How To Identify And Treat A State Of Psychosis

Psychosis is a set of symptoms associated with loss of contact with reality. The hallmark symptoms of psychosis include hallucinations and delusions, but some people will experience behavioral changes before developing psychosis symptoms. In this article we'll explore the early signs and symptoms of a psychotic episode as well as how a psychotic episode is treated.

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What are psychotic states and psychotic symptoms?

Psychosis usually refers to a group of symptoms that often appear together and interfere with an affected individual’s ability to correctly perceive, think about, and understand reality. In many cases, these symptoms are signs of chronic psychotic disorders like schizophrenia, though they can also appear in other circumstances. 

Psychosis symptoms are often divided into “positive” and “negative” categories. Positive symptoms generally involve the emergence of behavior, thoughts, or perceptions that would not normally be present in healthy people. Negative symptoms typically involve the loss or weakening of capabilities that healthy people generally possess.

Positive symptoms of psychosis

Positive symptoms of psychosis include hallucinations, delusions, disorganized speech, confused thoughts, behavioral changes, and catatonia.

Hallucinations as symptoms of psychosis

Hallucinations occur when someone experiences a sensation (i.e. sight, sound, touch, smell, or taste) that doesn't exist outside of a person’s own mind. Examples of hallucinations can include hearing voices or seeing people that don't exist, or feeling insects crawling on your skin. 

Delusions in a state of psychosis

Delusions are typically described as persistent, false beliefs that don’t change even in the face of evidence against them. For instance, if you’re experiencing delusions, you might believe that you’re receiving secret messages from newspaper headlines or that your family members are actually government agents spying on you.

Disorganized speech and confused thoughts

Disorganized speech usually involves talking in a way that doesn’t make sense to other people. This could involve jumping rapidly between tangents rather than completing a thought or frequently making up words that have no meaning to others.

Confused thoughts are described as thinking in ways that don’t follow typical logic. Thoughts may occur in such rapid succession that you can’t organize them, or you could repeatedly draw associations between ideas with no logical connection.

Behavioral changes in psychosis

Behavioral changes associated psychosis can refer to actions that seem bizarre or illogical for your circumstances and cultural norms. Examples can include laughing at inappropriate moments, shining a high-powered flashlight during the daytime, or engaging in sexual behavior in public settings.

Catatonia and psychotic symptoms

Catatonia is generally defined as a specific type of disordered movement involving a diminished ability to initiate, control, or redirect behavior. Individuals with catatonia might freeze in one posture for a prolonged period until someone else moves them or continually repeat the words or gestures of other people. 

Negative symptoms of psychosis

• Avolition: A lack of motivation or desire to take action, complete tasks, or pursue goals.
• Anhedonia: A lack of happiness, pleasure, enjoyment, and satisfaction in circumstances where they’d usually be experienced.
• Blunted affect: A lack of emotional responsiveness, both internally and externally.
• Alogia: A lack of fluency and complexity in speech, such as using fewer words or speaking slowly and infrequently.
• Asociality: A lack of interest in and aptitude for engaging in social contact with others.

Some people may experience only one type of psychotic symptom, as in delusional disorder, which usually involves fixed delusions without hallucinations or disorganization. Others may display many symptoms concurrently.

Can a person enter and leave a state of psychosis?

The above symptoms aren’t necessarily always present in people with psychotic disorders. Instead, these conditions often follow a pattern of three recurring stages in which the individual:

1. Displays warning signs of impending psychosis. This stage may be referred to as the prodrome or prodromal stage.
2. Experiences frequent and severe positive symptoms. This stage is typically what people mean when they refer to a psychotic episode or the active phase of psychosis. 
3. Returns to a state of ordinary awareness of reality. This stage may be referred to as the residual stage or recovery stage of psychosis, and some people may need antipsychotic medication to reach it. 

Some people with chronic mental illnesses like schizophrenia may continue to experience negative symptoms, even during periods of recovery. These symptoms can be debilitating and may not respond strongly to antipsychotic medication. However, negative symptoms by themselves don’t usually constitute a psychotic state.

How long can a state of psychosis last?

The duration of psychotic episodes can vary between individuals based on many different factors. In some cases, psychotic episodes persist for only a few days, while in others, they may last for months or even years. 

According to the standards established by the American Psychiatric Association, a diagnosis of schizophrenia requires at least one month of active symptoms like hallucinations and delusions. However, other psychotic disorders may involve shorter periods of psychosis.

What can cause a state of psychosis in mental illnesses like bipolar disorder?

Many causal factors can contribute to the emergence of psychosis, including the following:

Mental health conditions like bipolar disorder

• Genetic susceptibility: Certain genetic variations can make a person more likely to experience psychosis. Many of them are associated with the development of nerve cells and brain structure, or with the control of the immune system. 
• Mental health conditions: While psychosis can be a primary symptom of disorders like schizophrenia, it can also appear alongside other symptoms in mental illnesses, such as bipolar disorder or severe depression. Intense emotional distress resulting from these conditions can lead to a temporary state of psychosis.
• Emotional stress: Serious psychological strain can sometimes lead to psychotic episodes, even in people with no history of mental illness. 
• Developmental disruption: Events that interfere with the healthy course of brain development, such as complications during pregnancy and birth, can increase the risk of psychosis. Psychological disturbances like childhood trauma can have a similar effect.
• Psychoactive substances: The use of some recreational substances, such as amphetamines or psychedelics, can induce states of psychosis, as can withdrawal from these substances in cases of addiction. Certain prescription medications, like steroids or anticonvulsants, may also induce psychosis. 
• Diseases: In addition to mental health disorders, psychosis could result from physiological illnesses, including infectious diseases and neurodegenerative conditions such as Alzheimer’s disease. 
• Neurological injury: Physical damage to the brain, such as the effects of a stroke or a traumatic brain injury, can sometimes lead to symptoms of psychosis.

Some of the above causes may only lead to short-lived psychotic states. For example, someone who develops psychosis due to substance use may begin to recover soon after they stop taking the substance in question. In other cases, psychosis may be part of a chronic condition that requires ongoing management with medication and therapy.

Is someone in a state of psychosis aware they’re experiencing symptoms?

This impaired awareness can make the treatment of psychosis difficult. Affected individuals may be less likely to cooperate with therapists or follow medication recommendations when they don’t see themselves as unwell. Some treatment approaches for psychotic disorders based on cognitive therapy focus on helping people achieve greater insight. 

Recognizing and treating psychosis for better mental health

Recognizing early signs of psychosis can be crucial for effective treatment.

Early signs of psychotic states

Psychosis treatment may be more effective the earlier it’s provided. Researchers have found that the odds of symptomatic and functional recovery tend to decrease the longer an individual goes without help. Learning to recognize a state of early psychosis and encouraging the person to seek treatment may be beneficial to their long-term prognosis. 

Signs that someone may be approaching a psychotic episode can include those listed below:

• Sudden decline in performance at school, work, or other areas of life
• Withdrawal from social life
• Lack of interest in or enjoyment of activities
• Suspicious or paranoid behavior
• Diminished attention to grooming and hygiene
• Endorsing strange beliefs, such as magical thinking or perceptions of hidden patterns in everyday events
• Describing strange perceptions, such as shadows moving on their own, muffled voices that no one else can hear, or a sense of being watched
• Saying they don’t know who they are or don’t feel in control of their actions
• Expressing a sense that something undefinable is wrong
• Unusually intense, flat, or inappropriate emotional responses

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What to do if you observe signs of psychosis

If you’re concerned that someone you know might be nearing a psychotic break, you may want to encourage them to seek early treatment. 

Supporting mental health during psychosis

Rather than dismissing their beliefs or perceptions, you can express empathy and compassion, but let them know that you’re not experiencing the same thing. Suggesting that they talk with a mental health professional for emotional support could be a beneficial first step. Once they’re in contact with a treatment provider, that person can help them develop a treatment plan. Depending on the severity of their symptoms, they may need psychotherapy, antipsychotic medication, or some combination of both.

Scheduling therapy may not always be easy when you’re experiencing functional impairment related to psychosis. If you’ve decided to seek help with recovery from psychotic symptoms, you might find online treatment helpful. Since you can attend sessions from anywhere with an internet connection, finding time to meet may be easier. However, it can be important to note that individuals experiencing acute psychosis may require in-person treatment from a psychiatrist who can prescribe medication.

Online interventions for people in recovery from psychosis often show positive results in controlled trials. Treatments based on cognitive behavioral therapy (CBT) may be particularly effective. A 2017 trial of one such treatment found that it typically helped patients reduce psychotic symptoms, increase their understanding of their conditions, and improve their social function.