November 20, 2018
4 Things to Know About Psychosis

4 Things to Know About Psychosis

by Keng Lam, MD  

Even with the growing attention to mental health conditions in our culture, many people remain unfamiliar with psychosis—especially if they haven’t had firsthand experience with a person having a psychotic episode. Would you recognize psychosis if you saw it? Would you know what to do (and not do) to help? Here’s a brief look at this serious psychiatric condition, from how to recognize it to where to find the right treatment.

What is psychosis?

Psychosis is a severe mental health condition that causes a person to have trouble distinguishing what is real from what is not (psychiatrists call this “impaired reality testing”). It’s helpful to frame psychosis as a cluster of symptoms, rather than a diagnosis by itself. Those symptoms may include delusions (believing the government is recording your conversations in your house, for example), hallucinations (such as hearing voices when no one is around), bizarre behavior (such as wearing winter clothing when it’s very hot outside or talking loudly when nobody is around), and disorganized speech (for example, saying a string of sentences that are off topic or difficult for others to understand). The symptoms tend to last for at least several days and can be very menacing, either to the person experiencing them or to others.

What causes psychosis?

Perhaps the best-known cause is the mental illness schizophrenia, though it’s far from the only cause. According to the DSM-V, the official diagnostic manual for mental health disorders, a person must have at least some of the symptoms discussed above for at least six months in order to be diagnosed with schizophrenia.

Other potential causes of psychosis include a mood disorder such as bipolar disorder or major depression, which can come with psychotic symptoms when severe. Substance use is also an important cause, with stimulants and hallucinogens the most common culprits. Certain medications, such as corticosteroids, can induce a psychotic episode when taken at high doses. Even some medical conditions (including syphilis, brain inflammation, and endocrine disorders) can lead to psychosis, though this is fairly rare.

Are people with psychotic disorders violent?

Some studies show that people with psychosis are at higher risk for committing violent acts than the average person. However, the media tend to exaggerate that picture. In fact, it is much more likely for a person with a psychotic disorder to be the victim of violence or an accident than to be the perpetrator. Such individuals are often scared and confused, and that can mislead bystanders into thinking that they are dangerous even though they aren’t hurting anybody. Still, it is rarely a good idea to actively confront someone who has psychosis. Instead, call 911 or alert a law enforcement officer who can transport the person to a hospital.

How is psychosis treated?

When a person is actively psychotic, he or she often requires hospitalization for stabilization. The first choice of treatment is usually an antipsychotic medication—two examples are haloperidol (brand name Haldol) and olanzapine (brand name Zyprexa)—which help by reducing hallucinations and agitation. These same medications may also be used for long-term therapy for people with schizophrenia and even some mood disorders. If the psychosis is caused by a medication or substance abuse, it may resolve itself once the substance is discontinued; the same goes for treating any underlying medical conditions causing psychotic symptoms.

Talk therapy generally isn’t useful for acute psychosis. But once the person is stabilized and more in touch with reality, certain types of therapy or other psychosocial interventions can be helpful for people who experience repeated or ongoing episodes (due to schizophrenia, for example). These include family therapy and social skills training.

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