Is Psychosis A Lifelong Illness? Factors That Influence The Prognosis

Psychosis is a serious mental health condition that involves a disconnection from reality and may be a symptom of other mental illnesses or mental health conditions. Answering the question, “Is psychosis a lifelong illness?” can be complicated and may depend on the underlying disease or condition causing symptoms. Individuals may experience psychosis due to various underlying conditions, including but not limited to bipolar disorder and schizophrenia. Psychosis symptoms can impact home, work, and school life and may make it challenging to maintain interpersonal relationships. 

For individuals who experience psychosis, working with a team of medical and mental health professionals may be a part of treatment and recovery. Treating psychosis may involve managing psychotic symptoms while also treating the underlying cause or condition. To understand the prognosis of psychosis, it may be helpful to explore the symptoms of psychosis, how psychosis is diagnosed, and long-term management implications for people with psychosis. 

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What are the symptoms of psychosis?

The symptoms of psychosis are varied, and each individual with psychosis may experience symptoms differently during a psychotic episode. Psychotic symptoms are often divided into two categories: negative symptoms and positive symptoms. 

Positive symptoms

Positive symptoms distort or occur in addition to a person’s normal functioning. These symptoms can be highly impactful and may include the following: 

• Hallucinations: A person with psychosis may experience or sense stimuli that are not real. For example, they may experience seeing shadows, feeling sensations, hearing voices, or smelling and tasting stimuli that are not there. For the person experiencing the hallucination, these sensations may seem real, and it can be confusing or frightening when others are not experiencing the same. 
• Delusions: A person with psychosis may experience false beliefs or delusions about reality. These beliefs could include thoughts that people or organizations are “out to get them,” frequently referred to as a persecutory delusion. Individuals may also have grandiose delusions, such as believing they are extraordinary compared to others or a specific historical or famous figure. Delusions can lead to frustration or paranoia when others do not share the same false beliefs. 
• Disorganized thinking: Psychosis can cause a person’s thought patterns to move from typically linear and logical to disorganized and illogical. This illogical thought pattern may manifest most clearly in a person’s speech patterns, which may become nonsensical or confusing.  
• Abnormal or disorganized behavior: Individuals with psychosis may exhibit abnormal or socially unacceptable behavior, including unpredictable agitation, childlike silliness, or inappropriate emotional responses. 

Negative symptoms

While positive symptoms involve the addition of behaviors not considered a part of a person’s typical functioning, negative symptoms are the opposite. Negative symptoms include the reduction or absence of typical behaviors or feelings. These symptoms include the following: 

• Blunted affect: The blunted affect caused reduced expression of emotions through facial expressions, voice tone, and gestures. This symptom can give the appearance of apathy for patients with psychosis. They may appear lethargic and may have difficulty responding to social cues. 
• Alogia: Individuals with psychosis may experience a reduction of speech, causing a person to speak little or have difficulty initiating conversation. This symptom can make building and maintaining interpersonal relationships challenging due to a lack of communication. 
• Anhedonia: Anhedonia is typically a symptom of severe depression and is the inability to experience pleasure from previously enjoyed activities. This symptom can sometimes occur with psychosis, as well, especially when connected to major depressive disorder with psychotic features.  
• Avolition: Avolition is the lack of motivation to start or sustain meaningful activities, which can result in neglect of personal hygiene or responsibilities. Neglecting hygiene or personal needs may also cause physical illness or infection.
• Social withdrawal: Reduced desire or drive to engage in social interactions or maintain relationships can occur in individuals with psychosis. 

Positive symptoms may be more pronounced and recognizable. However, negative symptoms can also have significant impacts on individuals. Having psychosis diagnosed early may reduce the impact and progression of symptoms over time. 

How is psychosis diagnosed by a mental health professional? 

The mental health professional may start by gathering information about the individual's symptoms, medical history, psychiatric history, family history of mental illness, and any substance use, which may help them determine if the client is experiencing drug-induced psychosis or if there is another underlying cause.

After gathering basic information, a doctor may ask about current symptoms or experiences the individual may be having. These questions might involve asking the client to describe recent behaviors, evaluating personal appearance, and discussing thought processes, moods, and overall cognitive functioning. All assessments may help the evaluator determine whether positive or negative symptoms are present. 

If symptoms are present, the evaluator may use specific tools and questionnaires to evaluate the severity and type of psychotic symptoms. These tools can help in distinguishing psychosis from other mental health conditions with similar symptoms. The clinician may then consider and rule out other mental health conditions that might present with psychotic symptoms, such as severe depression (with psychotic features), bipolar disorder, schizoaffective disorder, and personality disorders.

The final diagnosis a person receives is based on criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). These criteria specify the types and duration of symptoms required for a diagnosis of disorders such as schizophrenia, brief psychotic disorder, or delusional disorder.

What factors influence the prognosis?

The long-term prognosis of psychosis may depend on various factors, including the underlying cause of psychosis and how early the symptoms are detected and treated. Factors that influence the overall prognosis of psychosis include the following: 

Individual factors

Factors like the age at onset, duration of untreated psychosis, and severity of initial episode may all play a role in the long-term prognosis of psychosis. Early intervention and early psychosis treatment may improve overall patient outcomes over time. 

Treatment factors for prevention of another psychotic episode

For a person with psychosis, treatment can play a role in the reduction of symptoms and prevention of another psychotic episode. Adherence to treatment, as well as early treatment, may improve an individual’s prognosis. 

Psychosocial factors such as strong mental health support

Having a strong support network and living in stable conditions may reduce stress and positively impact a person’s long-term prognosis. 

Environmental and lifestyle factors

Factors like added stress or substance use may negatively impact the long-term prognosis for individuals with psychosis, while factors like getting exercise, eating nutritious foods, and getting enough sleep may improve the prognosis. 

Is psychosis a lifelong illness that will come back from time to time?

Psychosis can continue to relapse over time, especially if the underlying causes or disorder is not treated. However, treating psychosis can often reduce symptoms. Over time, a person may recover fully from a psychotic episode. Although the prognosis with treatment can be positive, treatment may be recommended to continue as a person ages to prevent relapse and to monitor symptoms. 

Medication treatment for symptoms of psychosis and mental illness

Treating psychosis and managing the long-term impacts of the illness may be multifaceted and include a combination of medication, lifestyle changes, and psychotherapy options. For some who have experienced a psychotic episode, antipsychotic medications may be used to reduce immediate symptoms and to prevent a recurrence of psychosis in the future. These medications may be used in conjunction with other medications designed to treat other underlying disorders, such as depression or anxiety. 

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Alternative support options for people experiencing psychosis

In addition to medication, individuals experiencing psychosis may benefit from working with a therapist. A therapist can use various evidence-based techniques and recommend lifestyle changes to help clients manage and reduce the impact of symptoms. However, making it into an in-person therapist who specializes in treating psychosis can be challenging. In these cases, online therapy platforms like BetterHelp may be more available. 

Online therapy for managing symptoms of mental illness

Online therapy can offer flexibility when choosing a therapist, as clients can attend a session from anywhere with an internet connection and device. In addition, online platforms often offer unique tools for individuals, such as worksheets, journaling prompts, and weekly support groups. 

While in-person care may be required for a psychotic episode, online therapy can be effective for individuals who are recovering from psychosis. An online therapist may implement cognitive-behavioral therapy (CBT) techniques or other evidence-based approaches to help clients improve thinking patterns and make healthy lifestyle choices while coping with psychosis recovery.