FAQ

Q: What is psychosis?

Psychosis is a collection of psychiatric symptoms that affect our thoughts, perception, and functioning. The hallmark symptom of psychosis is unusual experiences that mark loss of contact with reality (e.g., hallucinations and delusions), but other symptoms can be present as well.

Q: Who develops psychosis?

It is hard to predict who will develop psychosis versus not, but there are some risk factors for psychosis. These include family history of psychotic disorders such as schizophrenia, pre and perinatal complications, history of psychological trauma, and schizotypal personality disorder. However, it is important to remember that no risk factor determines psychosis, and individuals without risk factors can develop psychosis as well.

Q: What are the signs and symptoms of psychosis?

In general, symptoms of psychosis include:

• Hallucinations: These are perceptual experiences without external stimuli. For example, an individual with auditory hallucinations may hear people talking to them when no one is around.
• Delusions: These are unusual beliefs held strongly even if they are considered unlikely or unfounded by most people. Some common examples of delusions include believing that people are out to get you, that one is Messiah, that microwaves can control your mind, etc.
• Disorganized speech: This is when an individual’s speech is hard to understand or does not make much sense to most people. Some examples include using words one invented and jumping from one place to another in speech.
• Disorganized or catatonic behavior: Disorganized behavior is when one’s behavior is odd, unusual, and inappropriate for their age and social context, such as getting naked in public. Catatonic behavior is when one has exaggerated, unusual, or very limited speech and movement.
• Negative symptoms: These are symptoms that represent a lack of functioning that most people have, such as ability to enjoy things, be motivated, socialize, and express emotions. When very severe, individuals with negative symptoms can completely ignore their basic needs such as eating or putting on clothes to stay warm.

Q: What is the long-term outcome of people who have psychosis?

Psychotic disorders can negatively impact the social, occupational, cognitive, and life functioning of individuals with psychosis. Unfortunately, some individuals with psychosis fail to finish school, hold a steady job, or have long-term healthy relationships. Some individuals with psychosis also get into trouble with the law because of their symptoms or become homeless. However, there are also examples of individuals with psychosis who achieve their life goals, such as earning a PhD, holding a well-paying job, and having a family or becoming parents. Some things that contribute to a better long-term outcome of psychosis includes having good social support, beginning treatment as early as possible, and being able to keep out of the hospital.

Q: How is psychosis diagnosed?

Psychosis is diagnosed by mental health professionals (e.g., psychiatrists, psychologists, psychiatric nurses, social workers, mental health counselors, etc.) Typically, these professionals will conduct an assessment/interview with the individual to evaluate the presenting symptoms and review their mental health history. Collateral information (e.g., reports from spouse, parents, etc.) can be helpful, but the presence of the individual in question is generally necessary.

Q: How is psychosis treated?

Currently, the most common interventions for psychosis are antipsychotic medications and psychotherapy. Antipsychotic medications are a family of medications that reduce psychotic symptoms by regulating the neurochemical activities in the brain. They are known to work reasonably well for symptoms such as hallucinations and delusions, but not as well for negative symptoms. Some common antipsychotic medications include Haldol, Abilify, Seroquel, and Clozaril. Antipsychotics have some side effects such as fatigue, weight gain, dry mouth, and movement effects such as restlessness and tremor. Psychiatrists work with patients to select antipsychotics that provide most control over psychosis and least side effects.

Individuals with psychosis can benefit from individual and group psychotherapy to better regulate the underlying emotions and beliefs that contribute to their psychosis, to develop insight into their symptoms, and to better cope with having psychosis. For example, cognitive behavioral therapy for psychosis (CBT-p) is an evidence-based intervention to help individuals with psychosis by adjusting their thoughts and behavior. Social skills training (SST) is an evidence-based intervention that improves social functioning and reduces negative symptoms in people with psychosis.

Other interventions that patients with psychosis receive include peer support, occupational and educational support, cognitive remediation, etc.

Q: What is first-episode psychosis?

First-episode psychosis refers to the stage when an individual first developed psychosis. Typically, these are individuals within the first two years of their first psychotic break. First episode psychosis has received much attention because there is evidence that if individuals get adequate intervention at this early stage, their outcome and functioning are better in the long run. As a result, there are many first-episode programs across the country that specialize in treating first-episode patients. These programs typically offer coordinated specialty care, which is intervention from a team of providers with different expertise including psychiatry, psychotherapy, nursing, social works, peer support, and education and occupation support, to maximally help an individual and increase their chance of doing well in the long run.

Q: What is clinical high risk for psychosis?

Clinical high risk for psychosis is a stage where individuals have not developed a psychotic disorder but have shown some signs of becoming psychotic later. It is also known as the ultra-high risk, at-risk mental state, or prodromal stage. Some examples of clinical high risk for psychosis include having attenuated symptoms of psychosis, having brief periods of psychosis, and having rapid decline in functioning when one already has a family history of psychosis. Clinical high risk for psychosis can be diagnosed by mental health professionals. There are programs that help individuals at clinical high risk for psychosis with the goal of preventing them from developing full psychosis.

Q: Does one have to be on medication if one has psychosis?

Currently, antipsychotic medication is the first-line treatment for psychosis. Individuals may also be prescribed additional medication to help their mood, sleep, and antipsychotics side effects. Some individuals with psychosis may not feel like taking medication due to some understandable reasons, such as medication side effects, not feeling like oneself when taking psychiatric medication, and the hassle of having to take medication every day. However, the benefits of taking medication likely outweigh the downsides, as psychosis, when poorly managed, can be debilitating, disruptive, and even life-threatening. Individuals with psychosis should discuss with their providers about whether it is necessary that they be on medication. We strongly recommend that you do not stop medication yourself.

Q: Is it safe to drink or use drugs when you have psychosis?

While individuals with mental illness should be careful with substances in general, individuals with psychosis are particularly advised against some substances. One example is marijuana. Marijuana is known to facilitate or exacerbate psychosis (especially paranoia) in individuals who have or are prone to have psychosis. Another example is psychostimulants, such as amphetamine, methamphetamine, cocaine, and Ritalin. Psychostimulants have a similar effect on brain chemistry as psychosis, thus they are likely to make psychotic symptoms worse.

Q: Are people with psychosis dangerous?

This is a common myth and stigma that people with psychosis are dangerous. Whenever there are events such as a mass shooting, the media may start speculating that the suspect has psychosis. Some people also mistake “psychosis” for “psycho” (which actually means “psychopath” or “antisocial”). Because people with psychosis may act in unusual ways that are hard to understand for others, their behavior is also more likely to be interpreted as potentially threatening (e.g., reciting the Bible loudly in public). However, it is not true that people with psychosis are always dangerous. Although some people with psychosis may act violently under certain circumstances, most people with psychosis are not violent. Sadly, people with psychosis are also more likely to become victims of violent crimes or become dangerous to themselves (e.g., committing suicide).

Q: Someone close to me may have psychosis. What do I do?

Individuals with psychosis may or may not have awareness of their symptoms. For many people, psychosis is a scary and taboo word, making it even harder to speak with someone about potentially having psychosis. However, individuals with psychosis have basic needs and goals just like any of us. Supporting them in these aspects and encouraging them to seek help when they encounter difficulties can be a good approach to helping people you think may have psychosis. For example, if an individual is avoiding leaving home because they have a paranoid ideation that people are after them, it may be more productive to discuss with them how this behavior is preventing them from getting the job they want, rather than trying to convince them that their belief is delusional. Another good strategy is to encourage these individuals to seek psychiatric help for some less threatening symptoms they may have, such as poor sleep, feeling stressed, and feeling depressed.