How To Recognize Psychotic Symptoms
- For those experiencing suicidal thoughts, please contact the 988 Suicide & Crisis Lifeline at 988
- For those experiencing abuse, please contact the Domestic Violence Hotline at 1-800-799-SAFE (7233)
- For those experiencing substance use, please contact SAMHSA National Helpline at 1-800-662-4357
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
Psychosis affects a relatively small portion of the population, with around 1.5% to 3% of people meeting diagnostic criteria for a psychotic disorder. There can be many different forms of psychosis, but what they usually have in common is a confused or warped view of what is and isn’t real.
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.
Takeaway
The symptoms of psychosis typically involve changes in thought and perception that can make it difficult to correctly identify what is and isn't real. An individual with psychosis may experience hallucinations of things that aren't there or have delusional ideas that don't correspond with reality. They may also experience and display changes in thinking and speech. Psychotic episodes are often preceded by indicators such as social withdrawal, emotional disturbances, and unusual speech or thought. It can be helpful to work with a mental health specialist, such as a licensed therapist, for psychosis prevention. One way to do so can be through an online therapy platform.
What can trigger a psychotic episode?
The best predictor of psychosis is a family history of psychotic episodes, but psychosis triggers can vary greatly based on the underlying cause. Most people who experience psychosis will only experience it once, and a cause or trigger may not be found. In those with underlying conditions that can induce psychosis, a stressful event might be a trigger. For others, psychosis can sometimes appear after a period of extreme sleep deprivation. Medical problems, like metabolic or autoimmune disorders, can also induce psychosis symptoms. The stress of childbirth and caring for a newborn can sometimes lead to psychotic symptoms. Psychosis caused by childbirth is typically referred to as postpartum psychosis. Finally, neurological disorders or dementias might trigger psychotic symptoms in many cases.
What does a psychotic episode feel like?
Psychotic experiences can vary considerably from person to person. Many people hear voices or see things others cannot. Many people who are experiencing an episode demonstrate powerful delusions, which are false beliefs that are often demonstrably untrue, such as when a person believes that they can read another person’s thoughts. The person experiencing psychosis may not be aware that their beliefs are unusual or impossible.
Auditory hallucinations are the most common psychotic symptom reported and may be the symptom people experiencing psychosis are most aware of. Hearing voices or strange sounds is common, and a person may find distinguishing between real sounds and hallucinations challenging. Similarly, a person might experience visual hallucinations, seeing shapes, people, or objects that others cannot. They might also feel paranoid or deeply suspicious of those around them.
Can psychosis be cured?
Psychosis is not a diagnosable condition. Rather, it is a syndrome - a collection of symptoms related to one another that commonly appear together. It is possible to manage psychosis symptoms through antipsychotic drugs or other medications. Individual or group psychotherapy can also help people develop skills to manage or reduce psychosis symptoms by avoiding triggers, recognizing when an episode is starting, and learning coping skills.
Completely resolving psychosis and preventing future episodes typically involves treating the underlying condition that induces psychotic symptoms. Psychotic spectrum disorders like schizophrenia typically require lifelong treatment and ongoing support. However, some conditions that induce psychosis may be able to be cured. Psychosis due to a medical condition, like metabolic or autoimmune disorders, may resolve completely if the underlying medical problem is effectively treated, much like how some cases of depression can be treated by addressing an underlying thyroid gland disorder. Similarly, psychosis triggered by sleep deprivation often resolves completely after the person gets enough sleep.
What is stage one of psychosis?
The first stage of psychosis is typically referred to as the prodromal phase or “prodrome.” The prodrome is characterized by similar symptoms to what is experienced during the acute phase of a psychotic episode. However, the severity and impact of the symptoms are typically much lower, and the symptoms may not be consistently present. The symptoms present during the prodromal phase often serve as early warning signs that a psychotic episode is imminent. Cognitive and behavioral therapies are often helpful for teaching people how to recognize prodromal symptoms and taking proactive steps to manage the psychosis, such as taking antipsychotic medications, calling a crisis lifeline, or reaching out to their support network. Therapy is also often useful for learning skills to address practical problems associated with oncoming psychosis.
How do you tell if someone is psychotic?
Although psychotic episodes are often associated with strange or unusual behaviors, it is typically not possible to tell if someone is experiencing one without professional evaluation. A person experiencing a psychotic episode might voice odd beliefs or be difficult to understand. They might also move and act erratically. Because psychosis can cause paranoia and persecutory delusions, it may not be possible to approach the person safely.
Can lack of sleep cause psychosis?
The National Library of Medicine, part of the National Institute of Health, indicates that severe sleep deprivation can induce psychotic symptoms that progressively worsen until the person gets adequate sleep. Psychotic episodes due to sleep deprivation are more common in those diagnosed with psychotic spectrum disorders, like schizophrenia or brief psychotic disorder, but going too long without sleep can also induce psychosis in those who do not have any underlying conditions. Evidence indicates it takes around 72 hours of continuous wakefulness to reach the level of psychosis.
Psychosis due to sleep deprivation is typically treated by enabling the person experiencing the symptoms to get adequate sleep. Comorbid mental illnesses, like PTSD or anxiety disorders, might also contribute to sleep deprivation and require treatment as well.
How does psychosis usually start?
Most people experience their first psychotic episode in early adulthood. Some evidence suggests that symptoms affect women more frequently than men. Lack of sleep, stressful life circumstances, or many other factors might trigger it. In many cases, there is no known trigger. However, many people report stressful events like a major catastrophe as a probable trigger. The majority of people who experience psychosis only experience one episode in their lifetime, and an underlying cause may not be found. If a person develops psychosis symptoms and seeks treatment, they will typically receive a comprehensive evaluation to manage the psychotic symptoms and determine underlying causes.
Most people who require ongoing treatment for their symptoms will be diagnosed with a psychotic spectrum disorder like schizophrenia, schizoaffective disorder, or brief psychotic disorder. They will typically follow a treatment plan designed to help them recognize and manage their symptoms. They might also participate in individual or group psychotherapy, education programs, and support groups as they learn to manage their symptoms. The most severe form of a condition that causes psychosis might require coordinated specialty care to resolve effectively. Psychosis treated by a professional team usually reduces in severity over time.
How do you know if someone is mentally ill?
It is typically not possible to know if someone is mentally ill without an appropriate professional evaluation unless the person communicates their diagnosis to you. It is typically unwise to make guesses regarding a person’s mental state. If you feel the person is a danger to themselves or others, you may want to contact someone to help them. If you know them personally, reaching out to loved ones who know any underlying conditions might be useful. If you do not know the person, it is often helpful to contact local authorities, who can ensure the person does not hurt themselves or another person.
How do you talk to a psychotic person?
Talking to a person experiencing an acute psychotic episode can sometimes be challenging. By definition, psychosis refers to a departure from reality. A person experiencing an episode may not make much sense and may behave strangely or erratically. Because psychosis can cause severe paranoia and suspicion, it is typically wise to give the person experiencing the episode plenty of space and to reiterate that you are not a threat.
Having a calm, level tone while speaking to someone experiencing an episode is often helpful. You might help by contacting family support, the person’s social worker (if they have one), or helping the person access prescribed medication. When experiencing psychosis, people often struggle to recognize that they need help and may refuse your offer of support.
How do you calm down psychosis?
Generally, resolving psychosis and preventing future episodes requires professional treatment. Psychotic symptoms are typically treated through medications, psychotherapy, and support services. Employment and education services are often helpful in teaching people who experience psychotic episodes how to manage practice problems that may arise due to their symptoms. Antipsychotic medications are typically the first-line treatment for psychotic episodes and one of the first skills people typically learn is medication management. While clinical trials are underway to develop easier-to-use medications, the antipsychotics currently available often require the person taking them to learn additional skills and strategies to use them properly.
- Previous Article