Psychosis: What you need to know

Psychosis is a common mental state that can affect anyone. It’s not something to feel ashamed or alone about. Around 7% of people will experience psychosis at some point in their lives. Experiencing psychosis can be frightening and disorientating for both the person going through it and for those around them who care about them. Remember that help is available and you are not alone. With the right support, most people go on to recover well.

It is often the changes in people’s behaviour that draw attention to the fact that they are unwell. The person may be behaving strangely and have difficulty performing usual activities like schoolwork, work or hobbies, or self-care.This isn’t laziness or a lack of effort, it’s part of what they’re going through.

Signs and symptoms of psychosis

If someone is experiencing psychosis, they can experience or interpret things differently from other people around them. It is as if the boundaries of reality become blurred or the person with psychosis lives in an alternate reality. Things take on a special meaning and people see or hear things that others cannot. The main symptoms of psychosis are delusional thinking, hallucinations and thought disorder.

Delusional thinking

Delusional thinking or magical thinking is when people develop unusual thoughts or beliefs. For instance people may believe that they have special powers or that strange things are happening around them that only they can understand.

Another form of delusional thinking is called paranoia. For example, people may believe that they are being monitored by other people or organisations and they may feel that they are being watched or filmed or followed. These symptoms are frightening and can cause people to behave strangely or isolate themselves.

Hallucinations

Hallucinations can involve any of the five senses (most commonly hearing and seeing) and affect the way in which a person interprets the world around them. A person may see, hear, taste, smell and feel things that simply aren’t there or misinterpret things that they are experiencing. These experiences seem so real that they have difficulty believing otherwise. For example, a person may hear voices that other people can’t hear which are saying critical things about them or telling them to do things. These experiences can feel completely real to the person.

Thought disorder

When a person experiences psychosis, their thoughts can become confused and muddled. It can be difficult to have a conversation with someone when this is happening because their speech can be disorganised and they may say unusual things.

Sometimes the person feels as though their thoughts are racing. They may speak very fast, jump from topic to topic and be hard to understand. Other times a person may feel that their thoughts are slowed down. They may struggle to concentrate and have difficulty following a conversation. Sometimes the person may speak very little or struggle to find simple words.

Phases of psychosis

Psychosis usually unfolds in stages and at every stage, support is available.

Early warning signs phase

There are some early warning signs that may happen before a first episode of psychosis:

• Reduced concentration or motivation
• Depressed mood or anxiety
• Sleep disturbance
• Suspiciousness, odd beliefs, or magical thinking
• Deterioration in daily functioning
• Withdrawal from family and friends

Acute Phase

The acute phase is when the main symptoms of psychosis emerge, such as hallucinations and delusional thinking. The person starts behaving strangely and saying unusual things. They may engage in risky behaviour. The person experiencing psychosis may not realise what is happening to them but it often leads themselves or their families to seek help, which is an important step toward recovery.

Recovery Phase

Recovery is always possible regardless of when you receive treatment. While getting help early gives the best chance of preventing another episode of psychosis, it is never too late to get support.

Lack of insight

One of the key issues with psychosis which makes it different from other conditions is called “lack of insight”. This is an integral part of psychosis. This means that the person who is experiencing the symptoms does not recognise that they are part of a psychosis. For instance, they firmly believe that the voices are real or that unusual things are happening that no-one else knows about. This means that people with psychosis will seldom seek help for themselves so it is usually family or friends who recognise that the person needs help.

Recognising Signs of Psychosis

It isn’t always easy to tell if someone is experiencing psychosis. Many people don’t talk openly about hallucinations or delusions. Instead, you might notice more subtle changes like strange behaviour or saying unusual things, trouble concentrating, withdrawing from friends, or struggling with everyday tasks like going to school or work or poor personal hygiene. A few gentle questions you could ask yourself to help you figure out whether it’s time to check in are

• What changes have you noticed?
• Is this out of character for them?
• How long has this been going on?
• Is it getting in the way of their daily life?

Some of the signs of psychosis are similar to signs of other mental health problems. For that reason, it’s important to be aware of signs that are specific to psychosis. Things to look out for that are more likely to be a sign of psychosis include someone:

•  Becoming very suspicious or paranoid about people
• Having unusual ideas or strange beliefs about things
•  Developing fixed ideas about conspiracy theories or people plotting to harm them
•  Believing they have special powers or a special purpose in the world
• Thinking that things on the internet have special messages for them
• Being very distracted, as though responding to something or someone, even if there is no one around
• Talking to themselves, as though they are responding to someone, even if no one is there

How to get help

If you, or a family member is experiencing psychosis, speak to your GP as soon as possible. There is no formal test that can be carried out, but if you explain your symptoms to your GP, they will be able to determine the possible cause and the next steps. Learn more about speaking to your GP about mental health here.

Your doctor may refer you to a community mental health team (if you are 18 or over) or a CAMHS (Child and Adolescent Mental Health Service) team (if you are under 18) that can develop a treatment plan with you. Or the GP may advise attending a local emergency department if symptoms are very severe or there is risky behaviour.

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