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Understanding Psychosis

What is psychosis?

The word psychosis is used to describe conditions that affect the mind, where there has been some loss of contact with reality. When someone becomes ill in this way, it is called a psychotic episode. During a period of psychosis, a person’s thoughts and perceptions are disturbed, and the individual may have difficulty understanding what is real and what is not.

Who develops psychosis?

Psychosis can affect people from all walks of life. Psychosis often begins when a person is in his or her late teens to mid-twenties. There are about 100,000 new cases of psychosis each year in the U.S.

What are the signs and symptoms of psychosis?

Typically, a person will show changes in his or her behavior before psychosis develops. Behavioral warning signs for psychosis include:

  • Sudden drop in grades or job performance
  • New trouble thinking clearly or concentrating
  • Suspiciousness, paranoid ideas, or uneasiness with others
  • Withdrawing socially, spending a lot more time alone than usual
  • Unusual, overly intense new ideas, strange feelings, or no feelings at all
  • Decline in self-care or personal hygiene
  • Difficulty telling reality from fantasy
  • Confused speech or trouble communicating

Symptoms of psychosis include delusions (false beliefs) and hallucinations (seeing or hearing things that others do not see or hear). Other symptoms include incoherent or nonsense speech and behavior that is inappropriate for the situation. A person in a psychotic episode also may experience depression, anxiety, sleep problems, social withdrawal, lack of motivation, and difficulty functioning overall.

Someone experiencing any of the symptoms on this list should consult a mental health professional.

What causes psychosis?

There is no one specific cause of psychosis. Psychosis may be a symptom of a mental illness, such as schizophrenia or bipolar disorder. However, a person may experience psychosis and never be diagnosed with schizophrenia or any other mental disorder. There are other causes, such as sleep deprivation, general medical conditions, certain prescription medications, and the misuse of alcohol or other drugs, such as marijuana. A mental illness, such as schizophrenia, is typically diagnosed by excluding all of these other causes of psychosis. To receive a thorough assessment and accurate diagnosis, visit a qualified health care professional (such as a psychologist, psychiatrist, or social worker).

How is psychosis treated?

Studies have shown that it is common for a person to have psychotic symptoms for more than a year before receiving treatment. Reducing this duration of untreated psychosis is critical because early treatment often means a better recovery. A qualified psychologist, psychiatrist, or social worker will be able to make a diagnosis and help develop a treatment plan.

People with psychosis may behave in confusing and unpredictable ways and may become threatening or violent. However, people with psychotic symptoms are more likely to harm themselves than someone else. If you notice these changes in behavior, and they begin to intensify or do not go away, it is important to seek help.

Research supports a variety of treatments for early psychosis, especially coordinated specialty care. In 2008, the National Institute of Mental Health (NIMH) launched the research initiative, Recovery After an Initial Schizophrenia Episode (RAISE) project. RAISE studied coordinated specialty care treatments and the best ways to intervene after people begin to experience psychotic symptoms and to help them return to a path toward productive, independent lives. Coordinated specialty care involves the following components:

  • Individual or group psychotherapy is typically based on principles of cognitive behavior therapy. This therapy is tailored to each patient’s needs and emphasizes resilience training, illness and wellness management, and building coping skills.
  • Family support and education teach family members about psychosis, coping, communication, and problem-solving skills. Family members who are informed and involved are more prepared to help loved ones through the recovery process.
  • Medication management (also called pharmacotherapy) helps reduce psychosis symptoms. Medication selection and dosing are tailored to patients with early psychosis and their individual needs. Like all medications, antipsychotic drugs have risks and benefits. Patients should talk with their health care providers about side effects, medication costs, and dosage preferences (daily pill or monthly injection).
  • Supported employment and education services help patients return to work or school and achieve their personal goals. Emphasis is on rapid placement in a work or school setting, combined with coaching and support, to ensure success.
  • Case management helps patients with problem-solving. The case manager may offer solutions to address practical problems and coordinate social services across multiple areas of need.

Individuals with psychosis should be involved in their treatment planning. Their needs and goals should drive their treatment programs, which will help them stay engaged throughout the recovery process.

It is important to find a mental health professional who is trained in psychosis treatment and who makes the patient feel comfortable.

Finding Help

NIMH does not endorse specific early psychosis clinics or evaluate professional qualifications or competence of individual practitioners. However, there are several organizations that may be able to assist you in finding a treatment program in your area. This list may not be comprehensive and does not constitute an endorsement by NIMH.

Behavioral Health Treatment Services Locator

The Substance Abuse and Mental Health Services Administration (SAMHSA) provides this online resource for locating mental health treatment facilities and programs in your state. For additional resources, visit our Help for Mental Illnesses webpage.

Talking to Your Health Care Provider About Your Mental Health

Communicating well with your doctor or health care provider can improve your care and help you both make good choices about your health. Read our Tips for Talking With Your Health Care Provider to help prepare for and get the most out of your visit. For additional resources, including questions to ask your doctor, visit the Agency for Healthcare Research and Quality.

U.S. Department of Health and Human Services
National Institutes of Health
NIH Publication No. 20-MH-8110