The word ‘psychosis’ refers to a collection of symptoms characterized by a person’s breakdown with reality. Such symptoms may manifest in changes in thinking, perception, feelings, or behaviour.
Psychosis is not a diagnosis in its own right but a symptom found within a range of psychiatric disorders; the condition most commonly associated with it is schizophrenia. Understanding what psychosis is can help remove the mysteriousness and fear associated with difficult experiences that are confusing and upsetting for individuals and those closest to them.
Essentially, psychosis involves an impairment in how an individual’s brain processes information. Individuals who have experiences of psychosis have difficulty differentiating between reality and the non-real and as such they perceive the world around them in an altered way. Such experiences can be very disturbing and may be highly impairing in their everyday lives.
Common Features of Psychosis
Key signs and symptoms of psychosis are:
- Hallucinations:
Hallucinations are feelings that can arise in the absence of anything actually present. It is possible to experience any sense as being subject to a hallucination, but the most prevalent type is an auditory hallucination (voices). The person may hear their behaviour being commented upon or converse with voices.
- Delusions:
Delusions are firmly held beliefs which do not have a basis in reality. Someone may, for instance, become convinced they are being watched, controlled or persecuted, despite having no realistic basis for this.
- Disorganised thinking or speech:
When thoughts become disorganised, spoken communication may wander, be difficult to follow and seemingly lack logical sense.
- Behavioural disturbances:
The individual may behave in peculiar, unpredictable or inappropriate ways. Daily activities and personal care may be neglected.
Psychosis and Schizophrenia: What’s the Link?
It’s easy to confuse psychosis and schizophrenia, as they’re very well-known related conditions, but actually they are not the same thing at all:
Psychosis is a symptom;
Experiences like hearing voices (hallucinations) or feeling that you know things that are not actually happening (delusions) are actually called psychotic experiences, i.e., symptoms.
Schizophrenia on the other hand is a diagnosis that uses a number of symptoms, including psychosis, as well as having other traits like lack of emotion and social problems for a longer amount of time.
You have to look at how long the symptoms are present for:
Some people might get an episode or two of psychosis, but others get chronic psychosis, and may have schizophrenia.
A one-off experience or short episodes are more likely in brief psychotic disorder, a manic episode of bipolar disorder, or a severely depressive episode of depression with psychotic features.
Everyone who gets one psychotic episode doesn’t mean that they will get schizophrenia: For example, if a person has a psychotic experience and this is down to stress, substance abuse or a physical cause then they may never get the condition again.
They may have further episodes but they might not all be psychotic and will have another diagnosis in other cases of this situation, such as schizoaffective disorder.
How Psychosis Is Managed
Experiencing psychosis can be really overwhelming and distressing, not just for the individual going through it, but also for their loved ones. It can feel like the world all of a sudden seems confusing, alien and even scary.
The most important thing to know is that with the right support, recovery from psychosis is completely possible and life can significantly improve. Getting help as early as possible really makes a huge difference. Early intervention helps manage symptoms and establish foundations for a faster and more robust return to loved ones, interests and everyday life.
Three key components of a comprehensive recovery plan:
1. Medication: Grounding the Experience
Medications known as antipsychotics are generally considered to be the first line of treatment for managing the symptoms of psychosis. They act by helping to correct the chemical imbalances in the brain when it is over stimulated.
This can bring a great relief in the number and intensity of hallucinations and delusional beliefs and racing or disorganized thought. They are always a collaborative treatment given to the individual by a psychiatrist or health professional; and as the drugs may not work for every one in the same way, the correct dosage and the most appropriate drug may require some time to establish through monitoring by a psychiatrist and/or a nurse, especially while side effects are considered.
2. Psychological Therapies: Understanding the Experience
While the medication attempts to redress chemical imbalances, psychological therapies equip individuals with the skills they require to deal with the emotional and psychological impact of psychosis.
CBT, adapted specifically for psychosis (CBTp), can offer a non-judgemental environment in which an individual may begin to make sense of what is occurring to them.
There may be a greater emphasis placed on alleviating distress, anxiety, confusion and fear associated with experiences, rather than on trying to eliminate them. The individual works collaboratively with a therapist to establish coping skills they can apply on a daily basis to challenge confusing thoughts and regain some degree of control, and they work best when taken alongside medication.
3. Psychosocial support: Re-engaging with life
In addition to drug treatments, an individual needs to achieve social recovery in order to reach their full potential. Psychosocial support can make an enormous difference in an individual’s life quality. It can take many forms from developing confidence and managing daily routine back towards work and study through to supporting relationships with family, friends, and in work and study situations.
In a condition like psychosis it is vital that an individual has human support at home and family therapy may support both individuals, their relatives, and family in general and through peer groups other individuals are united in support.
Helpful Links
NHS – Psychosis overview and symptoms: https://www.nhs.uk/mental-health/conditions/psychosis/symptoms/
Mayo Clinic – Schizophrenia symptoms & causes: https://www.mayoclinic.org/diseases-conditions/schizophrenia/symptoms-causes/syc-20354443
WHO – Schizophrenia fact sheet: https://www.who.int/news-room/fact-sheets/detail/schizophrenia
NIMH – Schizophrenia topic page: https://www.nimh.nih.gov/health/topics/schizophrenia
NHS – Schizophrenia treatment options: https://www.nhs.uk/mental-health/conditions/schizophrenia/treatment/