Psychosis occurs when a person’s ability to comprehend reality changes. It is a primary symptom of many other mental health disorders, including some substance abuse problems. A person struggling with psychosis does not experience a complete break from reality, but changes in their perceptions mean that it is difficult for them to recognize what is real and what is not. As many as three in every 100 people will experience psychosis at some point in their lives, and about 100,000 young people in the United States experience psychosis every year.

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What Are The Signs of Psychosis?

  • False beliefs
  • Hallucinations
  • Confused thinking
  • Changes in feelings
  • Changes in behavior

What Are The Phases of Psychosis?

  • Early Warning Signs
  • Acute Phase
  • Recovery Phase

What Are The Causes of Psychosis?

  • Schizophrenia
  • Schizophreniform Disorder
  • Schizoaffective Disorder
  • Bipolar Disorder
  • Delusional Disorder
  • Organic Psychosis
  • Dementia
  • Psychotic Depression
  • Postpartum Psychosis
  • Brief Psychotic Disorder
  • Substance Abuse Related

General Signs of Psychosis

There are five general categories of symptoms that indicate psychosis. A person may not experience all of these, but may display a few symptoms.

  1. False beliefs: Also called delusions, these are some of the main symptoms of psychosis. The individual may be convinced that an aspect of their reality is different, or that they have new insight into a different reality. For example, they could believe that they are receiving alien messages from their microwave. Delusions are often associated with paranoia, indicated by suspicion of others or the feeling of being monitored.
  2. Hallucinations: These are changes to perception or brain processing that lead the individual to believe something that is not real. Hallucinations can be auditory, such as hearing voices; visual, such as seeing disturbing things; tactile, including feeling different textures; taste, including changes in the taste of foods leading to the belief that the food is poisoned; or changes in smell, leading to the mistaken belief in the presence of something bad. Hallucinations are a primary indication of psychosis, although they do not appear in the early stages of the condition.
  3. Confused thinking: The person is unable to focus or think clearly. Their speech patterns or sentence structure may no longer make sense; this is sometimes this is referred to as “word salad.” The person’s thoughts may appear to race, or they could process information much more slowly than normal. They may have trouble following the topics in a conversation or remembering events, places, or people.
  4. Changes in feelings: The individual’s emotional responses or feelings about their life, the people in their life, their living situation, and more can change for no apparent reason. A common reaction to these emotional changes is for the person to become more cut off from their loved ones, stop going to work or school, or avoid social engagements. Mood swings are a common occurrence, particularly extreme excitement and depression. On the other end of the spectrum, the individual’s emotions could be dampened, or the person may not display an emotional reaction at all.
  5. Changes in behavior: This includes the individual reducing their involvement in social or family activities. It also includes extreme periods of mania or hyperactivity and lethargy. There may be no apparent cause for their excitement, anger, or fear reactions. They may engage with the world differently; for example, a person who believes they are being stalked may call 911, or a person who believes someone is trying to poison them may stop eating or drinking. They may lose sleep and be unable to take care of personal hygiene.

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Phases of Psychosis

There are generally three stages to psychosis. It is important to help a person who is experiencing early warning signs as soon as possible, but due to the person’s wish to withdraw from the world in most cases, this can be difficult. Young men, ages 15-30, and less often women ages 18-35, are more at risk of developing psychosis than other age groups. Here are signs and symptoms associated with each phase.

  1. Early Warning Signs, or Prodome

    Psychosis can be a persistent symptom of a larger problem, or it can occur one time (first-episode psychosis) and be successfully treated after the underlying cause is discovered. However, psychosis does not typically come out of the blue; most often, there are early warning signs that psychosis will occur. Early warning signs of psychosis include:

    • Decline in job or school performance
    • Difficulty concentrating
    • Cognitive difficulties or an inability to think clearly
    • Uneasiness around other people
    • Suspicion of people, places, or things
    • Decline in personal hygiene and self-care
    • Spending more time alone
    • Loss of emotional reaction, or strong reactions that are inappropriate to the situation
    • Changes in perception (sight, taste, or touch) that are radically different from others’ perspectives
    • Confused speech or difficulty communicating
    • Unusual or intense new ideas, especially if the individual did not think this way before

    There are also symptoms associated with the first episode of psychosis. While many people may believe that psychotic symptoms are easy to identify, a person who experiences this first episode may try to hide the symptoms or mistakenly believe they will go away without help. It can help if loved ones understand that first-episode psychosis is not grandiose or easy to pinpoint.

  1. Acute Phase
    This phase of psychosis is the most recognized and will continue until the person receives appropriate treatment. Symptoms of acute psychosis include:

    • Delusions of being persecuted
    • Religious or spiritual delusions
    • Grandiose delusions (for example, being bulletproof)
    • Delusions leading to self-harm
    • Somatic or bodily delusions
    • Feeling as though thoughts or emotions are being inserted into the person’s mind, such as through a broadcast
  1. Recovery Phase
    Many people recover from psychotic episodes with appropriate treatment. Even if they have a condition that puts them at risk of experiencing another episode, the severity of these can be controlled with medication and therapy. Treatment includes helping the person understand the difference between the symptoms of psychosis and the reality around them.

Causes of Psychosis and Associated Symptoms

There are several different conditions that can lead to psychotic symptoms. Dramatic changes in brain chemistry, brain structure, or hormones can lead to psychotic symptoms, both temporary symptoms and more permanent symptoms. Here are a few conditions that cause psychosis and the symptoms associated with them.

  • Schizophrenia: Most people associate the symptoms of schizophrenia with psychosis, and this is one of the major signs of this disorder. Schizophrenia is typically diagnosed by monitoring the experience of psychotic symptoms; if the person experiences psychosis for at least six months, they are likely experiencing schizophrenia.
  • Schizophreniform disorder: This is the experience of psychosis for less than six months. This condition may resolve itself, or it may develop later into other psychological disorders.
  • Schizoaffective disorder: This involves the occurrence of symptoms of both schizophrenia and a mood disturbance, either alternating or co-occurring.
  • Bipolar disorder: Mood disturbances and thought disturbance are the primary characteristics of psychosis in bipolar disorder. Hallucinations and delusions are rare, although they may occur during manic periods. During depressed periods, the person may hear voices that talk negatively to them.
  • Delusional disorder: This involves the experience of strong, persistent false beliefs. This condition typically does not have hallucinations associated with it, but changes in speech, action, beliefs, and emotions are present.
  • Organic psychosis: Damage to the brain due to head injury or a physical illness that changes brain structure can lead to long-term psychotic symptoms. Brain tumors, HIV/AIDS, some types of epilepsy, strokes, and other organic changes to the brain can affect specific areas, leading to perceptual, emotional, behavioral, and personality changes.
  • Dementia: Both Alzheimer’s disease and Parkinson’s disease lead to changes in brain chemistry and brain structure that can sometimes trigger psychotic reactions or symptoms.
  • Psychotic depression:This subtype of major clinical depression is defined by classic symptoms of depression, along with symptoms of psychosis. Symptoms include:
    • Agitation
    • Anxiety
    • Hypochondria
    • Insomnia
    • Difficulty thinking or other cognitive problems
    • Delusions and/or hallucinations
    • Physical immobility
    • Constipation
  • Postnatal or postpartum psychosis:This type of psychosis most often occurs in new mothers, although sometimes new fathers can experience milder symptoms. Postpartum psychosis is an extreme form of postpartum depression, and it affects roughly one out of every 1,000 new mothers after birth. Symptoms become most apparent a few weeks after the baby is born. Symptoms include:
    • Mania, especially talking or thinking too quickly
    • Extreme low mood, loss of energy, loss of appetite, and decreased sleep
    • Paranoia or delusions about the new child
  • Brief psychotic disorder:A major stress in a person’s life, such as sudden loss of a loved one, an experience of war or terrorism, or something equally devastating, can cause psychotic symptoms that resolve themselves. These symptoms usually last less than a month.
  • Substance abuse: Drug addiction and abuse can change the brain’s chemistry and sometimes the brain’s structure. This can lead to psychosis and, in some people, may trigger pre-existing conditions like schizophrenia or bipolar disorder, which, if untreated, can lead to psychosis. Substances that can lead to psychotic symptoms include:
    • Alcohol: Alcohol withdrawal syndrome, or delirium tremens, can include psychotic symptoms, such as hallucinations, paranoia, delusions, and extreme emotional changes.
    • Caffeine: Although it is unlikely that a person could take a large enough dose of caffeine to truly harm the brain, people who are predisposed to panic attacks or psychosis may have those symptoms triggered if they chronically ingest caffeine. Additionally, drinking a lot of caffeine can be a form of self-medicating depression and insomnia.
    • Cocaine and amphetamines: These powerful stimulants can, in large doses, induce psychosis while the person is intoxicated. When the person attempts to detox from these substances without medical supervision, they may experience anhedonia or a lack of emotion, that is tied to a longer lasting psychosis. Binges or long-term abuse of these drugs can lead to changes in the brain that can cause permanent psychosis.
    • Hallucinogens: LSD, mushrooms, and other hallucinogens can trigger psychosis in people predisposed to mental illnesses like schizophrenia or bipolar disorder. Although it is rare, people who abuse hallucinogens for a long time may also change their brain structure enough to develop permanent psychosis.
    • Opioids: Post-acute withdrawal syndrome from opioid drugs may lead to some symptoms of psychosis, including hallucinations.
    • Sedatives: Benzodiazepines in particular can lead to a post-acute withdrawal syndrome that features symptoms of psychosis, such as anxiety, paranoia, emotional changes, delusions, and hallucinations.
    • Nicotine: People who struggle with addiction to cigarettes or nicotine in other forms are more likely to also experience depression, although it is difficult to tell which came first. However, smoking or ingesting nicotine products may be associated with psychotic depression.
    • Marijuana: Using this drug can trigger psychosis in people who are predisposed to the condition, especially schizophrenia or bipolar disorder. Long-term abuse of marijuana has been linked to brain changes that can induce psychosis, especially paranoia and delusions.

Treatment for Psychosis and Substance Abuse

People who experience psychosis often need help from their loved ones to get treatment. It is important to keep early warning signs in mind and help those experiencing these symptoms find appropriate medical and therapeutic treatment. In some cases, people who struggle with substance abuse or addiction can induce psychotic symptoms; in other cases, a person who suffers a mental health issue, such as psychotic depression, bipolar disorder, or schizophrenia may self-medicate with intoxicating and addictive substances, especially alcohol, marijuana, or nicotine, in order to change their brain chemistry to feel normal.

Abusing substances with a mental illness results in co-occurring disorders, and it’s important to find a rehabilitation program that is equipped to help people with co-occurring disorders. Substance abuse and the mental health condition must be treated together, because one condition cannot resolve without appropriate treatment for the other.