In this section:
What is Psychosis?
In this interview from the National Institute of Mental Health, Ryan talks about his experiences with schizophrenia, his challenges, and his success in fulfilling his dreams.
What is psychosis?
"Psychosis" is a broad term that covers many different symptoms and experiences.
Common symptoms include:
- Hallucinations (seeing, hearing feeling or tasting things that other people don’t)
- Feeling overwhelmed by sensory information (lights seem too bright, noises too loud)
- Difficulty filtering stimulation from the environment
- Delusions (false personal beliefs based on incorrect inferences about reality which are inconsistent with culture and previous beliefs, and which are firmly sustained in spite of evidence or proof to the contrary)
- Confused thinking or speech
- Difficulty doing ordinary things (often includes problems with memory, attention, putting thoughts together)
Who experiences psychosis?
Anyone can develop psychosis. Many people see or hear things that others don't, or have ideas that are unusual. Psychosis is only a problem when it is causing you or someone close to you significant distress or harm.
It affects 3 in 100 people, and usually occurs for the first time between the ages of 15 and 30. Men often develop psychosis 5 to 10 years younger than women. It can be caused by a variety of medical illnesses, sleep deprivation, severe stress or trauma, drug reactions, genetic predisposition, and other factors.
Common Early Signs of Psychosis
Some of the most common signs of psychosis include:
- A sudden loss of interest in things that the person used to find enjoyable
- Inability to do the things that the person could do before (e.g., a person who normally loves math suddenly can't do it anymore)
- Social withdrawal and isolating from friends and family
- Dramatic changes in sleep pattern
- Statements or behavior that are bizarre and inconsistent with what’s going on around them
Emergence of Symptoms
Psychotic disorders rarely emerge suddenly. Most often, the symptoms evolve and become gradually worse over a period of months or even years. Early symptoms often include cognitive and sensory changes which can cause significant disability before the illness becomes acute and is finally diagnosed. Identifying and responding appropriately to the condition early can help to get the person and their family support.
1. Reduced Performance
- Trouble reading or understanding complex sentences
- Trouble speaking or understanding what others are saying
- Becoming easily confused or lost
- Trouble in sports or other activities that used to be easy (Example: can’t dribble basketball or pass to team members)
- Attendance problems related to sleep or fearfulness
2. Behavior Changes
- Extreme fear for no apparent reason
- Uncharacteristic and bizarre actions or statements
- New, bizarre beliefs
- Incoherent or bizarre writing
- Extreme social withdrawal
- Decline in appearance and hygiene
- Dramatic changes in sleeping or eating
3. Perceptual Changes
- Fear that others are trying to hurt them
- Heightened sensitivity to sights, sounds, smells or touch
- Making statements like “my brain is playing tricks on me”
- Hearing voices or other sounds that others don’t
- Reporting visual changes (colors more intense, faces distorted, lines turned wavy)
- Feeling like someone else is putting thoughts into their brain or that others are reading their thoughts
Earlier on, symptoms may be intermittent and the person often recognizes that something is wrong. As psychosis progresses, people lose their ability to distinguish symptoms from reality, and it becomes more difficult to have a conversation. For example, a person who has auditory hallucinations will hear voices which sound to them as loud and real and a person standing right next to them, even though others don’t hear it. A person whose psychosis has progressed may not believe that other people don’t hear the same voices and may not be able to integrate new information from others into their thinking.
Psychosis may also result from, or accompany, a mood disorder such as major depression or bipolar disorder (in which there are dramatic swings in energy level, sleep patterns, mood and behavior).
Example: A Concerning Change
Jonathan really liked two things: fixing computers and hanging out with his friends. So when he suddenly stopped doing both, it came as a big shock. His best friend came to visit and found him staring off into the distance.
"Have you been fixing that laptop?" she asked.
"No." Jonathan's face didn't seem to show any emotion. His tone was flat.
"Are you feeling down? Depressed?"
Jonathan shrugged. "I don't know. I can't seem to focus on anything anymore. My computer screen hurts my eyes."
As time passed, Jonathan's teachers and parents started noticing differences too. He stopped doing his homework and would skip class. Then, his friends noticed that he was posting unusual statements on Facebook.
"Aliens are out to get me and they're talking through the TV," he wrote. "I'm scared. I don't know what to do."
Stories like these are not uncommon for people experiencing psychosis for the first time. It can be very concerning for both the individual and their family, friends, and allies. But there is hope.
Many young people experience psychosis and still realize their hopes and goals. It is important that they receive support from their families, friends, allies, and mental health. Please use the "Get Help Now" button to find a support network near you.
It’s important to understand that people usually are aware of some symptoms but not others. This is in part because of the nature of the symptoms themselves. Think of the analogy of an optical illusion. Your brain perceives and interprets information, but the information is interpreted incorrectly because of the way your brain constructs the information. Only when someone points out the error and when you use tools such as a ruler to “reality test” your perception do you recognize that it is an optical illusion. Psychosis is very similar. The brain perceives and interprets information erroneously, but the person is unaware that this is happening. Certain symptoms such as distressing hallucinations, paranoia and anxiety are often perceived as problematic to the person. However, most people do not recognize them as medical symptoms, and many of the other symptoms are recognized primarily by other people. For this reason it is critical for close family members and others who are known and trusted by the individual to be involved in the assessment and ongoing treatment process. Part of the process of treatment is helping the person to learn to distinguish and differentiate symptomatic perceptions from normal perceptions.
Hallucinations: Seeing, hearing or feeling things that others don’t. This can range from an intense experience of color, blurring or distortion of visual images, to hearing sounds or voices with no apparent source, and seeing or feeling objects or phenomena which others do not.
Delusions: False beliefs based on incorrect inferences about reality, inconsistent with culture, experience and previous beliefs, and held with conviction despite evidence to the contrary. Delusions can be caused by a variety of information processing dysfunctions, involving sensory input, memory, attention, and interpretation. Some common delusions:
Delusions of reference: Belief that day-to-day events or experiences refer directly to you; for example, that the people on the TV set are talking directly to you, that street signs, license plates, or behaviors (such as coughing) carry communications specifically aimed at you.
Delusions of grandeur: Belief that you are able to do things which are beyond normal capacity, such as fly or act as royalty.
Persecutory delusions: Belief that others are trying to hurt you, for example, by poisoning you or through a conspiracy to cause you harm.
Nihilistic delusions: Belief that you or others do not exist.
Thought broadcasting: Belief that your thoughts can be read by others.
Thought insertion: Belief that others are placing thoughts in your head.
Thought withdrawal: Belief that one’s thoughts are being extracted from the mind.
Thought control: Belief that feelings, thoughts and actions are not one’s own, experienced as being imposed by an external source.
These are symptoms related to the person’s ability to communicate. The person may experience changes to their use of speech and the way they construct sentences. Examples include:
Frequent changes of ideas, making little sense to others (circumstantiality, tangentiality, derailment, looseness of association, flight of ideas)
Incoherent jumble of words (word salad)
Choosing words based on sound, such as rhyming or punning (clang associations)
Making up words which mean something only to the speaker (neologism)
Echoing others’ words (echolalia)
Abnormal movements and behaviors:
A person may develop odd behaviors, movements or mannerisms, or may become unable to move on their own (catatonia, waxy flexibility or posturing)
The following common symptoms are similar to some of the cognitive symptoms, but are commonly classified as “negative” symptoms (i.e. something taken away, versus “positive” symptoms, where something new is occurring):
Lack of facial expression (affective flattening) or inability , to detect facial cues from others;
Absence or restriction of speech (alogia);
Difficulty initiating goal-directed behavior (avolition/anhedonia)
Inability to experience pleasure and/or maintain social contacts (anhedonia/asociality)
Inability to maintain mental focus (attentional impairment)
Depression: Predominant mood is depressed and there is a loss of interest or pleasure in nearly all activities for at least 2 weeks. Depression in its severe forms can cause psychosis. Depression can also be an early warning sign of psychosis for people who have schizophrenia.
Suicidal thoughts. It is important to know that many people who experience psychosis also experience suicidal thoughts, and the risk of suicide is significantly greater than for people who do not experience psychosis.
Mania: Period of time in which a person’s mood is elevated or irritable, there is a lack of restraint in behavior, and highs in energy, requiring little or no sleep. Severe mania can cause psychosis, or a person can have both mania symptoms and psychosis symptoms distinctly from each other.
Anxiety. Extreme anxiety is common with psychosis.
Most people who experience psychosis also experiences difficulty with memory, attention, and organization of thoughts. These symptoms may improve but often do not disappear completely with treatment for psychosis.
For more information about psychosis, some good links to visit are:
[add new links]
For a comprehensive and highly useful text, we recommend Psychosis: A Wellness Approach, by Mary Moller. This text can be ordered at http://www.psychiatricwellness.com
The following illnesses or conditions, among others, can cause symptoms of psychosis.
- Sleep deprivation (psychosis should remit after the person sleeps)-
See www.sleepnet.com for more info on sleep disorders.
- Drug use (psychosis usually goes away within 72 hours, although our
experience with methamphetamine is that it may take longer). See
- Cushing’s syndrome
- Adverse reactions to prescribed medications, such as steroids
- Thyroid and parathyroid disorders
- Cerebral sarcoidosis
- Systemic lupus erythematosus
- Very advanced cases of AIDS (some of the medicines can also cause psychosis)
- Sex chromosone abnormalities http://turners.nichd.nih.gov/
- Demyelinating diseases such as multiple sclerosis and Schilder’s
disease, especially if they involve the temporal lobes
- Encephalitic diseases
- Wilson’s disease
- Huntington’s disease
- Friedreich’s ataxia
- Vitamin B12 deficiency
- Subarachnoid hemorrhage
- Cerebral tumors
- Head injury
- Temporal lobe epilepsy
- Mood disorders: Clinical depression or bipolar disorder
It is not uncommon for the diagnosis process to be ongoing over time. Some of the possible diagnoses require six months observation to confirm. You may be given a “rule-out” diagnosis, which means that additional observation or testing is needed to determine whether this diagnosis is correct.
Usually a preliminary diagnosis is made from the first interview, confirmed within approximately the first thirty days, and revisited periodically throughout treatment.
The following information will be important in any assessment:
How do you perceive what is going on- what do you observe? What changes or possible “symptoms” have you noticed:
- Current illnesses and treatment you may be receiving
- What medicines or supplements are you taking?
- Physical changes with your body
- Changes in your sleep and appetite
- Changes in your moods
- Changes in your thought process
- Illnesses that you or other family members have experienced
- Injuries. Have you ever been knocked unconscious?
- Allergies and adverse reactions to medicines
- Drug use and reactions
- Learning disabilities
- What do others around you observe (sometimes with neurochemical changes others notice changes when the individual doesn’t)
- How are these changes affecting your ability to focus at work/school and home?
- How are they affecting relationships with others?
- How are they affecting your ability to meet personal goals and priorities?
- What information do you and your supporters have, and what do you need?
- Do you have a strong support network?
- Is your living situation stable and supportive of your healing process?
- What are your personal goals and priorities, and are these changes interfering?
Medical tests which EASA routinely recommends for people experiencing psychosis include:
- CBC with differential
- Chemistry panel (with liver enzymes, electrolytes, BUN, Cr, calcium)
- Urine drug screen
- Urinalysis, with microscopy
- B-12 and folate
- Thyroid screen (TSH, T4)
- MRI or CT
- Other tests indicated by additional medical conditions identified
- A clarification of preliminary diagnosis. In some cases, it may take a while to get a final diagnosis.
- Identification of the type of treatment which is most likely to be helpful
- Initial goals for treatment, based on your needs and priorities