Psychosis

Psychosis is a condition in which a person is unable to distinguish between what is and is not real. It causes changes in how they see and believe things, sometimes making them hear or see things that aren’t there or believe things that aren’t true.

As a result, psychosis affects how someone processes thoughts and information. Psychosis can make someone feel really overwhelmed, as if the brain is taking on too much information, or confused and unable to focus.

Difference Between Psychosis and Schizophrenia

Sometimes people get schizophrenia mixed up with psychosis. Schizophrenia is a mental illness that causes psychosis, but it has other symptoms too. Psychosis can be caused by illnesses and circumstances other than schizophrenia.

How Psychosis Manifests

The brain of someone experiencing psychosis gets signals mixed up, and tricks the person into thinking that they can see, hear, taste or feel things that aren’t really there. Someone experiencing psychosis might not realize that something isn’t right, or that they are thinking or behaving in a way that doesn’t make sense. This is called a lack of “insight”, which means having trouble seeing yourself and your behaviour clearly.

Living with and Treating Psychosis

Psychosis is different for different people. People may experience the symptoms of psychosis in very different ways.

The symptoms of psychosis can be very disabling, and get worse over time if left untreated. Living with symptoms of psychosis can be frightening, confusing and debilitating. However, psychosis is treatable with professional help.

Misconceptions About Psychosis

Psychosis is not:

• A split personality.
• Caused by childhood trauma, bad parenting, or poverty.
• The result of any actions or personal failures of the individual.
• A sign or result of low intelligence.
• An indication that someone is dangerous or “psycho”.

Psychosis is complicated and there is still much to discover about exactly what causes it. It can start slowly and develop over time, or erupt suddenly, as if triggered by something immediate in one’s environment. It can occur once or twice in someone’s lifetime, or very frequently. There seems to be a number of factors that can work together that cause someone to have psychosis, including:

Genetics

Family history of illness or genetics can be a contributing factor. Someone who has a family member who has experienced psychosis may be at a higher risk for developing it themselves.

Environment and Life Experiences

Stress, significant life changes, trauma, serious or disturbing events might trigger psychosis for some, especially those who have a family history of psychosis. There is also some research to suggest that young males, people who live in poverty and people who live in urban settings (cities) are at a higher risk for developing psychosis.

Biology and Brain Chemistry

There are chemicals that work in unison to create a healthy brain. One of those chemicals is dopamine, which acts to do things like control the flow of information to the brain. Research tells us that someone who is experiencing psychosis is getting a rush of dopamine into the brain.

Drug Use

Substance use has been connected to psychotic episodes. Marijuana, LSD, cocaine, alcohol, and crystal meth are some drugs that have been known to trigger psychotic episodes for some, especially those who have a family history of psychosis. Sometimes, people can have a reaction to prescribed medications that can cause psychosis.

Illnesses

Psychotic symptoms may be part of a number of mental illnesses including schizophrenia, severe depression, bipolar disorder and post-traumatic stress disorder. Physical health issues, like dementia, brain diseases (like Parkinson’s), brain tumours and certain infections of the brain can also cause psychosis.

A person experiencing psychosis might not have all of these symptoms. Some of these symptoms might be explained by something other than psychosis. No two people are alike, and so one person’s experience with psychosis might differ from others. If you think yourself or a friend may be having problems with psychosis, it is important that you consult your family doctor.

Perceptual Symptoms

• Experiencing things that do not exist, like hearing things, seeing things, tasting things, smelling things or feeling things that are not real. These are called hallucinations. The most common type of hallucination is auditory (hearing voices or sounds that others don’t hear).
• Having beliefs that are extreme, unlikely, or clearly false to those around you, like family or friends. These beliefs are called delusions, and they may start to take up a lot of time and concern for someone experiencing psychosis. Some common delusions are believing that you have special powers such as being able to change the weather or control world events, believing you can control others’ minds, or believing others are controlling your mind.
• Paranoia – Being really worried about things that may not be real or rational.

Cognitive Symptoms

• Problems concentrating, confusion, racing thoughts, memory issues.
• Thoughts that race and/or jump around with no clear order.
• Not able to plan or not able to act on plans.
• Thoughts may seem blocked, sped up or slowed down.
• Difficulty problem solving and processing information.
• Lack of insight – not able to see or realize that there is something wrong or that thoughts/behaviours aren’t “right” or typical.

Emotional Symptoms

• Experiencing emotions that are out of control or feeling numb.
• Displaying the “wrong” thing at the wrong time. For example, your dog dies, and you can’t stop smiling despite feeling real grief.
• Depression, agitation or feeling really high and elated without the use of street drugs.
• Decreased reactions to the environment and what is going on around them – seeming emotionally “flat”.

Behavioural Symptoms

• Problems with ordinary things like getting out of bed, getting dressed, keeping clean or taking care of yourself.
• Sleep and eating problems.
• Lack of motivation.
• Lack of interest in friends, and withdrawal from life, school and normal activities.
• Unusual or bizarre behaviour that does not make sense, is out of character or serves no purpose.
• Strange movements, or difficulty physically moving from one position to another.

For any mental health concern, if signs or symptoms are interfering with your ability to live life, it’s time to get help. If you think that you, a friend, or a family member, might have psychosis, seek help from a doctor immediately. Psychosis is a treatable mental health condition, and it’s important to not wait until things get really “bad” before seeking help.

Helping a Friend with Psychosis

If it is a friend you are concerned about, they may resist help or not even recognize that they need it. They might need you to take the first step to getting help.  In any case, if you feel like your friend might hurt him/herself or someone else, it’s time to call emergency services.

People experiencing psychosis have an increased risk of suicide, especially when they are not receiving treatment. Substance use can also increase a person’s risk of hurting themselves.

Visit the Help Section to find out how to get psychosis help for yourself or a friend.

Like other mental health issues, psychosis and how it is experienced will differ from person to person. Some may have an early and sudden onset, while for others it may be more gradual. Some may have several, ongoing episodes, while others may have fewer and less “serious” symptoms or episodes.

Because each case is unique, the treatment will likely be unique for each individual. Psychosis can be treated, and many people make a good recovery. Research has suggested that the earlier the intervention, the better the outcome may be.

Medication and Therapy

Psychosis is typically treated with medication that is carefully monitored and adjusted as needed with the help of a doctor. Some people may also see a counselor or therapist, participate in group therapy, or spend time learning skills that can help them live with and identify symptoms of psychosis.

Stress Management

Learning how to cope with stress is another important part of the treatment strategy for psychosis, as well as building up a good network of family and friends who are supportive and understanding.

Support Networks

A person living with psychosis, like any other person, will benefit from maintaining wellness and having good support in their life.  Many people who have had psychosis benefit from having their family and friends become educated about the illness and on how they can be helpful and supportive.

Hospitalization

Some people, especially those who are in the middle of a serious psychotic episode or have been having ongoing issues with psychotic episodes/behaviour may need to spend time in a hospital in order to get help.

Finding the Right Psychosis Treatment Plan

Psychotic episodes can be caused by a mental illness, like severe depression, schizophrenia, PTSD, etc. Some medications and physical illnesses can also trigger psychosis. So, identifying any mental health issues or illnesses that are causing psychosis will be a part of figuring out what treatment strategy will work best for someone.

Every story is different, and sometimes people need to try different types of medications and support before they find the right plan for them.

Myth: People with psychosis cannot live normally, work, have families, etc.

Fact: With the right treatment and support, many people dealing with psychosis can fully recover or manage their symptoms enough to work, have relationships, attend school etc. Someone dealing with psychosis, especially as they begin their treatment, may need to take some time off or lighten their schedule for a while. Treatment is a process, and it takes time, but having psychosis isn’t the end of the road.

Myth: People who have psychosis need to be sent to a mental health facility for a long time.

Fact: Many people with psychosis can be treated in the community by visiting a local mental health clinic regularly. In some cases, hospitalization might be required, but usually for just a short time.

Myth: Treatment for psychosis involves going to a scary hospital, getting shock therapy or brain operations.

Fact: Movies have done a great job of making psychiatric care seem scary and awful. The visions of shock treatments, a lobotomy, scary nurses and dark corridors someone might have when picturing mental health care are very different from actual mental health facilities. Treatment for psychosis usually involves medication paired with therapy of some sort. Medications can be monitored and adjusted to find the right “fit” for each individual. Spending time in a psychiatric clinic or hospital may be necessary for someone who is having symptoms of severe or ongoing psychosis in order to keep them safe while they have time to stabilize.

Myth: Having psychosis means I’m “crazy”.

Fact: Having psychosis means that you have an illness. Just like people who have a physical illness, a person who has psychosis needs to get treatment, monitor their progress, lean on family and friends for support etc. to stay well.

Myth: People with mental illnesses like psychosis are unpredictable and violent.

Fact: Statistically, people living with mental illnesses are actually more likely to be victims of violence, and those with psychosis are more likely to hurt themselves than others. Most violent crimes are committed by people who do not have psychosis.  Psychosis, especially when it is untreated, can certainly cause someone to have delusions, hallucinations, and do things that don’t make sense to those around them, but this alone is not a predictor of violence.

Myth: If someone in my family has psychosis, then I’ll likely have it too.

Fact: Even though genetics seem to play a part in the development of psychosis, it’s not the only factor. Family history of mental illness doesn’t mean that you will have a mental illness.

Myth: People diagnosed with psychosis are beyond help.

Fact: There are all sorts of supports, treatments, and strategies available that can help a person diagnosed with psychosis live a productive life, especially if it is diagnosed and treated early.

Myth: Psychosis is caused by bad parents or an unstable childhood.

Fact: There are environmental factors that can contribute to the development of psychosis, but it can happen to anyone. Even a person who grew up in a loving, supportive home with an amazing family and friends can develop psychosis.

Supporting someone with any type of serious illness can be challenging. Ways to help and support a friend or loved one who is living with psychosis:

Recognize the Signs of Psychosis

Know the signs and symptoms of psychosis and how it presents with your friend specifically. No two people experiencing this illness are the same. Treatment is a process. Medications can cause side effects and may need to be changed and adjusted. Be aware of this and try to be supportive.

Encourage Ongoing Treatment

Get your friend into treatment and encourage them to stay in treatment whenever possible. This can be tough. Sometimes people may resist or not want to continue with medication or other treatment strategies. The best you can do is encourage them and be supportive.

Give Them Space

Yes, you want to help your friend, but hovering over them, constantly checking on them and not allowing them to live their life can cause stress, and stress can cause relapses. Part of recovery is learning how to live life and manage symptoms independently.

Set Realistic Expectations

Have realistic goals. While your friend is in treatment and deals with psychosis, they may need to step back a bit from school or work.

Remember that their beliefs or hallucinations seem very real to them. Trying to apply logic to things they are saying, thinking or doing may not work when someone is having delusions or hallucinations.

Stay Calm

Stay calm with your friend if they are experiencing symptoms of psychosis. Tell them that you acknowledge that everyone has the right to see things their own way.

Establish Healthy Boundaries

Set some boundaries for yourself and take care. You can’t help someone if you’re feeling overwhelmed too yourself. You do not have to tolerate dangerous or inappropriate behaviour. Being respectful, supportive and kind should be a goal when supporting your friend, but don’t be afraid to set personal boundaries for yourself.

Seek Support Groups

Check to see if there are any support groups in your area for your friend and/or yourself. Supporting someone who is living with psychosis can be very stressful, and there’s nothing wrong with seeking help and support for this.

Visit Them in the Hospital

If your friend is in the hospital, go and visit them if you are able. The hospital may be scary and overwhelming for them, and a friendly face can help. Ask about visitors’ rules first.

Provide Support

Help your friend to avoid triggers like substances or situations that can cause them to relapse or feel unwell.

Know that your friend may need help or support with things that might seem simple to you. The loss of concentration and clear thinking can be hard to adjust to for someone living with psychosis.

Ask How You Can Help

Ask your friend how else you can help. It may be as easy as just providing a distraction, asking them to do simple, relaxing things with you (like hanging out, watching a movie etc.) or just listening to them without judgement.

See the Help Section for more psychosis info about helping a friend and self-care.

A film, My Story with Schizophrenia, created with a young person and mindyourmind. It tells the story of her struggles with psychosis and eventual diagnosis of

A personal story, Standing Proud – Jaymin’s Story, about the experience and seeking help for psychosis.

Find more about Psychosis.

The information on psychosis is a simple overview of a complicated mental health issue. For more in-depth information, please visit these Canadian resources and references or speak to a medical professional.

Ontario – call ConnexOntario to find out where there are mental health supports in your community.

Crisis – in any situation where someone is at risk of hurting themselves or others, call 911 or a local crisis line. You can find resources near you on the free and confidential Be Safe App.

Please see the Help Section for more information and resources.

References

1. Centre for Addiction and Mental Health (CAMH)
2. Canadian Mental Health Association (CMHA)
3. Psychosis 101