Psychosis And Stress

Introduction

What is psychosis?

Psychosis refers to a state of detachment from reality. It affects the mind and is called a ‘psychotic episode’ when it occurs. During psychotic episodes, it becomes difficult for a person to tell the difference between what is real and what is not due to the disruption in their thoughts.¹

What is stress?

As you might already know, stress is simply our body’s natural response to different types of pressure, mainly emotional. It is a state of mental strain triggered by challenging or tough circumstances.²

Did you know that extreme stress can trigger psychotic episodes? A 2023 cohort study³ in the UK revealed that individuals who underwent stressful life events after a first episode of psychosis showed a higher risk, incidence, and duration of relapses compared to those not exposed to stress.

What are the symptoms and signs of psychosis?

Psychosis is not a single condition, rather it is a collection of symptoms. The three most common symptoms of psychosis include:⁴

• Seeing, feeling, or hearing things that aren’t actually there, known as hallucinations
• Strongly holding onto false beliefs, even when there’s evidence to prove otherwise, known as delusions
• Having confused or disoriented thoughts and speech, which may result in:
  • suddenly losing your flow of thoughts and feeling lost, while doing something or talking to someone
  • talking very fast, without breaking the flow of speech
  • inappropriate behaviour in certain situations

Before someone goes through a psychotic episode, they might start acting differently. These changes can be small and easy to miss at first. However, it’s important to pay attention to them as the severity of these early warning signs can differ from person to person. Some people might only experience a few signs briefly, while others might have them for months. Examples of these early signs of psychosis include:^4,5

• Anxiety, suspicious thoughts, or discomfort around other people
• Decrease in personal hygiene or self-care
• Difficulty in thinking rationally and clearly
• Feeling unmotivated
• Avoiding social interactions and spending more time alone
• Having unusual or intense thoughts, weird feelings, or feeling emotionally numb
• Sudden decline in work performance or class grades
• Having trouble falling asleep or shorter sleep durations 
• Difficulty in communicating or speaking clearly
• Struggling with differentiating between what is real and not real

If you have prolonged or increased experiences of these symptoms, it is important that you seek medical attention promptly. The earlier you seek treatment, the better it’s likely to work for you.

What leads to psychosis?

Generally, there is no single cause of psychosis. In fact, it is quite difficult to find out what might have caused a person’s first psychotic episode. A combination of factors including genetic risk, pre-existing psychological conditions, or substance use can contribute.⁶

• Psychosis can also be a symptom of other mental illnesses, such as depression, schizophrenia, bipolar disorder, severe stress, and anxiety
• In older people, psychosis can occur as a result of conditions, such as Parkinson’s disease, Alzheimer’s disease, and other dementias
• Some general medical conditions that have been seen to cause psychotic episodes in people are malaria, hypoglycaemia, Lyme disease, lupus, multiple sclerosis, and brain tumours
• Poor sleep, certain medications, and misuse of alcohol and drugs can also trigger stress-induced psychosis

With so many possible causes, it can become quite difficult to figure out which of these factors contributed more to a psychotic episode, which one contributed less, or if a combination of all these factors was at play.

How are stress and psychosis related?

While stress is a regular part of life, excessive stress levels can impact physical and mental health. For some individuals, prolonged or significant stress can trigger psychosis.⁷ 

A study, along with many others found that stressful life events put you at more risk of developing a psychotic disorder.⁷ Moreover, a comprehensive review of 23 studies revealed that when people with psychosis face stressful events in their adult lives, it can make their symptoms come back or get worse, leading to what is called a relapse.⁸

Stress can trigger psychosis by affecting how the brain responds and functions. When under stress, our body releases various chemicals, including cortisol (a stress hormone) and inflammatory markers. These chemicals can affect the functioning of neurotransmitters such as dopamine and serotonin in the brain.⁹ 

Hence, extreme stress will disrupt the balance of certain chemicals in the brain, which may lead to changes that, for some people, can include signs of psychosis.⁹

While excessive stress can trigger psychosis in people with mental illnesses such as schizophrenia and bipolar disorder,¹⁰ extremely high levels of stress can also independently cause isolated, short episodes of psychosis, known as brief psychotic disorder (BPD). This behaviour is sudden and lasts for more than a day but less than a month. After this, there’s a full recovery, but the possibility of the symptoms returning later remains. BPD mostly affects people in their 20s to 40s.¹⁰

The main symptoms of brief psychotic disorder are hallucinations, delusions, disturbed thoughts or speech, and highly disorganised or impulsive (catatonic) behaviour.¹⁰

Although stress can contribute significantly to why someone experiences a psychotic episode, triggers for stress-induced psychosis may not always align with the diagnostic criteria for brief psychotic disorder. It’s important to seek professional guidance and support.

What can cause stress-induced psychosis?

Extremely stressful events or traumatic experiences are the root cause of stress-induced psychosis. These can be:⁴

• Losing a loved one
• Experiencing a natural disaster 
• A road accident
• Experiencing or witnessing violence or harassment
• Childbirth
• War
• Recent immigration 

People who have been diagnosed with personality disorders or mood disorders may be more likely to develop BPD or experience stress-induced psychosis.

How is stress-induced psychosis diagnosed?

If you are experiencing hallucinations, delusions, or other psychotic symptoms, you must immediately see your GP. Early treatment is likely to lead to better long-term outcomes.⁶

Your GP/healthcare professional may perform a psychiatric evaluation. They’ll observe your behaviour and ask about your thoughts and experiences to check your symptoms. You may be asked:⁶

• If you’re on medication 
• If you’re using any illegal substances 
• How your mood has been lately
• If you have a family history of mental health issues
• If you’ve experienced any hallucinations or delusions and, if so, what they were like
• How you’ve been doing your daily activities

There are no specific lab tests that can be done currently to provide a formal diagnosis for BPD. To rule out other possible, temporary causes for behaviour change, your GP might run some tests or imaging, such as:⁹

• Pregnancy tests, if appropriate, to check if pregnancy is causing behavioural changes or emotional triggers
• ECG to check the heart for any possible cardiac abnormalities
• Electrolyte test, to evaluate electrolyte levels and look for any imbalances causing changes in brain function and behaviour, e.g., confusion, lethargy, etc.
• Blood sugar test, to check for too high or low blood sugar that may be impacting your mental state 
• Liver function test to assess alcohol or medication intoxication
• Thyroid function test to check thyroid hormone levels and potentially any thyroid disorders causing mood changes
• Urine test to check for drug or medication intoxication
• CT scan or MRI of the brain to check for physical problems or any structural abnormalities causing symptoms

For further assessment, your GP may refer you to a mental health specialist.

How is stress-induced psychosis treated?

Firstly, it’s important to determine if you can be treated at home. This depends on factors like the intensity of symptoms, personal finances, support from family or friends, and if you have thoughts about hurting yourself or others.⁹

Treatment will most commonly include:¹¹

• Pharmacotherapy, including antipsychotic medication, can help in reducing or stopping psychosis symptoms
• Referral to an early intervention team¹¹
• Psychotherapy, which may involve:
  • Cognitive behavioural therapy (CBT): Your therapist will help you understand your experiences better and why they are causing you distress. They’ll help you regain control of your life by helping you explore different perspectives and set and achieve personal goals that matter to you
  • Family therapy: Your therapist will have sessions with you and your family, so you understand the situation better, find solutions, support each other, and cope as a team
• Self-help groups: If you’re dealing with psychosis, spending time with others who have been through similar experiences may be helpful
• Social support: In some cases, you might be given help with education, employment, or accommodation

Summary

Stress and traumatic experiences can trigger psychotic episodes in individuals, particularly if they have other risk factors. Sometimes these episodes can involve thoughts of violence, self-harm, suicide, a lack of self-care, or using drugs or alcohol to cope with symptoms. 

People having psychotic episodes are often unaware of changes to their speech and behaviour. Therefore, others may need to help them to seek support, or make contact with services themselves if they are concerned. There are various therapies listed above that might aid in recovery. 

If you notice signs of psychosis in yourself or a loved one, call your GP, early intervention team, or emergency services right away by dialling 999 or the local emergency number for your area.