How Long Can Psychosis Last With And Without Treatment?

Psychosis can be a distressing and frightening mental state, often involving highly disordered behavior, speech, and thinking. If someone you know is experiencing a psychotic episode, you may be greatly concerned for them and eager for their symptoms to go away. How long does a psychotic episode typically last, and what effect could medication and therapy have?

The duration of acute psychosis can be highly variable. In some people, psychosis may last for only a few days, while others may experience severe symptoms for six months or longer. However, antipsychotic medication is often effective at suppressing psychotic symptoms and may be able to end a psychotic episode much sooner. Treating a psychotic disorder early on with both doctor-prescribed medication and therapy may significantly improve the prognosis.

Psychotic disorders vs. psychotic episodes

Psychosis generally refers to a constellation of symptoms that can appear in a variety of psychiatric conditions. These symptoms may occur together or separately, but they usually involve difficulties with “reality testing,” meaning the ability to correctly determine what is real. The characteristic symptoms of psychosis include the following:

• Hallucinations: Perceptions of stimuli that aren’t real, such as hearing disembodied voices or seeing nonexistent creatures
• Delusions: Strongly held beliefs that don’t match the observable evidence of reality, such as thinking that you’re being secretly filmed for a television show and all of the people in your life are actors
• Disorganized speech: Illogical or incoherent patterns of speech, such as frequently going on tangents and not being able to follow a single train of conversation
• Disorganized behavior: Actions that don’t make sense or have no explainable purpose
• Negative symptoms: Decreased functioning, such as a lack of motivation, desire, pleasure, speech, or emotional responsiveness

When a person experiences psychosis, they often have little or no awareness that they’re ill or that their thoughts, perceptions, and beliefs are unlikely to be accurate. This phenomenon is usually known as lack of insight or anosognosia and can be a significant obstacle to recovery.

Some kinds of mental illness, known as psychotic disorders, tend to be defined primarily by the presence of psychotic symptoms. Examples can include schizophrenia, delusional disorder, and schizoaffective disorder, among others. However, psychosis can occur even in the absence of these mental health conditions, and having a psychotic disorder doesn’t necessarily mean that a person continually experiences psychotic symptoms. 

Instead, psychosis often follows a recurring pattern in which an individual experiences periods of frequent positive psychotic symptoms (hallucinations, delusions, and disorganized thinking and speech) interspersed with stretches during which they have a relatively strong grasp on what’s real. This intensely symptomatic period is usually known as a psychotic episode or an acute phase of a psychotic disorder.

How long can psychotic episodes last?

Some psychotic episodes may be triggered by particular kinds of stress, disease, or the effects of psychoactive substances. In these cases, the length of psychosis may be tied to the inciting circumstances. Examples can include those discussed below:

• Affective psychosis: Psychotic symptoms can occur as part of a mood disorder, such as major depressive disorder or bipolar disorder. In this case, the individual may experience delusions or hallucinations mainly during strong manic or depressive phases, with psychosis going away when their mood stabilizes. 
• Substance-induced psychosis: Psychosis may be triggered by recreational substances or prescription medications ranging from amphetamines to corticosteroids. The symptoms typically go away after the person discontinues the use of the substance in question, though individuals with a genetic susceptibility may trigger chronic conditions like schizophrenia.
• Disease-induced psychosis: Sometimes, psychotic symptoms can result from non-psychiatric illnesses, such as meningitis or dengue fever. Treatment of the disease may relieve the symptoms. Chronic neurodegenerative conditions like Alzheimer’s disease or Parkinson’s disease can also cause psychosis, which may persist until treated with antipsychotics. 
• Postpartum psychosis: Psychotic episodes may occur following the stress and hormonal changes accompanying childbirth, a condition called postpartum psychosis. This condition may fade away naturally as the mother’s body returns to equilibrium in the following weeks and months, though treatment is still recommended due to the risk of harm to the mother and child.

How quickly can treatment relieve psychosis?

While the length of untreated psychosis can vary based on many factors, effective pharmacological treatment may significantly shorten the symptomatic period. Clinical evidence indicates that the effects of antipsychotic medications may be felt within one week after treatment begins, with a typical timeframe of four weeks to achieve maximum effect. Psychotic symptoms are often significantly attenuated within one to two months.

That said, results may differ considerably between individuals. Some people may have treatment-resistant psychosis, meaning they don’t respond well to two or more of the first-line medications. Even among people who do achieve relief with medication, the timeline can be quite variable.

How long can the psychosis prodrome last?

Before entering the acute phase of psychosis, many people experience an extended period of preliminary symptoms known as the prodromal phase. During this time, they may have mild psychotic experiences, such as hearing faint or indistinct voices, or having unusual ideas that don’t rise to the level of acute psychosis. 

The prodromal stage can also involve mental health concerns not specific to psychosis, such as the following:

• Decreased emotionality
• Depressive symptoms, such as lack of enjoyment (anhedonia)
• Social withdrawal
• Loss of motivation and interest in activities
• Paranoia and suspicion
• Diminished attention to personal grooming and hygiene
• Sleep disturbances
• Difficulties with logical thinking
• Decline in performance at work or school

In most cases, the psychosis prodrome lasts between one and five years. Research suggests that the average duration is approximately 21.6 months. 

Not all psychotic episodes involve a prodromal stage. The sudden appearance of psychotic symptoms with few warning signs may suggest that psychosis is caused by other factors, such as disease or substance use. Rapidly arising psychotic symptoms can also be a common characteristic of the mental health disorder known as acute and transient psychotic disorder. 

How long do psychotic disorders last? 

Even after a particular psychotic episode subsides, an individual with a psychotic disorder may face ongoing mental health difficulties. For example, people with schizophrenia whose hallucinations and delusions are in remission often continue to experience cognitive impairment or negative symptoms, including those listed below:

• Diminished desire or motivation to pursue meaningful activities
• Lack of enjoyment or pleasure in life
• Blunted emotional responses
• Limited speech and vocabulary
• Slower mental processing skills
• Decreased attention span
• Reduced working memory capacity

Other types of psychotic illness may be fully or mostly asymptomatic during periods of remission. However, people with these conditions may still need to receive ongoing treatment to avoid relapses.

Certain forms of psychosis may have a limited duration. Schizophreniform disorder can serve as one example, lasting between one and six months by definition. Others, like schizophrenia and delusional disorder, are typically considered chronic conditions requiring lifelong treatment and management.

How the duration of psychosis affects illness outcomes

There’s some evidence that the length of time a person remains in a psychotic state without receiving treatment may affect the long-term severity of their illness. A 2021 systematic review concluded that individuals who had a longer duration of untreated psychosis (DUP) usually had more severe symptoms and were less likely to achieve remission.

These outcomes may be due to the potentially damaging effects of psychosis on the brain. They might also result from the psychosocial impacts of prolonged psychotic episodes, such as homelessness, loneliness, fear, and negative interactions with the criminal justice system. 

Identifying and treating psychotic disorders early on may have a significant impact on their prognosis. Some studies suggest that early intervention programs that reach people within the first few years of their illnesses may lead to improved treatment responses and better long-term function. 

Managing mental health after psychosis

Individuals who have experienced a psychotic episode may be less likely to relapse and better able to navigate daily life with a combination of the following treatments:

• Family psychoeducation and therapy
• Monitoring and crisis plans for relapse
• Cognitive behavioral therapy (CBT)

Get professional support to help limit and prevent psychosis

Talk to a licensed therapist online

Both the symptoms and the psychosocial effects of psychosis can cause challenges in attending therapy regularly. Using an online therapy platform can make this easier since the online format typically eliminates the need to commute to appointments and may allow for greater flexibility in scheduling.

Although in-person care may be necessary for acute psychosis, internet-delivered therapy has been found useful for people with psychotic disorders in various clinical trials, For example, a 2017 paper reported that an online CBT program usually decreased the severity of auditory hallucinations, enhanced social function, and increased participants’ knowledge of psychological coping skills for psychosis.