What Is The Difference Between Mild, Moderate, And Severe Psychosis?

Psychosis is a mental state that can have a profound impact on a persons’ thoughts and actions and can impact the people around them. Symptoms of psychosis can range from mild to severe and may manifest differently depending on the underlying cause for psychosis symptoms. In this article, we’ll explore the differences between mild, moderate, and severe psychosis.

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What is psychosis? 

Beyond schizophrenia and bipolar disorder: Conditions linked to psychosis

Other conditions associated with psychosis include:

• Brain tumors
• Multiple sclerosis
• A family history of psychosis
• AIDS and HIV
• Stress
• Trauma or a mental illness like post-traumatic stress disorder (PTSD) 
• Severe sleep deprivation
• Lupus
• Alzheimer’s disease
• Malaria
• Parkinson’s disease
• Substance misuse 
• Severe injury 
• Medication side-effects
• Syphilis 

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The symptoms an individual experiences may vary based on the underlying cause. However, there are several that individuals with psychosis may have in common, such as hallucinations, delusions, and disorganized speech. 

What are psychosis hallucinations?

For those experiencing psychosis, hallucinations often take the form of false sensory events and false beliefs that can convince a person they are seeing, hearing, touching, smelling, or feeling a stimulus that is not present. 

Hallucinations can take the form of situations a person is familiar with or experiences they have never had. For example, an individual who is hallucinating may hear the voice of someone they know, such as a friend or family member. However, auditory hallucinations can also take the form of unknown entities or personified objects, which may increase the stress associated with the event. 

What are psychosis delusions?

Psychosis delusions can cause a person to strongly believe in untrue ideas. These delusions can be categorized in various forms, such as the following: 

• Paranoid: Paranoid delusions can lead a person to believe they are being monitored or pursued by entities that mean them harm, including government agencies or criminal organizations.
• Control: A control delusion can cause someone to think they are being externally controlled. The source of this control can vary but may include celebrities, politicians, electronics, coworkers, or larger groups. 
• Grandiose: A person experiencing delusions of grandeur may believe they are an important historical figure, famous, or the leader of a large organization. Grandiose delusions can also be supernatural, with some believing they have special powers or abilities. 
• Somatic: Somatic delusions may cause a person to believe that a certain event is happening to their body. For example, someone may think that they are suddenly terminally ill or that a creature is living inside of them. 
• Depressive: A depressive delusion can lead someone to feel significant shame or guilt, even about an occurrence they are not responsible for. This type may sometimes be referred to as “very depressed psychosis.” 

How does psychosis relate to disorganized speech?

Disorganized thoughts may cause a person to have confusing or disruptive patterns of thought, which can subsequently affect how effectively they communicate. For example, a person may have racing thoughts, which could cause them to speak quickly and change subjects abruptly. Disordered thoughts and speech may also cause a person to use meaningless words or stop talking in the middle of their sentence, which may create further communication difficulties. 

These and other symptoms may present in various levels of severity. In some cases, psychosis may start with more mild symptoms before progressing to moderate and then severe as an episode progresses. Understanding how to tell these variations in severity apart may help you recognize when you or a loved one is entering a psychotic episode. 

How to tell mild, moderate, and severe psychosis apart

While a medical or mental health professional completes the assessment and diagnosis of psychosis, certain tools may be used to determine how severe the symptoms of psychosis are. For example, the American Psychiatric Association (APA) provides a measure known as the Clinician-Rated Dimensions of Psychosis Symptom Severity. This measurement lists various symptoms—including hallucinations, delusions, and disorganized speech—that may be associated with various psychotic disorders. 

A mental health specialist rates the severity of these symptoms on a scale of zero to four, where higher numbers indicate greater severity. A rank of zero or one suggests that a symptom is not severe enough to be considered psychosis, while ranks two through four may indicate that a person is experiencing mild, moderate, or severe psychotic symptoms. 

Rank two: Mild psychosis symptoms

Mild psychotic symptoms can look like the following: 

• Mild hallucinations: Hallucinations are present, but they do not significantly bother a person, and the individual is not inclined to act upon them.
• Mild delusions: Delusions are present, but the person experiencing these delusions is not significantly bothered by them. Like mild hallucinations, a person with mild delusions may not have a sense of pressure to act.
• Mild disorganized speech: In this case, disorganized speech may be present but only manifest as “some difficulty following speech.” 

Rank three: Moderate psychosis symptoms

Moderate psychosis symptoms may present with the following: 

• Moderate hallucinations: Hallucinations may be more severe, with individuals becoming somewhat bothered by them or sensing some pressure to respond. 
• Moderate delusions: Delusions may be more severe, with individuals becoming somewhat bothered by their beliefs and experiencing some pressure to act upon them. 
• Moderate disorganized speech: The disorganization of one’s speech may be more severe, with an individual's speech becoming more challenging to follow. 

Rank four: Severe psychosis symptoms

Severe psychotic symptoms often occur when an individual has a total disconnect from reality, including the following: 

• Severe hallucinations: Hallucinations are significantly more severe, with a person becoming extremely bothered by their hallucinations and having a high level of pressure to respond. 
• Severe delusions: Delusions are significantly more severe, with a person becoming highly bothered by their beliefs and experiencing a high level of pressure to act upon them. 
• Severe disorganized speech: The disorganization of one’s speech is significantly more severe, which may make it highly difficult to understand them. 

This scale is only one way for a mental health worker or doctor to measure the severity of psychosis symptoms and note whether an individual develops psychosis. Seek the support of a medical or mental health professional if you believe you are experiencing psychotic episodes. These professionals may be able to assess your condition, provide a diagnosis, and recommend treatments that could alleviate psychotic symptoms. 

What is the best way to treat psychotic symptoms?

While the best treatment for psychosis may vary from person to person, there are several treatments that experts recommend. According to the UK National Health Service (NHS), these treatments include certain medications, such as antipsychotics, and several forms of therapy, such as cognitive-behavioral therapy (CBT).

Benefits of CBT when people lose some contact with reality

A CBT provider may help an individual with psychosis recognize their symptoms and find coping methods to alleviate their discomfort. Research suggests that CBT may have several other benefits for those with psychosis, such as:

• Prevention of initial episode of psychosis in “ultra-high risk” individuals
• Improvement in self-esteem, psychological well-being, and feelings of depression
• Positive changes in mood, thinking, and sleep quality
• Fewer hospitalizations
• A higher number of voluntary hospitalizations than involuntary

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Alternative support options for psychotic disorder

In-person forms of CBT and other types of therapy may not be available or convenient for everyone experiencing psychosis. People with psychosis may also have difficulty trusting others, which may interfere with their willingness to find a therapist they click with or to participate in treatment. With online therapy, clients can choose to attend therapy sessions how they feel most comfortable: via phone, video or messaging. Online therapy also makes it simple for clients to change their therapist and find one that they click with.  

Effectiveness of online therapy for mental health

Research suggests that online therapy may be as effective as in-person therapy. In a 2022 systematic review and meta-analysis, researchers compared the efficacy of face-to-face and telehealth therapy for treating several mental health and physical conditions. They found no significant differences between the approaches for several outcomes, including overall improvement, function, and working alliance.