Psychosis occurs when an individual loses touch with reality—a break that can be terrifying to experience or to observe in a loved one. Psychosis can include hallucinations, delusions, disorganized speech, and abnormal movements. Hallucinations—perceiving something that doesn’t exist—and delusions or false beliefs are hallmarks of psychosis. Disorganized speech may manifest as incoherent babbling and abnormal movements can include motionlessness, a state called catatonia.
Psychosis is a symptom, not a classifiable disorder in and of itself. Persistent symptoms of psychosis may lead to a diagnosis of a schizophrenia spectrum disorder, such as schizophrenia, schizoaffective disorder, or schizophreniform disorder. Psychosis can also be a symptom of bipolar disorder. But psychosis can arise from other sources, such as sleep deprivation, alcohol, or drugs. It is important to seek professional help as soon as psychosis is experienced or suspected.
For signs, causes, and treatment of schizophrenia, see our Diagnosis Dictionary.
Before young adults experience their first psychotic episode, they often show signs that something is awry. Their behavior may seem unusual, confused, or withdrawn, and they may begin to struggle in school or at work. Seeking help during this phase or active psychosis is key. Treatment can allow individuals to manage the condition and continue along their life path during the years of early adulthood.
Behavioral changes may be experienced and observed prior to a full psychotic episode. Those signs include:
• Withdrawal from friends and social activities
• A drop in grades or job performance
• Blunted emotion or inappropriate emotion
• An inability to think clearly and the sense that something is "off"
• Suspicions about the behavior of others
• Aggression toward others
• Memory problems and distractibility
• Sensitivity to stimuli such as bright lights, noise, colors, and textures
• Peculiar use of words and phrases, and mangled syntax
• Rapid speech and nonsensical statements.
Psychosis most often emerges in adolescence and young adulthood. In fact, around 100,000 individuals in the U.S. experience a first episode of psychosis, or FEP, each year. This may be preceded by a phase when their grasp on reality cracks and slips away. They may perceive things that aren't there, misinterpret social interactions, or struggle with abstract thought.
The acute phase of psychotic episodes can vary in length, spanning a few days to a few weeks. A diagnosis of schizophrenia involves symptoms such as delusions, hallucinations, and disorganized speech that last longer than a month while brief psychotic disorder is diagnosed those symptoms last for less than one month.
Psychosis is a hallmark of schizophrenia, which affects 20 million people worldwide, and other schizophrenia spectrum disorders, such as schizoaffective disorder and schizophreniform disorder. It can also occur during manic episodes of bipolar disorder, severe depression, delirium, and other conditions.
It can be very scary to see a loved one lose touch with reality, but people experiencing psychosis are almost never dangerous. They’re more likely to harm themselves than others, through self-harm, an accident, neglect, or vulnerability to exploitation. Therefore, it’s vital to help the individual seek medical and/or psychiatric attention.
Scientists still don’t have a clear understanding of what causes psychosis. Genetics plays a role, because the risk of developing schizophrenia is higher for twins and immediate relatives with the condition. But the development of psychosis encompasses much more than one’s genetic profile—it’s likely due to a combination of biological, psychological, and social factors. For those who are more vulnerable to it, psychosis can emerge due to stress, trauma, or other events.
Psychotic episodes, in some cases, may be sparked by specific triggers. In addition to the underlying presence of conditions such as schizophrenia and bipolar disorder, symptoms may be provoked by anxiety and stress, alcohol or drug use, and lack of sleep.
The relationship between psychosis and cannabis is complicated, and it’s difficult to disentangle whether one causes the other. But some research suggests that using cannabis on a daily basis and using cannabis with high THC content are associated with increased odds of developing psychosis.
Case studies have found that high caffeine use can induce psychosis in otherwise healthy people. Caffeine can also exacerbate symptoms in those who already have a psychotic disorder. Reducing and eliminating caffeine, in those cases, allowed symptoms to abate.
Early research suggests that between 1 and 4 percent of COVID-19 patients experience psychosis. It’s still unclear whether psychosis stems from the virus itself, such as through inflammation or abnormal coagulation, symptoms of the illness, or fears surrounding the virus.
A single episode of psychosis—especially the first (First Episode Psychosis) can be controlled with medication; and a recurrence can often be prevented once the underlying cause is identified. To prevent further episodes, it is critical to seek treatment immediately.
Symptoms of psychosis are treated with both antipsychotic medications and psychotherapy. Antipsychotics can take the form of pills, liquids, or monthly injections. Hallucinations tend to subside in a couple of days and delusions in a few weeks, but medications require around six weeks to be fully effective. When individuals adhere to a treatment plan, even those who have experienced multiple psychotic episodes can manage their symptoms effectively and lead fulfilling lives.
While psychosis can be successfully managed over time, there is no medication or therapy that targets and cures the underlying disorder. Treatment instead focuses on curbing the symptoms of psychosis with therapy and medication so that the individual can live a functional, full life.
Treatment is more successful when it begins right after symptoms emerge, research finds. One theory is that brain changes may spread during the delay. Perhaps more intuitively, early treatment prevents young adults from missing key developmental milestones, such as getting a job, going to college, or forging relationships.
Psychosis has historically been treated with antipsychotic medication. However, those drugs can have debilitating side effects that prevent people from taking them. Newer successful approaches, such as Coordinated Specialty Care, incorporate cognitive behavioral therapy, job assistance, family support, substance use intervention, and lower doses of antipsychotics.
Antipsychotics can have difficult side effects such as exhaustion, extreme weight gain, and tremors or uncontrollable movements, which can lead people to stop taking their medication altogether. Taking lower doses of antipsychotics provides an alternative that can lead to better recovery outcomes.
The first episode often occurs during the college years, when parents may not be able to easily help their children. Parents should understand a few basic points to help their college student cope with psychosis: Comprehensive treatment can reduce symptoms, their academic career isn’t necessarily over, being a strong advocate is key, and regular sleep helps with prevention.