What Might Incite a Psychotic Episode? Exploring Common Inducing Factors

Psychotic episodes can be disruptive and distressing experiences that involve a loss of connection to reality and difficulty determining what is and isn’t real. Psychosis has various causes, including certain mental health conditions, physical illnesses, head injuries, and others.  

Learning more about what circumstances and conditions may incite a psychotic episode may be useful when trying to manage these symptoms. Below, learn more about what defines a psychotic episode, what may incite one, and the available treatment options if you’re struggling with this experience.

What is a psychotic episode?

A psychotic episode is an incidence of psychosis, a group of symptoms characterized by a disconnection from reality. Psychosis can occur as a result of many different causes, including a range of mental and physical conditions. In many cases, psychosis affects a person’s ability to carry out daily activities and interact with loved ones. It's crucial for individuals experiencing or showing signs of early psychosis or an initial schizophrenia episode to consult a qualified healthcare professional.

Symptoms of psychosis

Psychosis symptoms can differ for each person experiencing them, but several symptom categories describe the types of psychosis often reported in connection to a psychotic episode, including the following. 

Hallucinations

Hallucinations are sensory experiences involving stimuli others cannot perceive. Hallucinations may affect your sense of sight, sound, taste, touch, or smell. It can be crucial to note that hallucinations are perceived as real by the person experiencing them. Some people experience combination hallucinations, such as hearing voices and talking to someone who isn’t there. Hallucinations may make intrusive, distressing comments, commands, or otherwise influence your mood and behavior. 

Delusions

Psychosis delusions involve fixed beliefs in ideas that aren’t true, such as the conviction that a celebrity you’ve never met is in love with you. Delusions in psychosis also include persecutory delusions, in which an individual might irrationally believe they are being harassed, poisoned, or conspired against by others. Grandiose delusions are beliefs in one's exaggerated self-importance, power, or abilities.

Disorganized thoughts and behavior

Catatonia

Advanced psychotic disorders or extreme psychotic episodes may include a state of catatonia, which can appear as unusual movements, lack of movement, or unresponsive staring. 

Negative symptoms

A psychotic episode can reduce your cognitive, physical, and emotional functional ability, presenting as a marked decline in your speech, movement speed, physical activity, emotional responsiveness, pleasure from social contact, and loss of interest in previously enjoyed activities. 

According to the National Alliance on Mental Illness (NAMI), psychosis is more common than people may assume. It is estimated that as many as three in 100 people will have an episode of psychosis at some point in their lives.

Possible inciting events

There is a wide range of possible inciting events for a psychotic episode, which can differ from one person to the next. Included below are several possible causes. 

Medical conditions or head injuries

A psychotic episode doesn’t necessarily mean there’s an underlying psychological disorder. Psychosis can also occur due to a range of other medical conditions, head injuries, or physical illness. For instance, people may experience psychosis in connection with medical conditions like Alzheimer’s disease and other types of dementia, lupus, Lyme disease, multiple sclerosis, movement disorders, Cushing’s disease, infections of the brain or spinal cord, or stroke. People may also experience psychosis after experiencing head injuries like a concussion or traumatic brain injury (TBI). 

Mental health conditions

Psychosis can sometimes be a symptom of an underlying mental health condition. In many cases, certain mental health disorders involve psychosis as the main symptom, especially in people with schizophrenia and other psychotic disorders. However, it may not always be a primary symptom, as psychosis can often accompany other symptoms of mental illnesses. Mood disorders (e.g., bipolar disorder), anxiety disorders (e.g., panic disorder), and addiction-related mental health conditions (e.g., substance use disorder) may also feature psychotic symptoms. Mental health conditions associated with psychosis include:

• Schizophrenia

• Schizoaffective disorder

• Delusional disorder

• Brief psychotic disorder

• Postpartum psychosis

• Bipolar disorder

• Major depressive disorder (MDD)

• Anxiety disorders 

• Substance use disorder

Witnessing or experiencing a traumatic event

Traumatic events can be another cause of psychosis. In some cases, a person witnesses or experiences an event so traumatic that their mind separates from reality and drastically alters thinking and perception, leading to a psychotic episode. For example, experiencing sexual assault during childhood may be linked to an increased risk of psychosis. Psychosis commonly develops alongside post-traumatic stress disorder, potentially exacerbating trauma symptoms.  

Substance use 

Substance use has also been linked to psychotic episodes. Some people may experience psychosis after drinking significant amounts of alcohol or consuming certain illicit substances. Recreational drugs like LSD, cocaine, MDMA, and ketamine may contribute to a psychotic episode or make symptoms worse. In some cases, prescription medications, such as certain steroids, seizure medications, and antiretroviral drugs, can sometimes trigger psychotic episodes as a side effect. 

In addition, a person could have a psychotic episode as part of experiencing withdrawal symptoms. For example, a person who suddenly stops drinking alcohol or consuming illicit drugs after they’ve been doing so for a long time might experience visual or auditory hallucinations, delusions, or other symptoms of psychosis. 

If you are having an unwanted reaction to your prescribed medication, reach out to your prescribing doctor for support. Do not stop a medication without consulting a medical or mental health professional.   

Low blood sugar

Low blood sugar can contribute to a psychotic episode in rare cases. Researchers note that hypoglycemia can lead to “psychiatric symptoms ranging from delirium and confusional states to psychosis.”

Severe sleep deprivation

Another possible cause of psychotic symptoms is severe sleep deprivation. A 2018 study conducted a systematic review of the effects of sleep deprivation, looking at studies that involved sleep loss ranging from 24 hours to 11 nights. The researchers found that psychotic symptoms developed with increasing time awake, ranging from simple visual misperceptions to delusions and hallucinations, ultimately ending in a condition “resembling acute psychosis.” While this connection can be partially explained by the connection between sleep and mental health challenges, the study notes that some people who experience psychosis due to sleep disruptions do not have a history of mental illness. 

Genetic factors and differences in brain development

Researchers also believe genetic risk and differences in brain development may be factors in the presence of psychosis symptoms. Several psychotic and mood disorders seem to have a genetic component, like schizophrenia and bipolar disorder—making people with a family history of psychosis at higher risk for a psychotic episode. 

Types of treatment available

The most appropriate psychosis treatment option depends on the cause and the individual. Below are a few options for treating psychosis. 

Common treatment approaches

If psychosis is caused by an underlying medical condition, treating that condition sooner rather than later may be vital. Healthcare providers will typically prescribe antipsychotic drugs in addition to recommending therapy or other options.

Mental health care can address the emotional and cognitive challenges of psychosis. Antipsychotic medications are a common treatment for psychosis, and cognitive-behavioral therapy (CBT) is a common form of talk therapy that can be used to help clients manage long-term symptoms. Cases of severe psychotic episodes may cause an individual to become a danger to themselves or others. In severe cases, inpatient treatment may be recommended for people with psychosis. 

Alternative support options

A psychotic episode can be a distressing, confusing experience that is often difficult to navigate on your own. Working with a licensed mental health professional can help you manage psychosis and identify underlying physical or psychological causes. Help is available in person and online, and different situations may require different approaches. 

For some people, symptoms of psychosis or underlying causes may make it difficult to leave the house to attend an in-person appointment. In these cases, online therapy through a platform like BetterHelp may be more convenient, as it allows you to meet with a licensed therapist from the comfort of your home. In addition, online platforms are often more cost-effective than in-person treatment options. 

A significant body of research has also demonstrated the effectiveness of online therapy. For instance, a 2021 study conducted a review of online interventions for psychosis and found that a growing body of evidence suggested online interventions could be “feasible and acceptable to individuals with psychotic disorders and may be effective in assisting with clinical and social outcomes amongst this population.” Specifically, the review notes that studies have found that online interventions have been associated with improving hallucinations, depressive symptoms, self-efficacy, motivation, and daily functioning.