Psychosis: Symptoms, Causes & Treatment

Psychosis is a loss of contact with reality that can cause confusion, hallucinations, delusions, and other symptoms of a psychotic episode. A person experiencing psychosis may have difficulty telling what is real from what is imagined.

Psychosis is considered a symptom rather than a disease and often first appears during adolescence or early adulthood. It may be temporary, as in brief psychotic disorder, or associated with psychiatric conditions such as bipolar disorder, schizophrenia, or depression.

Psychosis can also occur in people who use certain drugs or substances. Treatment is provided by a psychiatrist and may involve psychotherapy, antipsychotic medications, mood stabilizers, or hospitalization in more severe cases.

Psychosis symptoms

According to the National Institute of Mental Health, symptoms and warning signs of psychosis may include:

• Delusions
• Hallucinations, such as hearing voices or seeing things that others do not
• Difficulty thinking clearly or logically
• Difficulty telling reality from fantasy
• Confused or incoherent speech
• Behavior that is inappropriate, confusing, or unpredictable
• Self-harm or threatening behavior in some cases

A person experiencing psychosis may also have an exaggerated and unrealistic belief about their identity or importance, such as believing they are a god or have been given a special mission.

Other symptoms may include feeling that other people are controlling their thoughts or actions. A person may also experience erotomanic delusions, in which they believe that someone else is in love with them.

Childhood psychosis

The main symptoms of childhood psychosis include:

• A decline in school performance

• Talking or laughing for no apparent reason

• Not wanting to play with other children

• Distrust of other people

• Developmental or speech delays

The child may also experience irritability, agitation, aggression, a depressed mood, or a loss of interest or motivation.

Confirming a diagnosis

Psychosis is diagnosed through an evaluation by a psychiatrist or another qualified healthcare professional. The assessment includes the person’s symptoms, when they began, their severity, and changes in behavior, mood, speech, or thinking.

The healthcare professional will also review the person’s medical and psychiatric history, medication and substance use, social history, and any history of trauma. Information from family members or friends may also be helpful.

Tests may be ordered to rule out medical or substance-related causes. These may include blood tests, thyroid tests, urinalysis, or toxicology screening. A CT scan or MRI may be considered when neurological symptoms are present or another medical cause is suspected.

What causes psychosis?

According to the National Institute of Mental Health, psychosis may be linked to genetic factors, brain development, stress or trauma, mental health conditions, medical problems, medications, or substance use.

The main causes and risk factors for psychosis include:

• A family history of psychosis, particularly in a parent or sibling

• Psychiatric conditions, such as schizophrenia, bipolar disorder, severe depression, or other psychotic disorders

• Conditions that affect the central nervous system, such as dementia, Alzheimer’s disease, or Parkinson’s disease

• Emotional, physical, or sexual trauma

• Periods of extreme stress

• Brain tumors, traumatic brain injuries, or brain infections

Other possible causes include drug or alcohol use, hallucinogenic substances, certain medications such as barbiturates or benzodiazepines, alcohol withdrawal, and poisoning from lead, mercury, or arsenic.

Postpartum psychosis

Postpartum psychosis is a rare psychiatric condition that can occur after childbirth. It may be associated with the hormonal and physical changes that occur during the postpartum period and can cause agitation, restlessness, delusions, or hallucinations.

Psychosis treatments

Treatment for psychosis depends on the underlying cause and the severity of symptoms and may include:

1. Medications

Medications may be prescribed by a psychiatrist to help control psychotic episodes and related symptoms.

Medications that may be prescribed include:

• Antipsychotics, such as chlorpromazine, thioridazine, or clozapine

• Mood stabilizers, such as lithium, carbamazepine, or valproic acid

• Benzodiazepines, such as lorazepam, for symptoms of catatonia

Postpartum psychosis is a psychiatric emergency that requires immediate treatment. Medications may be prescribed, and hospitalization is often necessary to protect the health and safety of both the mother and the baby. Temporary separation from the baby may be recommended if there are concerns about the safety of either the mother or the infant.

With prompt treatment, symptoms often improve, and most women are able to return to their usual activities. However, postpartum psychosis can recur in a future pregnancy, so close monitoring by a healthcare team is recommended.

2. Hospitalization

Hospitalization may be necessary during a severe psychotic episode, especially if the person poses a danger to themselves or others or is unable to care for themselves safely.

During hospitalization, the person can receive close monitoring, treatment, and medications as needed until the symptoms are stabilized.

The length of hospitalization depends on the severity of the condition and the person's response to treatment. After discharge, ongoing treatment may include taking prescribed medications and attending follow-up appointments with a mental health professional.

3. Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) helps people develop skills to cope with psychosis, manage symptoms, and work toward personal recovery goals. Family education and support may also help relatives understand psychosis and develop communication, coping, and problem-solving skills.

CBT should be provided by a qualified mental health professional and may be used alongside medication and other treatments. Rehabilitation, case management, and employment or education support may also help the person return to everyday activities.