What is psychosis?
The word psychosis is used to describe conditions that affect the mind, in which people have trouble distinguishing between what is real and what is not. When this occurs, it is called a psychotic episode. A first episode of psychosis is often very frightening, confusing and distressing, particularly because it is an unfamiliar experience.
About three out of every 100 people will experience an episode of psychosis in their lifetime. Psychosis affects men and women equally and occurs across all cultures and socioeconomic groups.
Psychosis usually first appears in a person’s late teens or early 20s. Psychotic illnesses seem to affect women at a later age than men, when women may be farther along in their social and work lives. On the whole, women respond better than men to most treatments.
However, there are times when the risk of relapse for women is greater. These times are before their period is due, after childbirth and around menopause. This suggests that women’s hormones may in some way affect psychosis.
A number of mental illnesses can include psychosis as a symptom, including:
Schizophrenia: A person has some psychotic symptoms for at least six months, with a significant decline in the ability to function.
Schizophreniform disorder: A person has some psychotic symptoms for more than one month and less than six months.
Bipolar disorder: With this type of illness, the symptoms of psychosis relate more to mood disturbance than to thought disturbance.
Schizoaffective disorder: A person will have symptoms of schizophrenia, and at some point in the course of illness, concurrent symptoms of a mood disturbance.
Depression with psychotic features: A person has severe depression and symptoms of psychosis without the mania associated with bipolar disorder.
Drug-induced psychosis: The use of drugs such as marijuana, cocaine, ecstasy, ketamine, LSD, amphetamines and alcohol can sometimes cause psychotic symptoms.
Organic psychosis: Sometimes, symptoms of psychosis may appear as a result of a physical illness or a head injury.
Brief psychotic disorder: This illness usually lasts less than a month. It is sometimes triggered by a major stress in the person’s life, such as a death in the family.
Delusional disorder: This type of psychosis consists of very strong, fixed beliefs in things that are not true.
What are the signs & symptoms of psychosis?
Psychosis affects the way a person thinks, feels and behaves. The experience of psychosis varies greatly from person to person. Psychosis can come on suddenly or can develop very gradually.
The symptoms of psychosis are often categorized as either “positive” or “negative.”
Positive symptoms are those that add to or distort the person’s normal functioning. They include:
Negative symptoms involve normal functioning becoming lost or reduced. They may include:
Psychosis occurs in a variety of mental and physical disorders, so it is often difficult to know what has caused a first episode. Research shows that a combination of biological factors, including genetic factors, place a person at greater risk of developing symptoms of psychosis. For such a person, a psychotic episode may be triggered by many different environmental factors, such as stressful events or substance use.
An imbalance in brain chemicals such as dopamine and serotonin can also be a factor.
A person who is having symptoms of psychosis should have a thorough medical assessment to rule out any physical illness that may be the cause.
What is the treatment for psychosis?
Psychosis can be treated, and many people make a good recovery, especially if they get help early. Treatment may be recommended either on an outpatient basis or in hospital. It usually consists of medication and psychosocial interventions (e.g., counselling).
Throughout treatment, families can receive support and education during sessions with the treatment team.
Medications called antipsychotics are usually essential. They relieve symptoms of psychosis and may prevent further episodes of illness.
A case manager or therapist can provide emotional support, education about the illness and its management, and practical assistance with day-to-day living. They may also recommend programs in the community and provide supportive psychotherapy and vocational counselling.
Recovery from a first episode of psychosis varies from person to person. Sometimes symptoms go away quickly and people are able to resume their regular life right away. Other people may need several weeks or months to recover, and they may need support over a longer period of time.
Ontario Mental Health Helpline (open 24/7 for treatment anywhere in Ontario)
Beyond Psychosis (video)
First Episode Psychosis: An Information Guide (CAMH online store)
Promoting Recovery from First Episode Psychosis (CAMH online store)
Psychosis 101 (online tutorial) Please Note: Your pop-up blocker must be turned off to view this tutorial
Women and Psychosis (CAMH online store)