Understanding Psychosis: A helpful guide for health professionals

In today’s Osmosis from Elsevier blog, we’re exploring the impact and causes of psychosis, its diverse symptoms, and the importance of early intervention. Learn how to recognize, support, and reduce stigma as a clinician, caregiver, or family member.

Imagine if how you perceive reality changed radically, with a disconnect in the way you experience the world around you. Perhaps you aren’t sure if some things you see or hear are real. It may be hard to imagine, but 100,000 people in the US experience this each year, and 3 in 100 will experience it at some point in their lifetime. This distorted sense of reality is called psychosis, and it’s a collection of symptoms caused by a multitude of things, including mental health conditions, medical conditions, stress, trauma, and more.

What Is Psychosis?

Psychosis is the impairment of a person’s perception of reality. Someone experiencing psychosis can present with symptoms including:

Spending more time alone or social withdrawal
Heightened suspicion, paranoid ideas, uneasiness around others
Difficulty falling asleep or reduction in sleep overall
Difficulty communicating and confusing speech
Difficulty with thinking logically and clearly
Struggling to differentiate between reality and fantasy
Experiencing unusual thoughts or a lack of feelings
Neglecting personal hygiene
Academic or work performance decline
Lack of motivation
Very strong fixed false beliefs (delusions)
Perception of something that is not present; this can occur with any of the five senses (hallucinations)

Anyone can experience psychosis, and it can be a scary experience for them and their loved ones. Recognizing the symptoms of psychosis is crucial to helping patients get treatment promptly. The longer it takes for a person to get help, the more disruptive it can be to their lives and those around them.

What Causes Psychosis?

Psychosis itself is not a diagnosis but a collection of symptoms that can present with certain mental health disorders, medical conditions, traumatic injuries, and substance use. Below is an expanded, but not exhaustive, list of the various causes of psychosis.

Mental Health Conditions:

Schizophrenia
Schizophreniform Disorder
Brief psychotic Disorder
Bipolar Disorder
Major Depressive Disorder with psychotic symptoms
Anxiety
Stress

Medical Conditions:

Alzheimer’s disease
HIV and AIDS
Multiple Sclerosis
Brain tumor
Malaria

Substance Use:

Methamphetamine
Cocaine
Cannabis
LSD
Ketamine

Other causes:

Severe head injuries
Sleep deprivation
Vitamin deficiency

In addition to the array of different conditions and substances that can trigger it, did you know that stress can cause psychosis as well? While various studies are working to pinpoint the exact reasons, there are a few theories. One is that stress causes a release of dopamine, which worsens psychotic symptoms such as delusions and hallucinations. Another theory is that people who experience psychotic episodes or symptoms have a higher amount of stress than those who do not, and this may trigger a psychotic episode.

Extreme amounts of stress, trauma, and sleep deprivation can negatively impact the mind. For example, if a person experiences just 24 hours of sleep deprivation, they’ll begin to have a distorted perception of reality and experience hallucinations and delusions. Therefore, it’s crucial to reduce stress when possible and engage in healthy sleep hygiene. These lifestyle modifications can improve overall wellness and may help reduce the risk of an episode of psychosis.

Different Types of Psychotic Experiences

Psychosis affects individuals in different ways. As previously mentioned, psychotic experiences can be triggered by a variety of things. Stepping into the world of someone experiencing psychosis can provide a better understanding of what it’s like, whether it’s a person with Schizophrenia, Bipolar Disorder, or a psychotic episode. Take a moment to learn more about what it’s like to experience psychosis firsthand.

Recognizing Psychosis

If you recognize symptoms of psychosis in someone and want to offer support, here are a few actionable steps to empathetically listen, understand, and support them. Remember, the goal is to make sure the person feels safe, heard, and open to ask for help.

Speak slowly and clearly, and avoid raising your voice.
Stay calm and be aware that the person may be fearful of the symptoms they are experiencing.
Validate their feelings and listen without judgment.
Do not attempt to challenge their beliefs.
Offer to help them access treatment, and be aware that they may initially reject your help.
Do not restrict their movement.

Getting Help and Treatment

Since there are medical conditions, substances, and stressors that can cause psychosis, it’s crucial to get a detailed history and physical exam to pinpoint the cause and provide the best treatment. If medical causes or substance use are ruled out, a healthcare provider will look into mental health issues as the cause.

Coordinated Specialty Care is a team-based service that works to improve a patient’s outcome with their first episode of psychosis. It includes several components: family education and support, case management, psychotherapy, medication, peer support, and education/employment support.

Understanding the underlying cause of psychosis is what helps healthcare providers accurately tailor care. However, a few of the common interventions include antipsychotics, which block dopamine receptors in the brain.

Psychotherapy, specifically Cognitive Behavioral Therapy (CBT), draws attention to negative thought patterns and maladaptive behaviors to provide patients with healthy coping strategies. Family therapy is also commonly used to help family members learn how to support someone dealing with psychosis, educate them on the condition, and provide support for caregivers as well.

The Impact On Individuals and Families

As psychotic symptoms persist, they become more distressing for individuals and their families. At first, they may not be as noticeable, but they’ll eventually impair an individual’s ability to function personally and professionally. Reduced concentration, anxiety, social withdrawal, strange beliefs, and difficulty with logical thinking and communicating are very worrisome for both the individual and their family because their change in behavior can be drastic. Getting help as soon as possible is important, as well as working with a treatment team to support the individual dealing with psychosis. Remember to be as patient, open-minded, and empathetic as possible. Dealing with psychosis is not easy, but there are effective treatments that work to reduce symptoms.

In addition to providing support for a loved one, family members may also need support. Remember, you can’t pour from an empty cup. Resources such as support groups, family therapy, and counseling are available. So, if you have a loved one dealing with psychosis, make the time to find some support for yourself as well.

Let’s Talk About Stigma

There are a variety of misconceptions and stereotypes associated with the term psychosis. It’s important to clarify that an individual experiencing psychosis isn’t simply “crazy” or just “talking to themselves.” We discussed the altered reality that these individuals experience. Their responses are linked to that alternate reality. So, while their perception may differ from ours, they may respond directly to their hallucination, convinced that it’s real.

Another problematic stereotype about psychosis is that it means an individual will be violent. The media often shows a person with psychosis acting erratically and lashing out physically, but it’s not an accurate depiction. In fact, those with mental illness are more often victims of violence rather than perpetrators of it.

Most notable is the need to distinguish psychosis and psychopathy. A psychopath is unable to experience empathy, which is very different from a psychotic episode. Psychosis involves a temporary disconnect from reality, marked by symptoms like hallucinations, while psychopathy is a personality disorder characterized by ongoing antisocial behavior, diminished empathy, and a lack of remorse. They differ in nature, symptoms, and underlying traits.

Talking about stereotypes and dispelling them is how we can work to reduce the stigma surrounding psychosis and other mental health disorders so that everyone can feel empowered to get the help that they need and deserve.

Learning and Growing Together

By learning more about psychosis, you’re taking an active step in creating a supportive community for those who experience it. Knowing how to recognize the signs, effectively provide support, and understand the treatment options are all helpful tools that will come in handy when interacting with your patients or a loved one experiencing psychosis.

If you’re interested in learning more, check out these great resources: