How To Recognize Psychotic Symptoms

Psychosis usually refers to a condition in which a person has trouble recognizing what’s real and what isn’t. Hallucinations, which might involve hearing voices or seeing things that aren’t there, and delusions, which are false beliefs or being confused between reality and imagination, are key psychosis symptoms. Changes in thinking and speech can also be symptoms of psychosis that can affect the daily life of an individual and those around them, including family members and friends.  

In many cases, a psychotic episode is preceded by certain symptoms like isolation, jumbled speech, and intense, unpredictable emotions. An online therapist may be a helpful resource for those who have experienced psychotic symptoms and would like professional guidance regarding preventing future episodes. Identifying the underlying conditions that involve psychosis may help in finding appropriate psychosis treatment options.

Psychotic symptoms: hallucinations, delusions, and others

The symptoms of psychosis can typically be grouped into three major categories:

#1: Hallucinations

A hallucination is generally a perception of someone or something that seems real, but doesn’t have an external source. Hallucinations can range from brief perceptions, such as hearing a short statement from a nonexistent voice to complex visions, in which an individual perceives a sequence of vivid and bizarre events. 

Hallucinations may involve any or all types of sensory perception. Auditory hallucinations, in which people with psychosis hear sounds with no source in reality, appear to be the most common type. 

Note that hallucinations by themselves aren’t necessarily a sign of psychosis. Many otherwise mentally healthy people occasionally experience brief hallucinations, especially shortly before falling asleep or after waking up. These hypnagogic or hypnopompic hallucinations may occur in as many as 25% of the general population. Other possible non-psychotic causes for hallucinations can include migraines and fevers.

Hallucinations may be more likely to be symptoms of psychosis when they’re frequent, prolonged, or cause significant distress. Difficulty telling the difference between real perceptions and hallucinations can also be an important warning sign. 

Sometimes, psychotic hallucinations may seem to be imparting disturbing information or commanding inappropriate or unhealthy behavior. If you’re hearing or seeing things that seem to be urging you to harm yourself or others, it’s often a good idea to seek help right away. You can dial 988 or click this link to reach the National Suicide Prevention Lifeline, or text HOME to 741741 and reach someone at the Crisis Text Line. These options can connect you to trained volunteers who can help you get expert assistance.

#2: Delusions

Though some people confuse delusions and hallucinations, a delusion usually involves thoughts, not sensory impressions. A person with a delusion may not see, hear, or feel anything different from anyone else, but they may hold one or more ideas that don’t line up with reality. 

Persistent delusions can be symptoms of psychosis, especially when they cause significant distress or impair a person’s ability to function in daily life.

One well-known example may be a paranoid delusion, in which a person can become convinced that other people are secretly working against them. Other recognized types of delusions can include the following:

• Bizarre delusions: These are generally delusions that could not possibly be real, are obviously untrue, or are completely at odds with the common understanding of the world. For example, the individual might believe their body is made of glass and could shatter if they fall over.

• Erotomanic delusion: This is normally a belief that another person, often someone famous or high-status, is secretly in love with the individual.

• Delusional jealousy: This can refer to a persistent conviction that the individual’s romantic partner is unfaithful to them.

• Somatic delusions: These are typically beliefs about something being wrong with the individual’s body, such as a disease or an infestation by parasites.

• Grandiose delusions: These usually refer to delusions involving the individual being someone of immense importance or talent, such as a divine being or the secret ruler of the world.

• Thought broadcasting or insertion delusion: These can involve the ideas that other people can read the individual’s thoughts, or that their thoughts are being implanted in their mind from some outside source. Some might classify this as a type of bizarre delusion.

Studies of patients experiencing delusions suggest that they may not recognize anything unusual in their thinking, even though they can accurately identify other people with delusional beliefs. If they’re shown evidence that their belief is untrue, they will often explain it away, even if this requires coming up with additional extremely implausible ideas.

#3: Changes in thinking and speech

Many people with early psychosis experience changes in the way they think, which may lead to unusual speech patterns as well. This is commonly known as disorganized thinking or formal thought disorder (FTD). 

Racing thoughts can be one common manifestation of this symptom, in which it may seem that you’re thinking almost too quickly to follow. Your thoughts might be repetitive and distracting, and you may feel unable to slow them down or redirect them. 

You might also experience a “flight of ideas” in FTD. This is normally when thoughts seem to shift quickly from one topic or idea to another, despite having no logical connections. You may make links between thoughts that other people wouldn’t connect or view things as very meaningful that others consider trivial.

FTD in psychosis can also involve negative symptoms, in which thoughts seem slower and often overly rigid or literal. The intensity of emotions may also be decreased in negative formal thought disorder, and the individual may have trouble remembering things or making connections between ideas.

When experiencing these kinds of shifts in thinking, it can be very difficult to speak clearly. A person with FTD might display any of the following unusual speech patterns:

• Jumping between topics abruptly or going off on tangents

• Speaking so rapidly that it’s difficult to follow

• Speaking very slowly or pausing frequently

• Making incoherent, nonsensical statements

• Referring to people or things ambiguously — for example, saying “She said I would be alright,” when there was no previous mention of the “she” in question

• Excessive repetition

• Using made-up words or expressions

• Linking words based on sound rather than logical connections

• Overly simplistic or vague speech, sometimes with a reduced vocabulary

• Speaking in a flat, monotonous tone

Pre-psychotic symptoms

When someone is experiencing psychosis, the changes to their thinking may make it hard for them to recognize that they’re experiencing symptoms of mental illness. This can lead to delays in treatment, which might make recovery more difficult in the long run. 

That’s one reason it can be so important to watch for early warning signs. It can be common for people to exhibit behavioral changes or experience unusual thoughts and perceptions in the weeks and months leading up to a psychotic episode. 

Examples of common pre-psychotic symptoms

• Isolating or withdrawing from others

• Suspicion or paranoia

• Odd, jumbled speech

• Expressing strange and illogical ideas or having difficulty thinking clearly

• Intense, unpredictable emotion (or unusually limited emotional responses)

• Lack of attention to hygiene, nutrition, cleanliness, and other types of self-care

• Disturbed sleep patterns, such as waking up at odd hours or staying up all night

• An abrupt decline in academic or career performance

Changes like these can be signs that you should consult a mental health care provider. If you notice these indicators in someone close to you, it might be a good idea to suggest that they seek treatment.

What causes psychotic disorders? Bipolar disorder, giving birth, and other risk factors

Psychosis can result from a variety of causes. In some cases, it may be a symptom of a psychotic disorder or another mental health disorder, which may result from a combination of genetic factors, life experiences, and environmental factors. Schizophrenia is usually the most well-known psychotic disorder, which often develops after an initial schizophrenia episode. Young people—specifically individuals in their late teens or twenties—are thought to have a higher risk of experiencing psychosis than individuals in other age groups. 

Puerperal psychosis symptoms

Some birthing parents may develop postnatal psychosis, also called puerperal psychosis, which is a serious mental health condition that can occur after childbirth. This type of psychotic episode occurs in the early postpartum period and is characterized by a break in reality, delusions, and hallucinations. It's a rare but severe mental illness that requires immediate attention. 

Parkinson’s, bipolar disorder, lupus, syphilis, and other mental health conditions

Psychosis can also be caused by Parkinson’s disease, bipolar disorder, lupus, syphilis, and many other physical health conditions. Psychosis may also manifest in people with severe mood disorders, such as bipolar disorder, where one might experience depressed psychosis, or major depressive disorder with psychotic features. Psychosis symptoms are most common during manic episodes of bipolar disorder. In these cases, the psychological symptoms can include delusions or hallucinations alongside the typical symptoms of depression.

Other mental health conditions that can occur alongside psychosis symptoms

People who experience psychosis may also have other mental health conditions, such as severe depression or anxiety. In many cases, treating psychosis involves addressing a specific mental health condition that may be occurring alongside psychosis. As with psychosis symptoms, psychotherapy, medications, and lifestyle changes are often employed to alleviate these mental health conditions. Psychosis can also be caused by medical conditions, such as dementia, malaria, or multiple sclerosis. By addressing these conditions, psychosis symptoms may be managed. 

Other causes of psychotic episodes

Some people may also develop psychotic symptoms temporarily in response to severe stress, such as postpartum depression or the loss of a family member. Excessive use of intoxicating substances might also lead to periods of psychosis, either during heavy use or withdrawal. 

Psychosis may be brief and temporary. An individual who goes through a psychotic episode during a difficult period of their life might never have another. However, even a brief episode of psychosis is often associated with a high risk of future episodes and disorders like schizophrenia. If you’ve experienced symptoms of psychosis, it’s usually a good idea to seek out a mental health professional for observation and treatment.

Mental health treatment options for psychosis symptoms

While treatment for psychotic disorders often involves medication, there’s a substantial body of evidence indicating that psychotherapy can help as well. Talking to a therapist or other mental health care professional may be useful in treating psychosis, as they can often guide people through early treatment options and address hallucinations, delusions, and other symptoms. Therapy, in addition to prescription medications, may help reduce your likelihood of experiencing future psychotic episodes, potentially improving your odds of long-term recovery. 

Seeking support online

Many people who’ve had psychotic symptoms may be reluctant to seek help because they’re worried about how others will view them. If you’re concerned about the possible stigma of mental illness, you might find talking with a therapist online is an easier way to get started with treatment. Chatting with a mental health professional through text, voice, or video conference may increase your sense of control and inconspicuousness, increasing your comfort with the process.

Effectiveness of online treatment for psychosis and psychotic disorders

In general, researchers have repeatedly found significant, positive results from online therapy. A 2006 meta-analysis comparing it to in-person treatment found “no difference in effectiveness.” Though there hasn’t been much research into whether online therapy helps with psychosis prevention, it’s usually considered a reliable and helpful form of psychiatric treatment.