Psychosis, marked by symptoms like hallucinations, delusions, and disordered thinking, can be triggered by substance use, neurological issues, or psychiatric disorders. New research from the Department of Psychiatry offers hope for people dealing with psychosis. Led by Oxford University, a global study is investigating the potential of cannabidiol (CBD) to alleviate symptoms and even prevent psychosis in high-risk individuals. According to Oxford Psychiatry Professor Philip McGuire, patients have shown interest in CBD-based treatments, and preliminary studies suggest it may offer significant benefits.

In this article, we’ll explore what causes psychosis, how it manifests, and the promising treatments that could reshape the future of psychosis care.

Overview

At the moment, between 1.5% and 3.5% of individuals will fit the diagnostic criteria for a psychotic disorder, whilst a considerably higher and more varied percentage will exhibit a psychotic symptom at some point in their lives.^1,2 Many neurological, neuropsychiatric, medical, developmental, and mental diseases are substantial manifestations of psychosis.

It's the defining characteristic of schizophrenia spectrum and other psychotic conditions co-occurring with many mood and drug use disorders. Psychosis is a challenging symptom of numerous medical and neurological diseases. About 50 out of every 100,000 individuals experience psychosis for the first time, compared to 15 out of every 100,000 people who have schizophrenia. 

For people assigned males at birth (AMAB), the peak age of onset is typically in their teens to mid-20s, whereas for people assigned females at birth (AFAB), it occurs in their teens to late 20s. While early intervention corresponds with better results, a faster onset is associated with worse implications. Children rarely experience psychosis. 

Patients experiencing or individuals at risk of developing psychosis need evaluation and treatment right away. Young people who experience psychosis usually wait two to three years, if not longer, before receiving proper assistance. Early therapy after a shorter untreated psychotic episode improves prognosis and reduces the risk of suicide. Preventative care results from early intervention with appropriate treatment for the disease.^1,2

Causes of psychosis

The table below illustrates the trio of distinct elements that lead to psychosis.

Table 1 Causes of Psychosis. 

Symptoms of psychosis

Several symptoms cover the word "psychosis".^1,2,5 Typically, these are separated into "positive" and "negative" symptoms, as the image below illustrates.

Figure 1 Symptoms of Psychosis. Created by Deepika Rana in Canva. 

Positive symptoms

Delusions

Delusions are unchangeable, incorrect beliefs that a person holds without question despite evidence to the contrary. There are many distinct kinds of delusions:^1,5 

• Delusions of persecution are the most prevalent type, in which an individual thinks someone or something is trying to harm them
• Referential delusions are the patient's perceptions that everything they see and hear in the outside world is aimed at them
• Grandiose delusions are unrealistic, self-delusion, and grand beliefs about oneself
• The belief that someone else is in love with them is known as an erotomanic delusion
• The belief that significant disasters will strike is known as a nihilistic illusion
• Somatic delusions are incorrect conceptions of how one's own or other people's bodies operate
• When delusions transcend reality and violate the rules and laws of the physician universe, they become bizarre
• Non-bizarre delusions are a feature of the delusional illness. "The CIA is monitoring me via satellite surveillance around the clock," for instance

Hallucinations

Hallucinations are perceived experiences that occur when there isn't enough external input to trigger them. All senses can experience hallucinations (visual, auditory, taste, smell, proprioceptive, touch, etc.), yet the most prevalent type in schizophrenia spectrum illnesses is auditory. Usually, subjects observe these as voices that are "outside" of their minds.^1,5 

Disorganised thoughts

In psychosis, it is possible to observe loosened connections or sequences of unrelated or loosely related concepts:^1,5

• When someone fails to respond to a question directly without going into undue or excessive detail, they are said to be using circumstantial cognition, also known as a "non-linear thought pattern"
• A person who frequently strays from the subject at hand and never brings it back is said to be in tangential thinking
• An incomprehensible or nonsensical collection of words is called a word salad
• Neologisms consist of single words or phrases
• Repetition of phrases and words is called perseveration

Disorganised behaviour

A wide range of improper goal-directed behaviours make up disorganised behaviour, which typically results in a deterioration in day-to-day functioning. Patients with psychosis exhibit erratic, inappropriate, and out-of-character emotional reactions to the circumstances; this can manifest as a lack of inhibition and impulse control.^1,5 

Negative symptoms

Potential symptoms include psychomotor inactivity, energy loss, interest, focus, and emotional blunting (flat affect). A significant reduction in responsiveness to the outside world defines catatonic conduct, which can range from an excitatory state of aimless and uncontrolled muscular activity to psychomotor retardation, immobility, and extreme rigidity with no vocal response.^1,5

Diagnosis and management 

The Diagnostic and Statistical Manual, Fifth Edition (DSM-V), avoids a strict definition of "psychosis," instead emphasizing abnormalities as a way to distinguish psychotic disorders linked to medical conditions. Similarly, the ICD-10's F29 code categorizes unspecified psychosis for cases lacking sufficient data for a specific diagnosis. The following image includes a detailed diagnostic summary of psychosis.^1,6

Figure 2 Psychosis Diagnosis. Complete blood count (CBC), metabolic panel, urinalysis, urine cultures, TSH, liver function tests, CT, MRI, EEG, vitamin B12 and lumbar puncture. Created by Deepika Rana in Canva. 

The origin of a patient's psychosis determines a lot about the most effective way to treat them.^1,5

Figure 3 Psychosis Management. Antipsychotic drugs, benzodiazepines, BFT and CBT. Created by Deepika Rana in Biorender.com. 

FAQs

What are the complications of psychosis?

Psychotic disorders reduce the capacity for day-to-day functioning as well as increase the risk of suicide compared to the general population. In individuals with schizophrenia, the suicide rate is approximately 5%. There's always a risk that someone may harm themselves or others during a psychotic episode, regardless of the cause. Antipsychotic drugs have serious side effects that can include tardive dyskinesia, extrapyramidal symptoms (EPS), metabolic syndrome, cardiac abnormalities and sexual side effects.¹

What is the prognosis for patients with psychotic conditions?

Patients now have more alternatives for treatment and can address noncompliance with treatment because of the abundance of newer drugs and the possibility of long-acting injectable antipsychotics. 

For individuals experiencing a single psychotic episode associated with a medical or neurological problem, there is little evidence to support it, and the prognosis would vary depending on the ailment. The optimal course of action would be to treat both the underlying condition and the current episode.¹

How many people with psychotic conditions recover?

Four years following the first psychotic episode, over half of the patients (54%) experience remission, and almost one-third (32%) are still in recovery after 5.5 years.⁴

When should I seek treatment from the doctor?

The NIMH suggests seeking medical attention if you or a friend or family member exhibits confusing, erratic behaviour and becomes hostile towards others while exhibiting symptoms that persist. 

Summary

The term "psychosis" is frequently used to describe a set of symptoms, including hallucinations and delusions, that result in a loss of contact with reality. Numerous illnesses, including infections, injuries, and mental health issues, can cause these symptoms. While these symptoms might cause distress to the individual experiencing them and others around them, they are frequently treatable. Under certain circumstances, addressing the underlying cause of the symptoms may alleviate them.