Is Psychosis A Lifelong Illness? Exploring The Facts

Psychosis isn’t considered a mental health disorder in and of itself. Instead, it is a term typically used to define a category of symptoms found in conditions like schizophrenia and other psychotic disorders. It may also occur in substance use and mood disorders like bipolar disorder or major depression with psychotic features. Individuals experiencing psychosis might have hallucinations, delusions, and disordered thoughts, speech, and behavior. Psychosis often makes it difficult for an individual to discern between what is real and what is not.

Psychosis treatment and management

Treating psychosis typically involves a combination of methods tailored to the needs of the individual. With treatment adherence and support from loved ones and healthcare professionals, it can be possible to reduce or completely eradicate symptoms of psychosis. 

Medication

Antipsychotic medications are typically the first-line treatment for psychotic disorders. They’re prescribed by doctors and psychiatrists to manage symptoms of psychosis like delusions and hallucinations. In some cases, physicians may also prescribe mood stabilizers or antidepressants to manage secondary symptoms. Be sure to inform your prescribing provider if you experience any medication side effects, and always consult them before starting, stopping, or changing the way you take medication.

Psychosocial interventions

There are many types of psychosocial treatments that, when paired with medication (if tolerated), can help individuals manage symptoms and navigate the challenges associated with them.

Individual therapy

Cognitive behavioral therapy (CBT) and other forms of psychotherapeutic treatment can help individuals with psychosis better understand their thoughts and behaviors and learn coping strategies to manage symptoms. 

Family therapy

Psychotic disorders typically affect every aspect of an individual’s life, but for many people, family life and relationships can be the most impacted. Family therapy is usually an integral part of helping individuals with psychosis by working with their family members to learn coping, conflict resolution, and communication skills. Family therapy can cultivate greater empathy and understanding of mental illness so members can better support each other.

Supportive services

Case management, supported employment, and housing assistance can help individuals with psychosis live and manage their symptoms more independently.

Education and skill-building

Psychoeducation programs can provide individuals with comprehensive information about the development of psychosis, how to manage a psychotic episode, treatment options, and more. Such programs typically teach individuals skills to manage symptoms and improve their quality of life.

Strategies for long-term management

For some people, psychosis symptoms subside on their own with short-term interventions. However, some individuals must work closely with a mental health professional to establish a long-term treatment plan, including, but not limited to, continuous medication management and ongoing therapy. There are some supplemental ways that individuals with psychosis may manage symptoms on their own as well.

Self-care practices

Individuals with psychosis are often encouraged to prioritize self-care and cultivate a healthy lifestyle, including regular exercise, nutrient-rich eating habits, and adequate sleep. Because stressful situations can exacerbate psychosis symptoms, counselors may teach individuals stress management techniques to prevent relapse and support overall mental health and well-being.

Social support

Building a solid network of friends, family, and community can provide emotional support, encouragement, and understanding. Many individuals with psychosis find that peer-led group therapy tends to be a beneficial part of ongoing management. In group treatment, individuals can share experiences, successes, and tips for living with psychosis.

Psychoeducation

It can be important for individuals with psychosis to stay informed about treatment options and self-management strategies through educational programs and resources. Psychoeducation can also be vital for reducing the stigma and misunderstanding often surrounding mental illnesses like psychotic disorders. 

Routine monitoring

Regularly monitoring symptoms, medication adherence, and overall mental health status may help individuals detect any notable changes or signs of impending relapse. Daily journaling and other reflective activities can be excellent ways to stay present and aware. 

Goal setting

Setting realistic goals for personal growth, recovery, and well-being can be a productive supplement to treatment. Individuals may track their progress over time to stay motivated and focused.\

Understanding psychosis

Psychosis symptoms often present differently between individuals. However, they typically emerge in the late teenage to early adult years. There tend to be core symptoms that arise in psychotic disorders, usually referred to as “positive” symptoms, because they tend to involve the acquisition of abnormal mental states that can be outwardly expressed. 

These include, but aren’t limited to, the following:

• Delusions: Delusions can be defined as false beliefs that are not reality-based. Delusions can be paranoid (believing others are conspiring against you), grandiose (believing you have special abilities or powers), or neutral. Individuals with psychosis typically continue to hold delusional beliefs despite evidence that they aren’t true. 
• Hallucinations: Hallucinating generally refers to seeing, hearing, feeling, smelling, or tasting things that are not actually there. Common hallucinations can include hearing voices (auditory), seeing things that others don’t (visual), or feeling sensations on the skin (tactile).
• Disorganized thoughts and speech: This usually refers to difficulty organizing thoughts, constructing coherent sentences, or connecting ideas logically. In many cases, this can emerge in the form of speech that is incoherent or difficult to follow. Colloquially, this is sometimes referred to as “word salad.”
• Disorganized behaviors: When a person displays disorganized behavior, they may act in an unusual, unpredictable, or inappropriate way for the situation. This can include agitation, catatonia (absence of movement or response to outside stimuli), or unusual mannerisms. 

Some psychotic disorders also feature “negative” symptoms labeled as such because they represent a decrease in activity, unlike the core “positive” symptoms. These can include a loss of motivation (avolition), social withdrawal (asociality), reduced emotional expression (blunted affect), and a reduced ability to experience enjoyment or pleasure (anhedonia).

In many cases, individuals experiencing psychosis symptoms also have cognitive impairments associated with executive function, memory, problem-solving, and concentration. 

Psychosis diagnosis

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) provides diagnosis criteria for mental health disorders. Criteria for psychotic disorders can vary between conditions, but there are a few critical criteria that apply to most of them:

• Two or more positive or negative symptoms must present for a significant portion of time during a one-month period.
• Symptoms must impact an individual’s function in one or more primary areas, such as work, relationships, or self-care. 
• Symptoms must persist continuously for a period of at least six months, including at least one month of active-phase symptoms (including prodromal or residual symptoms). 
• The effects of a substance, medication, or a medical condition cannot better explain symptoms. 

Portions of these criteria may not apply to some psychotic disorders. For example, schizophreniform and brief psychotic disorders usually have different onset criteria. In addition, some psychotic disorders can be characterized by additional symptoms that must be present for diagnosis. For instance, schizoaffective disorder can also feature symptoms of major depression or mania.

Psychotic disorders

The DSM-V lists several conditions under the category of disorders characterized by symptoms of psychosis.

Schizophrenia

Schizophrenia can be defined as a severe mental health condition featuring psychotic symptoms and the breakdown of one’s relationship with reality. Individuals with schizophrenia may experience isolation and withdraw from daily life and relationships as symptoms worsen. 

Schizophrenia symptoms typically present in stages:

• Prodromal: Marked by the emergence of negative symptoms, individuals in this phase might become depressed, lose interest in things they once enjoyed, and avoid social interaction. 
• Acute: People often experience psychosis symptoms during this phase, including delusions and hallucinations. Individuals in this phase might display unusual speech and behaviors.
• Residual: Negative symptoms tend to reemerge during this phase as positive symptoms recede. 

Schizophreniform disorder

Schizophreniform disorder tends to be similar to schizophrenia, but symptoms are typically milder. It usually features positive and negative symptoms that emerge in the prodromal, acute, and residual phases. While two or more core symptoms must be present over one month for schizophreniform disorder, clinicians might reassess to consider the possibility of schizophrenia if symptoms persist for six months or longer. 

Schizoaffective disorder

This disorder typically features symptoms of psychosis similar to schizophrenia with the addition of severe depression, mania, or both. It’s normally categorized into two types: 

• Schizoaffective bipolar type: This usually features extreme “highs” and episodes of mania, often alternating with episodes of major depression in addition to psychosis symptoms. 
• Schizoaffective depressive type: This may only feature major depressive symptoms along with psychosis. 

Delusional disorder

Delusional disorder normally features the presence of “non-bizarre” delusions defined as those involving conditions that could realistically occur. For example, one may experience delusions that they’re being stalked or followed, have been betrayed by a loved one, or are living with a chronic disease. In delusional disorder, one or more delusions must be present for one month or more. Hallucinations aren’t usually the most prominent symptom, and sensory experiences tend to be associated with a corresponding delusion.

Brief psychotic disorder

As the name implies, brief psychotic disorder tends to be characterized by shorter episodes of psychosis, usually lasting for at least one day but less than one month. 

Other psychotic disorders 

Substance or medication-induced psychosis and psychotic disorder due to another medical condition can fall under the category of psychotic disorders, as can unspecified schizophrenia spectrum and other psychotic disorders.

Seeking support

Though psychosis isn’t necessarily lifelong, individuals may experience relapse without treatment adherence. Even with support, challenges associated with accessibility, scheduling, and affordability may present barriers to essential treatment for people with psychosis and their families. 

It may not be appropriate for all cases of psychosis and could be best for individuals in the prodromal and residual phases, but many individuals find that alternative options like virtual therapy can provide an effective solution to such obstacles. 

Online platforms typically offer greater access to a larger pool of mental health professionals with experience in cases featuring psychotic symptoms. Sessions can be scheduled at convenient times, and online therapy is often less expensive than traditional options without insurance.