Understanding Psychosis: Signs, Causes, Diagnosis, And Treatments

When asked to define “psychosis,” you may be able to provide a general idea of the term. However, historically, psychosis has been challenging to define, treat, and destigmatize in everyday conversations. To understand psychosis more profoundly, it may be beneficial to recognize the complexity of this diagnosis as well as common misconceptions perpetuated by popular culture. 

Often, people with psychosis experience difficulty in distinguishing between what is and isn’t real. To properly treat psychosis, mental health professionals are working to clarify the general public’s understanding of this condition and its key warning signs so that individuals can receive early diagnosis and treatment. 

To start learning more about psychosis, it may be helpful to explore the primary definitions, signs, and causes of psychosis and discuss the importance of a proper diagnosis – paired with early treatment – for people with psychosis. 

What is psychosis?

According to the American Psychological Association, psychosis is an “abnormal” mental state characterized by significant challenges with understanding and navigating reality. 

A person experiencing psychosis may have serious impairments or disruptions in their perception, cognitive processing, emotions, and other brain functions. These disruptions may lead to delusions, hallucinations, disorganized speech, and other “unusual” behaviors that can interfere with a person’s daily life and interactions. When assessing a person for psychosis, psychologists may evaluate a person’s capacity for “reality testing,” the ability to distinguish between fantasy and reality. Typically, people experiencing psychosis have difficulty making these distinctions. 

Although psychosis can feel frightening, the Yale School of Medicine notes that this condition is quite common. Psychosis is more likely to occur in young adults. In a sample of 100 young people, researchers concluded around three out of 100 people will experience psychosis or a psychotic episode. Yale Medicine also reports that 25% of people who develop psychosis will never have another episode. In comparison, another 50% may have another episode but can still manage the symptoms and live healthy lives. 

Psychosis vs. psychotic disorders

If they experience multiple psychotic episodes and other symptoms, individuals may be diagnosed with a psychotic disorder. Compared to psychosis, which is a symptom, not an illness, a psychotic disorder is a diagnosable mental health condition characterized by persistent abnormal thinking and perceptions. 

Primary examples of psychotic disorders include schizophrenia, bipolar disorder, severe depression, delusional disorder, and schizoaffective disorder. Diagnosis of these disorders may depend on an individual’s display of symptoms and a licensed doctor’s assessment.  

Destigmatizing psychosis

While psychosis is relatively common and recognized in the psychological community, longstanding stigmas and stereotypes about this condition persist. Symptoms of psychosis can sometimes be linked to inappropriate and inaccurate descriptors like “crazy,” “psycho,” “schizophrenic,” “frightening,” and “dangerous.”

Knowledge and research may be antidotes to these stereotypes, which are often rooted in a misunderstanding of psychosis as well as miseducation about its true meaning and prevalence. Overcoming the stigma of psychosis and other mental health challenges may require more time and public education coupled with individuals’ willingness to learn. 

On an individual basis, you can challenge stigma by speaking up when you hear people make inaccurate or unkind comments about psychosis and mental illness. Language can be a powerful tool and may be used to destigmatize psychosis and other mental health challenges while promoting a deeper understanding of the common causes and signs. 

Causes of psychosis

The causes of psychosis can vary widely depending on a person’s mental health history and current circumstances. Often, psychosis can be a symptom of an existing mental health condition. Neurodevelopmental abnormalities, stress, the postpartum period, and genetic risk factors can also increase a person’s risk of psychosis.

In some cases, psychosis develops in response to substance use or brain abnormalities, which have been correlated with “first-episode” psychotic disorders. This terminology is used to describe the first time someone experiences psychotic symptoms or a psychotic episode. 

Some research suggests that first-episode psychotic disorders are linked to reduced gray matter in the brain’s prefrontal, superior, and medial temporal regions. More studies may be beneficial to understand this relationship. Still, some researchers theorize that reduced gray matter may be linked to higher inflammation, reduced concentration, and other challenges associated with psychotic disorders. 

Symptoms Of Psychosis 

Identifying the exact cause of psychosis can be difficult since this condition typically stems from a complex combination of factors. Regardless of the origin of psychosis, some people experience similar signs and symptoms during a psychotic episode, including the following: 

• Delusions: False beliefs that a person firmly upholds despite a lack of evidence
• Hallucinations: Perceived experiences in the absence of a real, external stimulus
• Disorganized thoughts: Switching from one topic to another and non-linear, jumbled speech
• Disorganized behaviors: A range of “unnatural” or unexpected behaviors, such as extreme silliness, agitation, or quick speech 
• Negative symptoms: A decrease or loss in a person’s normal functioning. A person may appear to have a “flat affect” or lack of emotional expression, as well as catatonia, a neuropsychiatric syndrome characterized by abnormal movements, behaviors, and withdrawal. 

In the diagnosis of psychotic disorders, the fifth edition of the Diagnostic and Statistical Manual (DSM-5) outlines the above five categories. As opposed to receiving a “hard” definition of psychosis, a person may be diagnosed with a psychotic disorder if they present with abnormalities in one of these five dimensions, as well as the other symptoms of the condition. 

Psychosis teatment

The treatment plan for psychosis symptoms may depend on several factors, including the severity and stage of the psychotic episode and any co-existing health conditions. In some cases, people experiencing psychosis may require in-person care or treatment from a psychiatrist. 

A psychiatrist may separate a psychotic episode into three distinct phases, including the following: 

• The prodrome phase: Also called psychosis syndrome or early psychosis, the prodrome phase occurs when a person first shows signs of losing contact with reality. 
• The acute phase: This “critical period” occurs when classic signs of psychosis, such as hallucinations, delusions, and confused thinking, begin to emerge, which may provoke more distress. 
• The recovery phase: In this phase, symptoms subside. 

Understanding psychosis as a symptom of an underlying condition or circumstance rather than a mental illness, psychiatrists can reference a patient’s medical history and current lifestyle before deciding on a treatment. Depending on their assessment, the treatment plan may include a tailored combination of psychotherapy, medication, and ongoing support and education for an individual and that individual’s family members and loved ones. 

Individuals experiencing psychosis may benefit from a peer support group where they can process and heal from their experiences. A 2015 study found that support groups may be beneficial for people with psychosis, considering the sometimes extreme nature of psychotic episodes and associated social stigma. These groups could be an invaluable source of solidarity, especially for individuals who might otherwise isolate themselves from social support.

Psychotherapy for psychosis

If you or a loved one are experiencing psychosis, you deserve proactive and responsive treatment. Psychotherapy can be especially valuable for those experiencing or recovering from psychosis.

While some individuals may prefer to begin these and other therapies in person, many clients seek online therapy through digital platforms like BetterHelp. Some traditional therapies can be adapted to online formats, easing the process of signing up for and attending therapy, especially for individuals experiencing the distress of psychosis. You can choose between phone, video, or live chat sessions through an online platform.  

A 2020 study of blended digital and in-person care for first-episode psychosis treatment in young people shows that online mental health interventions can be effective treatments for several mental health conditions. Researchers found that young people were “enthusiastic” about integrating digital treatments to enhance their in-person mental health care. The digital intervention included online therapy modules, group discussions, mood and symptom trackers, and individual web-based conversations with clinical and peer moderators. Collectively, these online features allowed young people to form stronger bonds with their therapists and engage more actively with their treatment program. 

Takeaway

Despite the stigmatization of psychosis, many people experience this cluster of symptoms at some point in their lives. With responsive treatment and social support, it can be possible to recover and experience relief from psychosis symptoms. If you’re ready to talk to a professional, consider contacting a licensed therapist online or in your area for support.