased Risk of Harm: Psychosis can increase the risk of self-harm or harm to others, particularly if delusions or hallucinations are threatening or command in nature.
  7. Legal and Societal Issues: Behavioral issues stemming from psychosis can lead to encounters with the criminal justice system. Stigma and misunderstanding about psychotic disorders can lead to social isolation and discrimination.

 

Prevalence of Psychosis

The prevalence of psychosis varies depending on the specific psychotic disorder and the population being studied. Here’s a summary of the prevalence rates for some of the more common forms of psychosis:

  1. Schizophrenia: Typically affects about 0.3% to 0.7% of the population. It is one of the most well-known psychotic disorders, characterized by chronic symptoms that can impact all areas of life.
  2. Schizoaffective Disorder: Less common than schizophrenia, affecting about 0.3% of the population. This disorder combines symptoms of schizophrenia with mood disorder symptoms, such as depression or bipolar disorder.
  3. Brief Psychotic Disorder: Relatively rare, this condition is usually triggered by extreme stress and affects about 0.2% of people. It tends to resolve quickly with treatment.
  4. Delusional Disorder: Also relatively rare, with an estimated prevalence of about 0.2%. It involves persistent delusions without the other hallmark symptoms of schizophrenia like hallucinations.
  5. Bipolar Disorder with Psychotic Features: Bipolar disorder affects about 2.8% of the U.S. population, but not all sufferers experience psychosis. Those who do typically have more severe symptoms during mood episodes.
  6. Major Depressive Disorder with Psychotic Features: Depression is common, affecting about 7% of adults, but psychotic features occur in a smaller subset of those individuals, particularly in severe cases of depression.
  7. Substance-Induced Psychosis: The prevalence varies widely based on the substance used and the vulnerability of the population. Psychosis can occur acutely during intoxication or withdrawal, especially with alcohol, cannabis, hallucinogens, and stimulants.

 

Understanding the prevalence of different types of psychosis can aid in early detection and the allocation of mental health resources. These disorders can profoundly impact individuals’ lives, making awareness and appropriate treatment critical.

 

How is Psychosis Diagnosed?

Diagnosing psychosis typically involves a comprehensive assessment conducted by mental health professionals. Here’s a brief overview of the diagnostic process:

  1. Clinical Interview: The process starts with a detailed interview where the clinician gathers information about the person’s symptoms, medical history, and personal and family history of mental health issues.
  2. Medical Examination: To rule out physical illnesses that could cause psychotic symptoms, a physical examination and possibly lab tests or brain imaging studies (like MRI or CT scans) are performed.
  3. Psychiatric Evaluation: A psychiatrist will assess mental health status through observations and specific questions. This helps determine if symptoms like delusions or hallucinations are present and assesses their impact on functioning.
  4. Use of Diagnostic Criteria: Clinicians use established criteria from diagnostic manuals such as the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) or the ICD-10 (International Classification of Diseases) to determine the specific type of psychotic disorder.
  5. Psychological Testing: In some cases, structured psychological tests may be used to provide further insights into a person’s mental state and help differentiate between different types of mental health disorders.

 

Is Psychosis Hereditary?

Yes, psychosis can be hereditary. Genetic factors play a significant role in many psychotic disorders, including schizophrenia and bipolar disorder. Having a family member with a psychotic disorder increases the likelihood of developing similar conditions, though it is not a guarantee. Environmental factors, personal experiences, and other biological factors also contribute to the development of psychosis, interacting with genetic predispositions.

 

Can Psychosis Be Prevented?

Preventing psychosis is challenging, especially since it can be caused by a variety of genetic, biological, and environmental factors. However, there are strategies that can reduce the risk or delay the onset of psychotic episodes, particularly in individuals at high risk:

  1. Early Intervention: Identifying and treating early symptoms or prodromal signs can significantly affect outcomes. Programs specialized in early intervention for psychosis can help manage symptoms before they fully develop.
  2. Reducing Risk Factors: Minimizing substance abuse (including alcohol and recreational drugs), managing stress effectively, and ensuring good physical health can help reduce the risk of developing psychosis.
  3. Family Therapy and Support: For those at high risk, family therapy can provide support and education to family members, improving the overall environment around the individual.
  4. Cognitive Behavioral Therapy (CBT): For individuals at high risk or those showing early signs of psychosis, CBT can help address problematic thoughts and behaviors, potentially preventing the progression to full-blown psychosis.
  5. Healthy Lifestyle: Regular physical activity, a balanced diet, and adequate sleep are important for mental health and can help mitigate factors that contribute to the development of psychosis.

 

Is Psychosis Curable?

Psychosis itself is not typically considered “curable” in the traditional sense, but it can often be effectively managed and treated. Many people with psychotic disorders can achieve significant improvement or even remission of symptoms through a combination of treatments. These treatments include medication (usually antipsychotics), psychotherapy, and support programs tailored to individual needs. The goal is to manage symptoms, improve quality of life, and prevent relapses, rather than to cure the disorder completely. Early diagnosis and ongoing, comprehensive treatment are crucial for optimal outcomes.

 

What are the Risk Factors of Psychosis?

Several risk factors can increase the likelihood of developing psychosis, including:

  1. Genetic Factors: A family history of psychotic disorders like schizophrenia or bipolar disorder significantly raises the risk.
  2. Substance Use: Abuse of substances such as cannabis, hallucinogens, stimulants, and even alcohol can trigger psychotic episodes.
  3. Brain Chemistry and Structure: Abnormalities in brain structure or neurotransmitter systems, particularly those involving dopamine, are linked to psychosis.
  4. Stressful Life Events: Major stress or traumatic events, such as the death of a loved one, abuse, or other significant life changes, can precipitate psychotic episodes.
  5. Early Developmental Problems: Complications during pregnancy or birth, early developmental delays, and early childhood trauma are potential risk factors.
  6. Age: The initial onset of psychotic disorders commonly occurs in late adolescence to early adulthood, although it can start at any age.

 

Understanding these risks, anyone can help in early detection and intervention, potentially mitigating the severity or delaying the onset of psychotic symptoms.

 

How Do You Help a Loved One with Psychosis?

Helping a loved one with psychosis involves a combination of support, understanding, and action. Here are some steps to consider:

  1. Educate Yourself: Learn about psychosis and its symptoms to better understand what your loved one is experiencing.
  2. Encourage Treatment: Gently encourage them to seek professional help from mental health professionals. Offer to help them find a healthcare provider or to accompany them to appointments.
  3. Be Supportive: Listen to their experiences and feelings without judgment. Offer reassurance and understanding, emphasizing that you care about them and are there to help.
  4. Manage Emergencies: In cases where they might be a danger to themselves or others, it may be necessary to seek emergency assistance.
  5. Establish a Routine: Help them establish a simple, structured daily routine that can provide a sense of normalcy.
  6. Promote Healthy Habits: Encourage physical activity, good nutrition, and sufficient sleep, all of which can help manage symptoms.
  7. Be Patient: Recovery can be a slow process with ups and downs. Patience and persistent support are crucial.

 

Supporting someone with psychosis requires compassion, resilience, and a proactive approach to ensure they receive the necessary care and treatment.

 

Treatment Options

Treatment for psychosis typically involves a multi-faceted approach tailored to the individual’s specific symptoms and needs. Here are some common treatment options:

  1. Medication: Antipsychotic medications are the cornerstone of treatment for psychotic disorders. They help reduce the severity of symptoms like hallucinations and delusions and can prevent relapses.
  2. Psychotherapy:
    • Cognitive Behavioral Therapy (CBT): Helps patients recognize and change harmful thought patterns and behaviors.
    • Family Therapy: Provides support and education for family members, helping them to better understand and support their loved one.
    • Supportive Therapy: Offers a supportive environment to discuss problems and learn coping strategies.
  3. Psychosocial Treatments:
    • Assertive Community Treatment (ACT): Intensive, team-based treatment for people with severe symptoms who require more than typical outpatient care.
    • Social Skills Training: Focuses on improving communication and social interactions.
    • Supported Employment and Education: Helps individuals in maintaining or returning to work or school.
  4. Hospitalization: May be necessary during acute episodes when a person might be at risk of harming themselves or others. Hospitalization provides a safe environment for stabilization and intensive treatment.
  5. Lifestyle and Integrative Interventions:
    • Physical Activity: Regular exercise can help reduce symptoms and improve overall mental health.
    • Nutrition and Diet: Some evidence suggests that omega-3 fatty acids and reductions in sugar and fat might be beneficial.
    • Mindfulness and Meditation: Can help manage stress and improve mental state.

Early intervention and a tailored treatment plan are crucial for effectively managing psychosis and improving outcomes. Regular monitoring and adjustments to the treatment plan help address the changing needs of the individual over time.

 

Common Medications for Psychosis

Common medications used to treat psychosis are primarily antipsychotics, which help manage symptoms like hallucinations, delusions, and disorganized thinking. These are categorized into two main groups:

  1. Typical Antipsychotics (First-Generation):
    • Haloperidol (Haldol)
    • Chlorpromazine (Thorazine)
    • Perphenazine (Trilafon)
    • These medications are effective at controlling positive symptoms but can have significant side effects, such as movement disorders (tardive dyskinesia).
  2. Atypical Antipsychotics (Second-Generation):
    • Risperidone (Risperdal)
    • Olanzapine (Zyprexa)
    • Quetiapine (Seroquel)
    • Aripiprazole (Abilify)
    • Clozapine (Clozaril) – particularly effective for treatment-resistant schizophrenia.
    • These are preferred for their lower risk of certain side effects and are effective at managing both positive and negative symptoms.

 

The choice of medication often depends on the specific symptoms, potential side effects, and the individual’s response to previous treatments. Regular follow-up and adjustments are crucial to manage effectiveness and minimize side effects.

 

Dosage Guidelines

Dosage guidelines for antipsychotic medications vary depending on the specific drug, the condition being treated, the severity of symptoms, and individual factors like age, health status, and response to treatment. Here’s a general overview for some common antipsychotics:

  1. Haloperidol (Haldol):
    • Typical starting dose: 0.5-5 mg per day.
    • Maintenance dose: 5-20 mg per day.
    • Doses can be adjusted based on response and side effects.
  2. Risperidone (Risperdal):
    • Initial dose: 1-2 mg per day.
    • Maintenance dose: 2-8 mg per day.
    • Dose adjustments should consider efficacy and tolerance.
  3. Olanzapine (Zyprexa):
    • Typical starting dose: 5-10 mg per day.
    • Maintenance dose: 10-20 mg per day.
    • Adjustments are based on clinical response and side effects.
  4. Quetiapine (Seroquel):
    • Starting dose: 25-50 mg per day.
    • Maintenance dose: 300-800 mg per day.
    • Gradual increases are recommended to minimize side effects.
  5. Aripiprazole (Abilify):
    • Initial dose: 10-15 mg per day.
    • Maintenance dose: 10-30 mg per day.
    • Adjust based on response and tolerability.
  6. Clozapine (Clozaril):
    • Starting dose: 12.5-25 mg per day.
    • Maintenance dose: 300-600 mg per day.
    • Requires close monitoring due to the risk of serious side effects.

 

Does Insurance Cover Psychosis Treatment?

In the United States, the Mental Health Parity and Addiction Equity Act requires most insurers to cover mental health conditions, including psychosis, at levels comparable to medical/surgical coverage. This applies to most types of health insurance, including private plans, Medicaid, and Medicare. However, the extent of coverage can vary by insurance plan regarding the types of services covered, the duration of coverage, co-pays, and choice of healthcare providers.

Outside the United States, health care systems often cover mental health services, including those for psychosis, but the specifics can vary widely. Some countries have universal health care systems that cover a wide range of treatments with minimal out-of-pocket costs, while in others, private insurance or out-of-pocket payments might be necessary for more comprehensive coverage.

 

Common Insurance Plans for Mental Health Treatment

  1. Employer-Provided Health Insurance: Many employers offer group health insurance plans that include mental health benefits. These plans are subject to federal laws like the Mental Health Parity and Addiction Equity Act, which require mental health services to be covered at least on par with medical and surgical services.
  2. Medicaid: This state and federally funded program provides health coverage to eligible low-income individuals and families. Medicaid is required to cover essential health benefits, including mental health and substance use disorder services.
  3. Medicare: Primarily for people age 65 and older, Medicare also covers individuals with certain disabilities. Medicare Part A covers hospital stays, which can include inpatient mental health care, and Part B covers outpatient mental health services.
  4. Marketplace Insurance Plans: Available through the Health Insurance Marketplace established by the Affordable Care Act (ACA), these plans must cover mental health and substance use disorder services as essential health benefits.
  5. Medicare Advantage Plans (Part C): These are offered by private companies approved by Medicare and must provide at least the same level of benefit coverage as Medicare Parts A and B, but they often include additional benefits, including mental health services.
  6. TRICARE: This plan covers U.S. military personnel, retirees, and their families. TRICARE provides comprehensive mental health coverage, including outpatient, inpatient, and prescription medications.

 

Conclusion

Treating psychosis, especially when addressed during the early psychosis stage or immediately after the first episode of psychosis, can significantly improve outcomes. Antipsychotic drugs, coordinated specialty care from health care providers, and interventions like suicide prevention and self-care play pivotal roles in reducing psychosis symptoms. Furthermore, recognizing the early warning signs and securing treatment from a mental health professional can prevent the condition from escalating. Effective treatment plans, including antipsychotic medicine and therapy, are essential in helping those experiencing psychosis regain control over their lives. Ultimately, educated, and timely intervention remains key to managing this complex mental illness, ensuring those affected can lead fulfilling lives despite their challenges.

 

Seeking Treatment? We Can Help!

At New Hope Healthcare, as an in-network provider we work with most insurance plans, such as:

 

If you or a loved one are struggling with mental health challenges or substance abuse, reach out to New Hope Healthcare today. Our team of compassionate professionals is here to support your journey towards lasting well-being. Give us a call at 866-799-0806

psychosis

Frequently Asked Questions

Causes can include genetic factors, brain chemistry imbalances, severe stress, substance abuse, and certain medical conditions.

While psychosis often cannot be “cured,” many people can manage and significantly reduce their symptoms with the right treatment, which might include medication, therapy, and support.
Common symptoms include hallucinations (seeing or hearing things that are not present), delusions (strongly held false beliefs), disorganized thinking, and significant social withdrawal.
Treatments include antipsychotic medications, psychotherapy (like cognitive-behavioral therapy), and community support programs.
No, psychosis is a symptom that can be part of several different mental health conditions, including schizophrenia. Schizophrenia is a specific, chronic psychiatric disorder that includes psychosis but also other symptoms like negative symptoms and cognitive issues.

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