What Is Psychosis

Psychosis refers to a loss of contact with reality, where a person experiences hallucinations, delusions, or disordered thoughts. During a psychotic episode, it can be difficult for an individual to tell the difference between what is real and what is imagined. However, the experience of psychosis can vary between individuals. These episodes could be due to several factors, from mental illness to taking drugs. 

Psychosis has a complex history, so let’s unravel it to gain a better understanding.

Introduction

A history of psychosis

The idea of psychosis has been around for over 170 years, with delusions, hallucinations and thoughts as the core features. However, in the 19th century, a German neuropathologist called Carl Wernicke defined psychosis as a distinction between the consciousness of three things:

• One’s own body - somatopsychosis
• One’s personality - autopsychosis
• The outside world - allopsychosis¹

Following on from Wernicke, there was a shift in perspective, with an importance in determining the loss of reality underlying hallucinations and delusions. The term “psychosis” has been used to define hallucinations, delusions and disordered thinking, as well as encompassing all severe mental disorders.¹ 

However, today the symptoms of psychosis are described based on their severity. The most severe symptom is psychosis itself, however, symptoms also include a lack of insight, trouble communicating, and difficulty understanding symptoms.¹ 

Psychosis typically affects between 15 and 100 people out of 100,000 and often occurs when someone is in their late teens to mid-twenties. However, older adults already living with neurological disorders, such as dementia, are at a higher risk of developing psychosis symptoms. 

What causes psychosis?

Psychosis can be caused by a combination of the following factors:

• Mental health conditions: Psychosis is a symptom of various mental health conditions, including schizophrenia, bipolar disorder, and schizoaffective disorder
• Substance abuse: The use of certain substances, such as cannabis, LSD, and methamphetamine, can trigger psychosis
• Neurological factors: Brain injuries, tumours, and certain types of infection can also lead to a psychotic episode
• Genetics and environment: Research suggests that there is a genetic component to psychosis, but the exact genes involved are not fully understood. Factors in the external environment, such as abuse, adverse childhood experiences, lifestyle, and social withdrawal can also contribute to an increased risk of developing psychosis, by interacting with pre-existing genetic factors²

What are the key symptoms of psychosis?

Hallucinations

Hallucinations are sensory experiences that occur in the absence of external stimuli. Individuals with psychosis may experience hallucinations in any of the five senses:

• Auditory hallucinations: Hearing voices, music, or other sounds that are not present in the environment
• Visual hallucinations: Seeing things that are not there, such as people, animals, or objects
• Tactile hallucinations: Feeling sensations on the skin, such as tingling, crawling, or bugs, without a trigger being present
• Gustatory hallucinations: Tasting things, such as metal or poison, that are not present in a person’s mouth or food
• Olfactory hallucinations: Smelling things that are not there, such as smoke, gas, or burning

Delusions

Delusions are false beliefs that are firmly held despite evidence to the contrary. Common delusions associated with psychosis include:

• Persecutory delusions: Believing that others are trying to harm, control, or conspire against a person experiencing psychosis
• Grandiose delusions: Believing that they have extraordinary powers, abilities, or importance
• Somatic delusions: Believing that an individual’s body is malfunctioning or that they have a serious illness
• Religious delusions: Believing that they have a special connection with a deity or that they are on a religious mission

Disorganised thinking

Disorganised thinking, also known as a disordered thought process, refers to disturbances in the flow and coherence of thoughts. Individuals with psychosis may exhibit:

• Disorganised speech: Rapid, incoherent, or illogical speech
• Thought derailment: Abruptly switching from one topic to another without a clear connection
• Tangential thinking: Providing irrelevant or indirect responses to questions
• Concrete thinking: Difficulty understanding abstract concepts or figurative language¹

Here are some of the specific ways in which psychosis can impact individuals:

• Hallucinations and delusions can be very frightening. They could lead to distractions when sleeping, working, or general daily life
• Disordered thought processes and actions make it hard to hold conversations with others and to keep up relationships
• Symptoms might lead to reluctance to obtain care, for example through social isolation
• Psychosis may create a stigma, making it hard to gain support and much-needed help
• Psychosis can be associated with increased aggression, self-harm and suicide³

It is essential to note that despite the difficulties that psychosis poses to an individual it is a treatable condition. Many of those suffering from psychosis are in a position to lead normal lives if they receive the right therapy and care.

Conditions associated with psychosis

An individual experiencing psychosis symptoms, such as hallucinations, delusions and disorganised thinking needs to undergo a medical examination to receive an appropriate diagnosis to help them manage their symptoms. The experience of mental health condition can substantially hamper performance in various aspects of daily life. A multitude of symptoms and their severity may vary between individuals and certain conditions. Therefore, it’s important to get a diagnosis and tailored support from a mental health professional. 

Schizophrenia

Schizophrenia is one of the most prevalent mental disorders, affecting 221 in every 100,000 people. Symptoms in individuals assigned male at birth (AMABs) start in their early 20s, with symptoms in individuals assigned female at birth (AFABs) starting in their late 20s. Around 20% of schizophrenia cases occur in people over age 45 and are more common in AMABs.

In its most common form, schizophrenia can be described as symptoms of paranoid delusions and auditory hallucinations. However, the history of schizophrenia has changed as different theories were developed.⁴

Symptoms can lead to deterioration in work and social relationships as well as self-care of individuals experiencing the condition.⁵ 

Bipolar disorder

What is bipolar disorder?

Previously known as manic depression, bipolar disorder causes extreme mood swings including mania and depression. Bipolar affects around 1 in every 100 people and can occur at any age, although it’s most commonly diagnosed between the ages of 15 and 19. 

Bipolar disorders are a complex group of mental disorders, and can be split into two subtypes; bipolar I and bipolar II. Bipolar I generally consists of a manic episode, whereas bipolar II is defined by manic and major depressive episodes.⁶ 

Symptoms

Typically the symptoms of bipolar disorder can last for several days or much longer.

A manic episode can be characterised by:

• Feeling incredibly happy and overjoyed
• Fast talking, with a sense of great importance
• Being easily distracted or agitated
• Feeling unable to sleep
• Delusional beliefs, hallucinations, or illogical thoughts
• Behaving without consequences, such as spending lots of money on expensive items
• Acting out of character, such as making risky and harmful decisions

Whereas a depressive episode can be characterised by:

• Feeling sad or hopeless most of the time
• Decrease in energy
• Difficulty when concentrating
• Feeling empty or worthless
• Delusional beliefs, hallucinations, or illogical thoughts

There is also a possibility of having mixed episodes, in which symptoms from manic and depressive episodes are present and can change quickly. 

Diagnosing psychosis

Diagnosing psychosis typically involves a comprehensive evaluation by a mental health professional. The evaluation may include:

• Clinical interview: A thorough discussion of the individual's experiences, symptoms, and medical history
• Psychological testing: Assessments to evaluate cognitive functioning, mood, and personality
• Physical examination: Ruling out any underlying medical conditions that could be contributing to the symptoms⁷

Treatment

The primary treatment for psychosis involves medication to manage symptoms, such as antipsychotics. Antipsychotics work by regulating dopamine and other neurotransmitters in the brain.⁷

Psychotherapy, such as cognitive behavioural therapy (CBT), can also be beneficial in helping individuals with psychosis:

• Develop coping strategies for dealing with symptoms and stress
• Improve social functioning and relationships
• Enhance self-esteem and self-efficacy⁷

Living with psychosis

Coping strategies and lifestyle adjustments

Individuals with psychosis can employ various coping strategies to manage their condition and improve their quality of life:

• Reducing stress levels: Identifying and managing stress triggers adopting stress-reduction techniques and engaging in regular physical activity 
• Avoiding situations that may exacerbate symptoms: For instance, avoiding crowded or noisy environments, as well as substance use
• Maintaining a structured routine: Establishing regular schedules for activities, sleep, and medication intake
• Seeking help when needed: Not hesitating to reach out for assistance from mental health professionals or support systems when experiencing difficulties

Support systems

Support systems play a crucial role in the well-being of individuals with psychosis. These systems may include:

• Family and friends: Providing emotional support, understanding, and practical assistance
• Mental health professionals: Ongoing monitoring, medication management, and counselling
• Support groups: Connecting with others who share similar experiences and providing a safe space to share challenges and successes⁸

FAQs

Some of the myths about psychosis include beliefs that people who experience psychosis can control their behaviour, do not need medical attention, or should first be taken to a correctional facility.

Perhaps one of the biggest misunderstandings of psychosis is its assumed association with “craziness” or madness. What psychosis is in actuality is a mental health condition changing an individual’s view of reality. Psychosis can manifest through hallucinations, delusions, and disordered thoughts, but does not necessarily make people violent, out of control or more likely to commit crime. 

What hallucinations could someone experience?

Individuals with psychosis may experience hallucinations in any of the five senses:

• Auditory hallucinations: Hearing voices, music, or other sounds that are not present in the environment
• Visual hallucinations: Seeing things that are not there, such as people, animals, or objects
• Tactile hallucinations: Feeling sensations on the skin that are not there, such as tingling, crawling, or bugs
• Gustatory hallucinations: Tasting things that are not there, such as metal or poison
• Olfactory hallucinations: Smelling things that are not there, such as smoke, gas, or burning⁷

What delusions could someone with psychosis experience?

Common delusions associated with psychosis include:

• Persecutory delusions: Believing that others are trying to harm, control, or conspire against them
• Grandiose delusions: Believing that they have extraordinary powers, abilities, or importance
• Somatic delusions: Believing that their body is malfunctioning or that they have a serious illness
• Religious delusions: Believing that they have a special connection with a deity or that they are on a religious mission⁷

What is a disorganised thought process like for someone experiencing psychosis?

Individuals with psychosis may exhibit:

• Disorganised speech: Rapid, incoherent, or illogical speech
• Thought derailment: Abruptly switching from one topic to another without a clear connection
• Tangential thinking: Providing irrelevant or indirect responses to questions
• Concrete thinking: Difficulty understanding abstract concepts or figurative language⁷

What may be done by one’s loved ones when a person experiencing psychosis has an attack of this nature?

The most important thing one’s family members can do for them is to support and understand them. Therefore, you should listen non-judgmentally, provide pragmatic assistance, and advise them to seek specialist assistance.⁸

How is psychosis treated, and what treatment modalities present themselves?

Yes, psychosis is treatable. It is largely treated with antipsychotics, which are used to keep in check dopamine and other neurotransmitters in the brain. People with psychosis may also benefit from psychotherapy.

Summary

Psychosis is a complex condition characterised by a range of symptoms, including hallucinations, delusions, and disorganised thinking. Psychosis can be caused by a combination of factors, including mental health conditions, substance abuse, and neurological factors. By delving into its complexities, we can foster empathy and ensure adequate support and resources for those navigating through psychosis, as well as remove the stigma associated with the disorder.