Psychosis

What is psychosis?

Psychosis is disconnection from reality. People may have false beliefs or experience things that aren’t real. Psychosis isn’t a condition. It’s a term that describes a collection of symptoms.

Two important types of psychosis include:

• Hallucinations. These are when parts of your brain mistakenly act like they would if your senses (vision, hearing, touch, smell and taste) picked up on something actually happening. An example of a hallucination is hearing voices that aren’t there (auditory hallucination).
• Delusions. These are false beliefs that someone holds onto very strongly, even when others don’t believe them or there’s plenty of evidence that a belief isn't true. For example, people with delusions of control believe someone is controlling their thoughts or actions remotely.

What are the most common causes of psychosis?

Psychosis is a common symptom of many mental health conditions. The America Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) has an entire category devoted to these conditions.

This category, “Schizophrenia Spectrum and Other Psychotic Disorders,” includes the following conditions:

• Schizophrenia.
• Brief psychotic disorder.
• Delusional disorder.
• Schizoaffective disorder.
• Schizophreniform disorder.
• Schizotypal (personality) disorder.
• Substance/medication-induced psychotic disorder.
• Psychotic disorder due to another medical condition.

Psychosis can also happen with certain types of mood disorders. Those include:

• Bipolar disorder.
• Major depression and related conditions.

Medical conditions that can cause psychosis

Psychosis can also happen because of a wide range of other conditions that affect your brain and body. These include:

• Alzheimer’s disease and other types of dementia.
• Hormone-related conditions like Addison’s disease and Cushing’s disease, and when your thyroid gland is too active or not active enough.
• Infections of your brain or spinal cord (encephalitis or meningitis).
• Lupus.
• Lyme disease.
• Multiple sclerosis.
• Postpartum psychosis (a rare, severe mental health emergency related to postpartum depression).
• Stroke and other neurological (brain-related) conditions.
• Vitamin B1 (thiamine) and vitamin B12 deficiencies.

Other causes of psychosis

Psychosis, or symptoms that look very much like it, can also happen under other circumstances. The causes will seem more like triggers in some cases because psychosis develops quickly. In others, it may be a slow process. Some of the circumstances or factors that can cause psychosis include:

• Misuse of alcohol, prescription medications or recreational drugs (the disorder mentioned above is when this lasts for a longer period).
• Severe head injuries (concussions and traumatic brain injuries).
• Traumatic experiences (past or present).
• Unusually high levels of stress or anxiety.

How is psychosis treated?

The treatment of psychosis depends mainly on the underlying cause. In those cases, treating the underlying cause is often the only treatment needed.

For psychosis that needs direct treatment, there are several approaches.

• Medications. Antipsychotic drugs are the most common type of medications to treat psychosis, but other medications, such as antidepressants or lithium, may also help.
• Cognitive behavioral therapy (CBT). This type of psychotherapy can help with certain mental health conditions that can cause psychosis or make it worse.
• Inpatient treatment. For severe cases of psychosis, especially when a person may poses a danger to themselves or others, inpatient treatment in a hospital or specialist facility is sometimes necessary.
• Support programs or care. Many people experience psychosis because of other conditions such as alcohol or substance use disorders and personality disorders. Treating these disorders or helping people with social, work and family programs can sometimes reduce the impact of psychosis and related conditions. These programs can also make it easier for people to manage psychosis and their underlying condition.

How can psychosis be prevented?

Psychosis is unpredictable. There are many genetic and lifestyle risk factors, but there’s no way to consistently predict if people will experience these symptoms.

There are some things people can do to make them less likely to develop these symptoms or conditions that involve it.

• Avoid recreational marijuana use earlier in life. Researchers have linked psychosis with heavy marijuana use during teenage years and early adulthood. However, there’s disagreement on whether or not marijuana use is a direct cause or if it’s just a contributing factor.
• Wear safety equipment. Head injuries can result in brain damage that causes psychosis or similar symptoms.
• Don’t ignore infections. Untreated infections, especially those that affect your eyes and ears, can spread to your brain and cause psychosis.
• Eat a balanced diet and maintain a healthy weight. Many conditions related to your circulatory and heart health, especially stroke, can cause psychosis and related conditions. Preventing stroke and similar conditions can help reduce your risk of developing psychosis.

When should I seek treatment from a doctor or healthcare provider?

Psychosis can sometimes happen with severe or even life-threatening conditions like stroke. It’s not a symptom you should try to self-diagnose or treat on your own. A person with psychotic symptoms needs a trained, qualified medical provider to examine them, make the diagnosis and recommend treatment.

Managing psychosis

A common symptom that happens along with conditions that cause psychosis is anosognosia, which means “lack of insight.” This is more than just denial. It means the person literally can’t recognize or understand the signs or symptoms of their condition.

If your healthcare provider diagnoses you with psychosis, it’s very important to follow their treatment recommendations. That can feel difficult, especially if you don’t think anything is wrong with you.

If you feel this way, it’s important to talk to your healthcare provider and loved ones about it. It may feel scary, upsetting or frustrating to discuss it, but it’s still something you should try to do. Building those relationships, as well as communicating with and trusting your healthcare provider and the people who care about you can make a big difference in how you feel and recover.

What is the difference between psychosis and schizophrenia?

Schizophrenia and psychosis are two strongly connected words, but they aren’t the same thing.

• Psychosis: This is a collection of symptoms that involves a disconnection from reality and the world around you. Psychosis can also happen with many medical conditions and mental health disorders, such as encephalitis or bipolar disorder.
• Schizophrenia: This is a condition and a spectrum of related disorders. Psychosis is a key symptom of all these conditions.

What is the difference between psychosis and neurosis?

Neurosis and psychosis are very different conditions, though there’s some confusion because of outdated definitions and word use.

• Psychosis: In the past, psychosis used to refer to any mental illness that caused a big enough disruption in a person’s ability to function and go about daily activities. Today, it refers to symptoms that show a person has some kind of disconnection from reality.
• Neurosis: A neurosis (the term for more than one is “neuroses”) is an obsolete term for very high levels of worry or anxiety (experts tend to describe these as anxiety disorders to avoid confusion). Disconnection from reality isn’t something that happens with anxiety on its own. However, people who have psychosis can also have anxiety-related conditions, and a person can have both at the same time.

Are there different kinds of psychosis?

Yes and no. Psychosis is a collection of symptoms that happen with other mental health conditions. Experts used to describe psychosis with different types or terms, but that’s not very common anymore. That said, there are still a few conditions that use “psychosis” or “psychotic” in their name. Examples include:

• Brief psychotic disorder.
• Postpartum psychosis.
• Substance/medication-induced psychotic disorder.

What are examples of psychosis?

There are different ways that delusions and hallucinations, the two key psychotic symptoms, can happen.

Types of delusions

One way experts split delusions into different categories is by determining whether they’re “bizarre” or “non-bizarre.”

• Bizarre delusions: These are so extreme that there’s no way they’re true. An example is someone believing an android (a robot that looks human) with the appearance of a loved one has taken that person’s place and is pretending to be them.
• Non-bizarre delusions: These are delusions that seem possible, but a person has no evidence to support the belief. An example of a non-bizarre delusion is that someone is following them.

Experts also tend to group delusions into common themes. A few examples include:

• Grandiose: A person with grandiose delusions may believe they’re a celebrity or have special powers.
• Nihilistic: These are delusions where a person believes a major catastrophe or disaster is going to happen.
• Persecutory: These are delusions where a person believes someone or something is trying to hurt them or is “out to get” them.

Types of hallucinations

Hallucinations can happen in many ways, depending on the involved senses. Sometimes, hallucinations can involve more than one sense at a time. Some examples of hallucinations include:

• Auditory: These are hallucinations you can hear. An example of an auditory hallucination is hearing someone speaking to you who isn’t really there.
• Visual: These are hallucinations you can see. An example of a visual hallucination is seeing something that isn’t there or seeing unusual lights or shapes.
• Tactile: These are hallucinations that involve things you can feel. A common example is feeling a crawling sensation on your skin.

Hallucinations that involve the senses of smell and taste are possible, but they aren’t very common.

What are the warning signs of psychosis?

The early warning signs of psychosis usually aren’t easy to spot. They can take different forms depending on the cause of the psychosis itself, and they can sometimes appear days or even weeks before other symptoms.

Some common early warning signs of schizophrenia — a condition that always involves some form of psychosis — include:

• Changes in emotions (acting afraid, suspicious or paranoid, or a noticeable decrease in showing emotions).
• Changes in behaviors (problems focusing or thinking, avoiding usual activities).
• Changes in socialization (avoiding friends and family).

How can I help a loved one who seems to have psychotic symptoms?

Because people with psychosis have trouble telling the difference between what’s real and what isn’t, they often can’t recognize or understand that they have these symptoms or a mental health condition. Commonly, they’ll dismiss or resist suggestions that they get care because they don’t believe anything is wrong with them. That’s why psychosis can be a source of frustration or fear for someone with these symptoms or their loved ones.

If you notice a loved one showing signs of schizophrenia or a related condition, you can try to help them by doing the following:

• Ask how you can help. People with psychosis or conditions that involve it may talk about their symptoms without realizing these are symptoms of a mental health issue. Listening and communicating may help your loved one see that others care for them and want to help.
• Encourage them to see someone who can help. Treatment for psychosis, especially medications, can make a big difference in a person’s ability to tell what’s real and what’s not. Once medications take effect, they may start to understand that they have a condition that needs care.
• Don’t judge or argue. People with psychosis have trouble telling what’s real and what isn’t. To compensate for this disconnection from reality, their brain may generate things that only they can see or hear. These things will feel real, so arguing or showing them evidence isn’t helpful. It’s also important not to judge someone who shows these symptoms. That can make them feel even more isolated, and it may push them away from seeking help.
• Stay calm. People with psychotic symptoms can feel afraid or frustrated when others don’t seem to understand or believe them. That can make them pull away from others, making them feel even more alone. Try to remain calm, reassure your loved one and help them feel as safe as possible (don’t make them feel trapped or threatened). If there’s a lot of noise nearby, try to make the environment quieter or ask if you can go somewhere more peaceful.
• Get help in emergencies. People with psychosis and related conditions have a much higher risk of dying by suicide. If someone with psychotic symptoms says they’re thinking about harming themselves or others, or if they show severe paranoia or agitation, or act abusively or violently, then you should immediately call your local emergency services.

Is someone with psychosis dangerous?

People who experience psychosis can sometimes behave in ways that put themselves or others at risk. You should go to the nearest emergency room or call 911 (or your local emergency services number) if you have thoughts about harming yourself, including thoughts of suicide or about harming others. If you have thoughts like this, then you can call any of the following:

• Suicide and Crisis Lifeline (United States). To call this line, dial 988.
• Local crisis lines. Mental health organizations and centers in your area may offer resources and help through crisis lines.
• 911 (or your local emergency services number). You should call 911 (or the local emergency services number) if you feel like you’re in immediate danger of harming yourself. Operators and dispatchers for 911 lines can often help people in immediate danger because of a severe mental crisis and send first responders to assist.

A note from Cleveland Clinic

Psychosis is a word commonly used — often incorrectly — to describe various mental health conditions or issues. The correct use of psychosis refers to a collection of symptoms, including delusions and hallucinations, which happen when a person experiences a disconnection from reality. These symptoms can happen for a wide range of reasons, from mental health conditions to injuries to infections. While these symptoms can be concerning for the person having them or for the people around them, it’s often possible to effectively treat these symptoms. In some cases, these symptoms can stop with treatment of whatever is causing them, or the underlying cause.