What is Psychosis?
“Psychosis” is a broad term that covers many different symptoms and experiences. Common symptoms include:
- Hallucinations (seeing, hearing feeling or tasting things that other people don’t)
- Feeling overwhelmed by sensory information (lights seem too bright, noises too loud)
- Difficulty filtering stimulation from the environment
- Delusions (false personal beliefs based on incorrect inferences about reality which are inconsistent with culture and previous beliefs, and which are firmly sustained in spite of evidence or proof to the contrary)
- Confused thinking or speech
- Difficulty doing ordinary things (often includes problems with memory, attention, putting thoughts together)
Anyone can develop psychosis. Many people see or hear things that others don’t, or have ideas that are unusual. Psychosis is only a problem when it is causing you or someone close to you significant distress or harm.
It affects 3 in 100 people, and usually occurs for the first time between the ages of 15 and 30. Men often develop psychosis 5 to 10 years younger than women. It can be caused by a variety of medical illnesses, sleep deprivation, severe stress or trauma, drug reactions, genetic predisposition, and other factors.
Some of the most common signs of psychosis include:
- A sudden loss of interest in things that the person used to find enjoyable
- Inability to do the things that the person could do before (e.g., a person who normally loves math suddenly can’t do it anymore)
- Social withdrawal and isolating from friends and family
- Dramatic changes in sleep pattern
- Statements or behavior that are bizarre and inconsistent with what’s going on around them
Psychotic disorders rarely emerge suddenly. Most often, the symptoms evolve and become gradually worse over a period of months or even years. Early symptoms often include cognitive and sensory changes which can cause significant disability before the illness becomes acute and is finally diagnosed. Identifying and responding appropriately to the condition early can help to get the person and their family support.
1. Reduced Performance
- Trouble reading or understanding complex sentences
- Trouble speaking or understanding what others are saying
- Becoming easily confused or lost
- Trouble in sports or other activities that used to be easy (Example: can’t dribble basketball or pass to team members)
- Attendance problems related to sleep or fearfulness
2. Behavior Changes
- Extreme fear for no apparent reason
- Uncharacteristic and bizarre actions or statements
- New, bizarre beliefs
- Incoherent or bizarre writing
- Extreme social withdrawal
- Decline in appearance and hygiene
- Dramatic changes in sleeping or eating
3. Perceptual Changes
- Fear that others are trying to hurt them
- Heightened sensitivity to sights, sounds, smells or touch
- Making statements like “my brain is playing tricks on me”
- Hearing voices or other sounds that others don’t
- Reporting visual changes (colors more intense, faces distorted, lines turned wavy)
- Feeling like someone else is putting thoughts into their brain or that others are reading their thoughts
Earlier on, symptoms may be intermittent and the person often recognizes that something is wrong. As psychosis progresses, people lose their ability to distinguish symptoms from reality, and it becomes more difficult to have a conversation. For example, a person who has auditory hallucinations will hear voices which sound to them as loud and real and a person standing right next to them, even though others don’t hear it. A person whose psychosis has progressed may not believe that other people don’t hear the same voices and may not be able to integrate new information from others into their thinking.
Psychosis may also result from, or accompany, a mood disorder such as major depression or bipolar disorder (in which there are dramatic swings in energy level, sleep patterns, mood and behavior).
Jonathan really liked two things: fixing computers and hanging out with his friends. So when he suddenly stopped doing both, it came as a big shock. His best friend came to visit and found him staring off into the distance.
“Have you been fixing that laptop?” she asked.
“No.” Jonathan’s face didn’t seem to show any emotion. His tone was flat.
“Are you feeling down? Depressed?”
Jonathan shrugged. “I don’t know. I can’t seem to focus on anything anymore. My computer screen hurts my eyes.”
As time passed, Jonathan’s teachers and parents started noticing differences too. He stopped doing his homework and would skip class. Then, his friends noticed that he was posting unusual statements on Facebook.
“Aliens are out to get me and they’re talking through the TV,” he wrote. “I’m scared. I don’t know what to do.”
Stories like these are not uncommon for people experiencing psychosis for the first time. It can be very concerning for both the individual and their family, friends, and allies. But there is hope.
Many young people experience psychosis and still realize their hopes and goals. It is important that they receive support from their families, friends, allies, and mental health.
Psychosis is generally defined in terms of “positive” symptoms. “Positive” symptoms are those symptoms which manifest outwardly, including hallucinations, delusions and speech disorder (also referred to as thought disorder). Many people who experience psychosis also experience additional types of symptoms: mood symptoms (relating to moods and energy levels), abnormal movements and behaviors, “negative” symptoms (things that aren’t there now that that used to be), and cognitive symptoms (having to do with information processing). Below is a more detailed description of each type of symptom. Below is a more detailed description of each type of symptom.
It’s important to understand that people usually are aware of some symptoms but not others. This is in part because of the nature of the symptoms themselves. Think of the analogy of an optical illusion. Your brain perceives and interprets information, but the information is interpreted incorrectly because of the way your brain constructs the information. Only when someone points out the error and when you use tools such as a ruler to “reality test” your perception do you recognize that it is an optical illusion. Psychosis is very similar. The brain perceives and interprets information erroneously, but the person is unaware that this is happening. Certain symptoms such as distressing hallucinations, paranoia and anxiety are often perceived as problematic to the person. However, most people do not recognize them as medical symptoms, and many of the other symptoms are recognized primarily by other people. For this reason it is critical for close family members and others who are known and trusted by the individual to be involved in the assessment and ongoing treatment process. Part of the process of treatment is helping the person to learn to distinguish and differentiate symptomatic perceptions from normal perceptions.
Hallucinations: Seeing, hearing or feeling things that others don’t. This can range from an intense experience of color, blurring or distortion of visual images, to hearing sounds or voices with no apparent source, and seeing or feeling objects or phenomena which others do not.
Speech/thought disorder: These are symptoms related to the person’s ability to communicate. The person may experience changes to their use of speech and the way they construct sentences. Examples include:
- Frequent changes of ideas, making little sense to others (circumstantiality, tangentiality, derailment, looseness of association, flight of ideas)
- Incoherent jumble of words (word salad)
- Choosing words based on sound, such as rhyming or punning (clang associations)
- Making up words which mean something only to the speaker (neologism)
- Echoing others’ words (echolalia)
Abnormal movements and behaviors: A person may develop odd behaviors, movements or mannerisms, or may become unable to move on their own (catatonia, waxy flexibility or posturing).
Delusions: False beliefs based on incorrect inferences about reality, inconsistent with culture, experience and previous beliefs, and held with conviction despite evidence to the contrary. Delusions can be caused by a variety of information processing dysfunctions, involving sensory input, memory, attention, and interpretation. Some common delusions:
- Delusions of reference: Belief that day-to-day events or experiences refer directly to you; for example, that the people on the TV set are talking directly to you, that street signs, license plates, or behaviors (such as coughing) carry communications specifically aimed at you.
- Delusions of grandeur: Belief that you are able to do things which are beyond normal capacity, such as fly or act as royalty.
- Persecutory delusions: Belief that others are trying to hurt you, for example, by poisoning you or through a conspiracy to cause you harm.
- Nihilistic delusions: Belief that you or others do not exist.
- Thought broadcasting: Belief that your thoughts can be read by others.
- Thought insertion: Belief that others are placing thoughts in your head.
- Thought withdrawal: Belief that one’s thoughts are being extracted from the mind.
- Thought control: Belief that feelings, thoughts and actions are not one’s own, experienced as being imposed by an external source.
- Depression: Predominant mood is depressed and there is a loss of interest or pleasure in nearly all activities for at least 2 weeks. Depression in its severe forms can cause psychosis. Depression can also be an early warning sign of psychosis for people who have schizophrenia.
- Suicidal thoughts. It is important to know that many people who experience psychosis also experience suicidal thoughts, and the risk of suicide is significantly greater than for people who do not experience psychosis.
- Mania: Period of time in which a person’s mood is elevated or irritable, there is a lack of restraint in behavior, and highs in energy, requiring little or no sleep. Severe mania can cause psychosis, or a person can have both mania symptoms and psychosis symptoms distinctly from each other.
- Anxiety. Extreme anxiety is common with psychosis.
Cognitive symptoms: Most people who experience psychosis also experiences difficulty with memory, attention, and organization of thoughts. These symptoms may improve but often do not disappear completely with treatment for psychosis.
For a comprehensive and highly useful text, we recommend Psychosis: A Wellness Approach, by Mary Moller. This text can be ordered at http://www.psychiatricwellness.com.
Psychosis is a condition which affects the brain’s ability to process information. Psychosis can affect sensory perception, ability to organize information, and ability to express information. There are many causes. Everyone has the potential to develop psychosis, if they don’t sleep for multiple days in a row, if they take certain drugs or develop certain medical conditions, or if they experience extremely severe and prolonged stress. Psychosis has a strong genetic component. Individuals whose family members have experienced psychosis will be at greater risk for developing it themselves. Some people with a particularly great vulnerability to developing psychosis have to manage it as an ongoing condition.
The following illnesses or conditions, among others, can cause symptoms of psychosis.
- Sleep deprivation (psychosis should remit after the person sleeps)-
See sleepnet.com for more info on sleep disorders.
- Drug use (psychosis usually goes away within 72 hours, although our experience with methamphetamine is that it may take longer). See http://www.psychosissucks.ca/epi/index.cfm?action=substanceuse
- Cushing’s syndrome
- Adverse reactions to prescribed medications, such as steroids
- Thyroid and parathyroid disorders
- Cerebral sarcoidosis
- Systemic lupus erythematosus
- Very advanced cases of AIDS (some of the medicines can also cause psychosis)
- Sex chromosone abnormalities https://www.nichd.nih.gov/health/topics/turner
- Demyelinating diseases such as multiple sclerosis and Schilder’s disease, especially if they involve the temporal lobes http://www.nmss.org/
- Encephalitic diseases http://www.ninds.nih.gov/health_and_medical/disorders/encmenin_doc.htm
- Wilson’s disease http://www.wilsonsdisease.org/
- Huntington’s disease http://www.ninds.nih.gov/health_and_medical/disorders/huntington.htm
- Friedreich’s ataxia http://www.ninds.nih.gov/health_and_medical/pubs/friedreich_ataxia.htm
- Vitamin B12 deficiency http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3404901/
- Subarachnoid hemorrhage
- Cerebral tumors
- Head injury
- Temporal lobe epilepsy http://www.epilepsy.com/information/professionals/about-epilepsy-seizures/psychiatric-and-behavioral-aspects/psychiatric-2
- Mood disorders: Clinical depression or bipolar disorder
- Schizophrenia schizophrenia.com
Grief. Psychosis can have a tremendous impact on all family members. Almost universally, psychosis is accompanied by a grief process which affects everyone. The stages of the grief process include shock/denial, learning to cope, and acceptance. Individuals at different stages of grief need different things.
Family conflict. Family members are often at different places in the grief process, which may cause conflict. As families continue to deal with psychosis, they may go through the grief process many times. This is normal. However, it is also important to pay attention to how family members are affected by the stress and grief associated by this illness, and not to hesitate to get additional counseling. Psychosis often causes a great strain on marriages and family relationships, since individuals may reach very different conclusions about how to handle the situation. Patience and communication skills become critically important.
Since psychosis is often preceded by early, or “prodromal” symptoms, families often observe changes for an extended period before they begin to understand what’s happening. Prodromal (early) symptoms such as sleep disorder, social withdrawal and behavior changes are often mistaken for drug use, intentional conduct problems or laziness. In fact, as people deal with some of the early changes to memory, concentration and thought process, they may turn to drugs as a way of coping.
Developmental impact. Psychosis has a direct effect on development. One of the goals of iHOPE is to minimize that impact so that the person will move on with life in a positive way. Since psychosis usually affects people starting between ages 15 and 25, some of the key developmental tasks can be directly impacted:
- Experimenting with and forming an independent identity
- Individuating and separating from parents
- Learning independent living skills
- Living independently
- Finishing school
- Entering the work force and identifying a career path
- Establishing adult peer relationships
- Starting a family
If these developmental tasks are interrupted, the person will have to return to them later before they’ll be able to progress developmentally. Also, each member of the family who is directly affected by psychosis will likely be affected developmentally. Parents who are preparing to send their child out into the world experience a return to dependency and a need to provide more direction. Siblings often develop a fear of developing psychosis themselves, and may make different choices in relationships because of their need to cope with confusion, grief and loss.
“Mental illness can happen to anyone, no matter what age, economic status, or race. At any given time, 25 million Americans, nearly one in five, suffer from a clearly diagnosable mental disorder that interferes with employment, attendance at school, or daily life.” –National Association of Mental Health.