Psychosis, a mental health condition where patients lose touch with reality, is estimated to affect as much as 3.5% of the population.
This article will provide a comprehensive understanding of psychosis, covering its symptoms, causes, diagnosis, treatments, and global perspectives. Please note that this article is for informational purposes and should not substitute for professional medical advice, diagnosis, or treatment.
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What is Psychosis?
Psychosis refers to mind-affecting symptoms where the patient has some loss of contact with reality. During an episode of psychosis, a person’s thoughts and perceptions are disrupted, and they may have difficulty recognizing what is real and what is not.
This disruption of reality can affect someone in a wide array of ways, from emotional symptoms such as anxiety and depression to hearing voices and seeing things that aren’t there.
While schizophrenia is the most publicly known form of psychosis, there are multiple diseases, including:
- Schizophrenia is characterized by hallucinations, delusions, and thought disorder.
- Schizoaffective disorder, which is a mix of schizophrenia mixed with depression and other mood disorders, is often misdiagnosed as bipolar disorder.
- Bipolar disorder, also known as manic-depressive disorder, is noted for dramatic shifts in mood, energy, and activity levels that affect day-to-day functioning.
- Brief psychotic disorder is characterized by sudden onset, short-term episodes of psychotic behaviors, often resulting from a stressful event and lasting less than one month.
- Postpartum psychosis is a rare but dangerous illness that is considered a psychiatric emergency. It occurs between two and four weeks after birth wherein the mother begins having psychotic symptoms.
Symptoms of Psychosis
Some of the common signs of psychosis are:
- Hallucinations that can be heard, seen, smelled, felt, or any combination of those.
- Delusions, or having an unshakeable belief in something that’s not true, such as paranoia, grandeur, or believing they are divine or possess divine powers.
- Disorganized thinking, like losing a thought, switching topics mid-sentence, or having rapid and constant speech.
- Impaired insights, such as being unable to understand they have an illness.
In rare cases, patients might become catatonic or experience Cotard’s Syndrome, which is the belief that they are dead or don’t exist.
Healthcare teams, patients, and families should be aware of early signs of a possibly impending psychotic episode. Those early signs include:
- Difficulty focusing with confusion and disorganized thinking.
- Unusually withdrawn and refusing to be part of society.
- Neglecting personal hygiene.
- Sudden changes in mood and personality.
- Excessively irritable and anxious with increased suspiciousness and paranoia.
Anyone experiencing these symptoms should seek evaluation by a qualified healthcare provider.
Causes and Risk Factors
There is no one cause of psychosis. The causes of psychosis are often due to a complex combination of genetic risk, differences in brain development, and exposure to stressors or trauma. With that in mind, the causes of psychosis can be broken down into three primary categories:
- Biological factors, including brain development, genetics, and malformation of dopamine centers in the brain.
- Environmental factors, such as trauma and abuse, significantly stressful life events, and substance abuse, including alcohol and illegal drugs.
- Psychosocial factors like experiencing extreme prejudice, being socially isolated, being in an unhealthy family with high levels of conflict, neglect, and abuse.
Diagnosis of Psychosis
For a complete diagnosis of psychosis, a healthcare team will often begin with a comprehensive evaluation by a mental health professional.
A clinical evaluation will examine a patient’s history and family history and evaluate symptoms. It will also include a battery of psychiatric evaluations and assessments. A team might also order imaging of the brain, such as an MRI, blood tests for specific psychosis-related markers, and genetic testing if there is a history of psychosis in the family.
For a diagnosis of psychosis to be made, a patient must show:
- Delusions, hallucinations, disorganized speech, disorganized behavior, or grossly disorganized thinking.
- Symptoms that have been present for at least a month.
- Symptoms that cannot be explained by other disorders or medical conditions.
Treatment and Management of Psychosis
Once a diagnosis has been made, treatment can begin to lessen or control the symptoms. Conventional treatments use antipsychotic medications, such as lithium, combined with psychotherapy, also known as talk therapy, and, in severe cases, hospitalization.
With a greater understanding of the connection between the mind, the body, and the gut microbiome, emerging integrative therapies are being explored as supportive approaches for individuals with psychosis.
Some emerging treatments for psychosis include:
- Art therapy
- Ecotherapy
- Aromatherapy
- Assertive Community Treatment (ACT)
- Cognitive Behavioral Therapy (CBT)
In addition, several nutrients, such as sarcosine, phytosterols, Vitamin D, and N-acetylcysteine, have been studied for their role in general brain health and neurotransmitter function. However, these are not approved treatments for psychosis, and any supplementation should be discussed with a healthcare provider.
While some emerging research suggests specific nutrients may support overall brain health, supplements are not approved by the FDA for the treatment of psychosis. Always consult a healthcare provider before beginning any new supplement regimen.
It is important for patients with psychosis to maintain a proper treatment protocol, including medication adherence and regular checkups, to ensure they remain episode-free. Unfortunately, it is well known that patients experiencing psychosis often stop taking their medication, resulting in increased psychotic events.
Family members and friends can play an important role in ensuring patients adhere to their medication schedules and continue to be treated for this disease.
Research and the Future of Psychosis Treatment
Ongoing research into the nature and treatment of psychosis includes early identification of psychosis, finding neural markers to identify psychosis, and investigating the connections between dopamine and psychosis.
In September 2024, the Federal Drug Administration (FDA) approved Cobenfy as a new oral medication for the treatment of schizophrenia. This new medication – the first breakthrough for schizophrenia in decades—may ease symptoms such as hearing voices, hallucinating, illogical or delusional thinking, and being suspicious of other people. It also appears to have fewer side effects than other medications. This medication may not be appropriate for everyone, and a licensed medical provider should make prescribing decisions.
A recent article, New Insights Into Psychotic Disorders, discussed new findings about psychosis that covered early symptoms, racial and ethnic influences on psychosis development, machine learning methods for accurate predictions, and more.
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Key Takeaways
Psychosis affects up to one in every 100 people, making it a disease of great importance to the medical community. It often presents with:
- Hallucinations
- Delusions
- Disorganized Thinking
- Paranoia
- An inability to recognize that one is ill
Psychosis is part of a large array of diseases, such as:
- Schizophrenia
- Schizoaffective Disorder
- Delusional Disorder
- Bipolar Disorder
- Postpartum Disorders
While there are treatments and emerging medications, it is still a disease that many find difficult to understand and a challenge to handle in daily life.
It is important that patients, their families, communities, and medical teams remember that psychosis is a multifaceted disease that can affect a wide range of individuals in a multitude of different ways. Empathy and education should be the foundation of psychotic care.
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