Psychosis

Psychosis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Mental health Psychosis Psychosis Introduction Symptoms Causes Diagnosis Treatment Complications Introduction Psychosis is a mental health problem that causes people to perceive or interpret things differently from those around them. This might involve hallucinations or delusions. The two main symptoms of psychosis are: hallucinationswhere a person hears, sees and, in some cases, feels, smells or tastes things that arent there; a common hallucination is hearing voices delusions where a person believes things that, when examined rationally, are obviously untruefor example,thinking your next door neighbour is planning to kill you The combination of hallucinations and delusional thinking can often severely disrupt perception, thinking, emotion, and behaviour. Experiencing the symptoms of psychosis is often referred to as having a psychotic episode. What causes psychosis? Psychosis isnt a condition in itselfits triggered byother conditions. Itssometimes possible to identify the cause of psychosis as a specific mental health condition, such as: schizophrenia a condition that causes a range of psychological symptoms, including hallucinations and delusions bipolar disorder a mental health condition that affects mood; a person with bipolar disorder can have episodes of depression (lows) and mania (highs) severe depression some people with depression also have symptoms of psychosis when theyre very depressed Psychosis can also be triggered by traumatic experiences, stress, or physical conditions, such as Parkinsons disease , a brain tumour , or asa result ofdrugmisuse or alcohol misuse . How often a psychotic episode occurs and how long it lasts can depend on the underlying cause. For example, schizophrenia can be long term, but most people can make a good recovery and about a quarter only have a single psychotic episode. Episodes related to bipolar disorder usually resolve, but may recur. Read more about the causes of psychosis . Diagnosing psychosis You should see your GP immediately if youre experiencing psychotic episodes. Its important psychosis is treated as soon as possible as early treatment usually has better long-term outcomes. Your GP will look at your symptoms and rule out short-term causes, such as drug misuse. They may ask you some questions to help determine whats causing your psychosis. For example, they may ask you: whether youre taking any medication whether youve been taking illegal substances how your mood has beenfor example, whether youve been depressed how youve been functioning day-to-dayfor example, whether youre still working whether you have a family history of mental health conditions such as schizophrenia about your hallucinations such as whether youve heard voices about your delusionssuch as whether you feel people are controlling you whether you have any other symptoms Your GP should refer you to a mental health specialist for further assessment and treatment. Read more about diagnosing psychosis . Treating psychosis Treatment for psychosis involves using a combination of: antipsychotic medication which can help relieve the symptoms of psychosis psychological therapies the one-to-one talking therapy cognitive behavioural therapy (CBT)has proved successful in helping people with schizophrenia;in appropriate cases, family therapy has been shown to reduce the need for hospital treatment in people with psychosis social support support with social needs, such as education, employment, or accommodation Most people with psychosis who get better with medication need to continue taking it for at least a year. Some people need to take medication long term to prevent symptoms recurring. If a persons psychotic episodes are severe, they may need to be admitted to a psychiatric hospital. Read more about the treatment of psychosis . Getting help for others People with psychosis often have a lack of insight. Theyre unaware that theyre thinking and acting strangely. Because oftheir lack of insight,its often down to the friends, relatives, or carers of a person affected by psychosis to seek help for them. If youre concerned about someone you know and think they may have psychosis, you could contact their social worker or community mental health nurse if theyve previously been diagnosed with a mental health condition. If you think the persons symptoms are placing them at possible risk of harm, you can: take them to the nearestaccident and emergency (A&E) department, if they agree call their GP orlocal out-of-hours GP call 999 and ask for an ambulance Complications People with a history of psychosis are much more likely to have drug or alcohol misuse problems, or both. This may be because thesesubstances can provide short-term symptom relief, although they usually make symptoms worse in the long term. People with psychosis also have a higher than average risk of suicide . Its estimated1 in 5 people with psychosis will attempt to commit suicide at some point in their life, and1 in 25 people with psychosis will kill themselves. Side effects can also occur if someone istaking antipsychotics on a long-term basis. Weight gain is a common side effect. In rare cases,a person with psychosis mayalso develop type 2 diabetes . Read more about the complications of psychosis . Symptoms Someone who develops psychosis will have their own unique set of symptoms and experiences, according to their particular circumstances. However, four main symptomsare associated with a psychotic episode. They are: hallucinations delusions confused and disturbed thoughts lack of insight and self-awareness These are outlined in more detail below. Hallucinations Hallucinationsare where a person perceives something that doesnt exist in reality. They can occur in all five of the senses: sight someone with psychosis may see colours and shapes, or people or animals that arent there sounds someone with psychosis may hear voices that are angry, unpleasant or sarcastic touch a common psychotic hallucination is that you are being touched when there is nobody there smell usually a strange or unpleasant odour taste  some people with psychosis have complained of having a constant unpleasant taste in their mouth Delusions A delusion is where a person has an unshakeable belief in something implausible, bizarre, or obviously untrue. Paranoid delusion and delusions of grandeur are two examples of psychotic delusions. A person with psychosis will often believe an individual or organisation is making plans to hurt or kill them. This can lead to unusual behaviour. For example, a person with psychosis may refuse to be in the same room as a mobile phone because they believe they are mind control devices. Someone with psychosis may also have delusions of grandeur. This is where they believe they have some imaginary power or authority. For example, they may think theyre the president of a country or they have the power to bring people back from the dead. Confused and disturbed thoughts People with psychosis often have disturbed, confused, and disrupted patterns of thought. Signs of this include: rapid and constant speech random speechfor example, they may switch from one topic to another mid-sentence a sudden lossin their train of thought, resulting in an abrupt pause in conversation or activity Lack of insight People who have psychotic episodes are often totally unaware their behaviour is in any way strange or that their delusions or hallucinations are not real. They may recognise delusional or bizarre behaviour in others, but lack the self-awareness to recognise it in themselves. For example, a person with psychosis being treated in a psychiatric ward may complain that their fellow patients are mentally unwell, while theyre perfectly normal. Postnatal psychosis Postnatal psychosis, also called puerperal psychosis, is a severe form of postnatal depression , a type of depression some women experience after having a baby. Its estimated postnatal psychosis affects around 1 in every 1,000 women who give birth. It most commonly occurs during the firstfew weeksafter having a baby. Postnatal psychosis is more likelyto affect women who already have a mental health condition, such as bipolar disorder or schizophrenia . As well as the symptoms of psychosis, symptoms of postnatal psychosis can also include: a high mood (mania) for example, talking and thinkingtoo much or too quickly a low mood for example, depression , lack of energy,loss ofappetite, and trouble sleeping Postnatal psychosis is regarded as a medical emergency. Contact your GP immediately if you think someone you know may have developed postnatal psychosis. If this isnt possible, call theNHS 24 111 serviceor your localout-of-hours service. If you think theres an imminent danger ofharm, call 999 and ask for an ambulance. Causes The causes of psychosis have three main classifications. They are psychosis caused by: mental (psychological)conditions general medical conditions substances, such as alcohol or drugs The three classifications are described in more detail below. Psychological causes The following conditions have been known to trigger psychotic episodes in some people: schizophrenia a long-term (chronic) mental health condition that causes hallucinations and delusions bipolar disorder a condition that affects a persons moods, which can swing from one extreme to another (highs and lows) severe stress or anxiety severe depression feelings of persistent sadness that last for morethan six weeks, including postnatal depression ,which some women experience after having a baby lack of sleep The underlying psychological cause will often influence the type of psychotic episode someone experiences. For example, a person with bipolar disorder is more likely to have delusions of grandeur, whereas someone with depression or schizophrenia is more likely to develop paranoid delusions . General medical conditions The following medical conditions have been known to trigger psychotic episodes in some people: HIV and AIDS a virus that attacks the bodys natural defence against illness and infection (the immune system) malaria a tropical disease spread by infected mosquitoes syphilisa bacterial infection usually passed on through sexual contact Alzheimers disease the most common form ofdementia, which causes a decline in mental abilities like memory and reasoning Parkinsons disease a long-term condition that affects the way the brain co-ordinates body movements, including walking, talking, and writing hypoglycaemia an abnormally low level of sugar (glucose) in the blood lupus  a condition where the immune system attacks healthy tissue Lyme disease a bacterial infection spread to humans by infected ticks multiple sclerosis a condition that affects the nerves in the brain and spinal cord, causing problems with muscle movement, balance, and vision brain tumour a growth of cells in the brain that multiply in an abnormal and uncontrollable way Substances Alcohol misuse anddrug misuse can trigger a psychotic episode. A person can also experience a psychotic episode if they suddenly stop drinkingalcohol ortaking drugs after using them for a long time. This is known as withdrawal. Its also possible to experience psychosis after drinking large amounts of alcohol or if youre high on drugs. Drugs known to trigger psychotic episodes include: cocaine amphetamine (speed) methamphetamine (crystal meth) mephedrone (MCAT or miaow) MDMA (ecstasy) cannabis LSD (acid) psilocybins (magic mushrooms) ketamine In rare situations, psychosis can also occur as a side effect of some types of medication or as a result of an overdose of that medication. For example, levodopa, a medication used to treat Parkinsons disease , can sometimes cause psychotic episodes. However, any medicine that acts on the brain can cause psychosis with an overdose. Never stop taking a prescribed medication unless advised to do so by your GP or another qualified healthcare professionalresponsible for your care. See your GP if youre experiencing psychotic side effectscaused bymedication. The brain Theres been a great deal of research into how psychosis affects the brain and how changes in the brain can trigger symptoms of psychosis . Grey matter Research has revealed several physical and biological changes occur in the brainduring a psychotic episode. Grey matter is the part of the brain responsible for processing thoughts. The results of magnetic resonance imaging (MRI) scans have shown some people with a history of psychosis have less grey matter than most other people. However, its not yet fully understood why this is. Dopamine Researchers also believe dopamine plays an important role in psychosis. Dopamine is a neurotransmitter,one of many chemicals the brain uses to transmit information from one brain cell to another.It is associated with how we feel whether something is significant, important, or interesting. Its thoughtlevels of dopamine in the brain become too highin people with psychosis. The excess dopamine interrupts specific pathways in the brain that are responsible for some of its most important functions, such as: memory emotion social behaviour self-awareness Disruption to these important brain functions may explain the symptoms of psychosis. Evidence for the role of dopamine in psychosis comes from several sources, including brain scans andthe fact medicationsknown to reduce the effects of dopamine in the brain also reduce thesymptoms of psychosis. However, illegal drugsknown to increaselevels of dopamine in the brainsuch as cannabis, cocaine and amphetaminescan trigger psychosis. Diagnosis You should visit your GP if youre experiencing psychotic episodes. Its important to speak to your GP as soon as possible as the early treatment of psychosis usually has better long-term outcomes. Initial assessment Theres no test to positively diagnose psychosis. However, your GP will look at your symptoms and rule out short-term causes, such as drug misuse. Your GP may ask questions to determine the cause of your psychosis. For example, they may askyou: whether youre taking any medication whether youve been takingillegal substances how your moods have beenfor example, whether youve been depressed how youve been functioning day-to-dayfor example, whether youre still working whether you have a family history of mental health conditions, such as schizophrenia about the details of your hallucinations, such as whether youve heard voices about the details of your delusions, such as whether you feel people are controlling you about any other symptoms you have Referral The evidence supporting the early treatment of psychosis means youre likely to be referred to a specialist urgently. This will either be during or after your first episode of psychosis. Who youre referred to will depend on the services available in your area. You may be referred to: a community mental health team a team of different mental health professionals who provide support to people with complex mental health conditions a crisis resolution team a team of different mental health professionals who treat people currently experiencing a psychotic episode who would otherwise require hospitalisation an early intervention team a team of mental health professionals who work with people who have experienced their first episode of psychosis These teams are likely to include some or all of the following healthcare professionals: a psychologist a healthcare professional who specialises in the assessment and treatment of mental health conditions a psychiatrist a qualified medical doctor who has received further training in treating mental health conditions a community mental health nurse a nurse with specialist training in mental health conditions Your psychiatrist will carry out a full assessment to help identify and diagnose any underlying mental health condition that could be causing your symptoms. This will helpwhen planning your treatment for psychosis . Helping others The lack of insight associated with psychosis means people experiencingit arent always able to recognise their strange behaviour. They may be reluctant to visit their GP if they believe theres nothing wrong with them, and you may need to get help for them. Someone who has had psychotic episodes in the past may have been assigned a mental health worker, who works in social services,so try to contact them to express your concerns. Someone who is having a psychotic episode for the first time may need a friend, relative or someone else close to them to persuade them to visit their GP. If theyre having a psychotic episode thats rapidly getting worse, you should contact their crisis team or,if the team isnt available,the duty psychiatrist at their nearest accident and emergency (A&E) department. If a person who is having a psychotic episode refuses to seek help andis believed to present a risk to themselves or others, their nearest relative can request a psychological assessment. Your local mental health trust can advise you about this. If someone has very severe psychosis, they can be compulsorily detained at hospital for assessment and treatmentunder the Mental Health (Scotland) Act 2015 . Treatment Treatment for psychosis involves a combination of antipsychotic medicines, psychological therapies, and social support. Your care team Your treatment is likely to be co-ordinated by a team of mental health professionals working together. If this is your first psychotic episode, you may be referred to an early intervention team. Early intervention teams An early intervention team is ateam of healthcare professionals set up specifically to work with people who have experienced their first episode of psychosis. Some early intervention teams only focus on a certain age range, such as people who are 14 to 35 years old. Depending on your care needs, early intervention teams aim to provide: a full assessment of your symptoms prescriptions for medications psychological services social, occupational, and educational interventions Treatment for psychosis will vary, depending on the underlying cause. Youll receive specific treatment if youve been diagnosed with an underlying mental health condition as well. For example, treatment for bipolar disorder uses a variety of medications, which could include antipsychotics to treat symptoms of mania, lithium and anticonvulsants to help stabilise mood, as well as psychological therapy, such as cognitive behavioural therapy (CBT). Treatment for schizophrenia usually involves a combination of antipsychotic medication and social support. CBT or another type of psychotherapy called family therapyare also often used. Psychosis related to drug or alcohol intoxication or withdrawal may only require a short course of antipsychotics or tranquillisers, which have a calming effect. Referral to an addiction counsellor may then be recommended. Antipsychotics Antipsychotic medicines, also known as neuroleptics, are usually recommended as the first treatment for psychosis. Theywork by blocking the effect of dopamine, a chemical that transmits messages in the brain. However, theyre not suitable or effective for everyone, as side effects can affect people differently. In particular, antipsychotics will be monitored closely in people who also have epilepsy , a condition that causes seizures or fits. People who have cardiovascular disease  conditions that affect the heart, blood vessels, or circulation, such as heart disease  will also be closely monitored. Antipsychotics can usually reduce feelings of anxiety or aggression within a few hours of use, but they may take several days or weeks to reduce other psychotic symptoms, such as hallucinations or delusional thoughts. Antipsychotics can be taken by mouth (orally) or given as an injection. There are several slow-release antipsychotics, where you only need one injection every two to six weeks. Depending on the underlying cause of your psychosis, you may only need to take antipsychotics until your psychosis subsides. However, if you have a condition like schizophrenia or bipolar disorder, you may need to take antipsychotics on a long-term basis to prevent further episodes of psychosis. Side effects Antipsychotics can have side effects, although not everyone will experience them and their severity will differ from person to person. Side effectscan include: drowsiness this may affect your ability to drive shaking and trembling restlessness muscle twitches and spasms where your muscles shorten tightly and painfully blurred vision dizziness constipation loss of sex drive (libido) dry mouth See the patient information leaflet that comes with your medicine for a full list of possible side effects. In addition,long-term use of antipsychotics can lead to complicationslikeweight gain and diabetes . Read more aboutthe complicationsof psychosis . Tell your GP if you haveside effects that are becoming particularly troublesome. There may be an alternative antipsychotic medicine you can take. Never stop taking medication prescribed for you unlessadvised to do so by a qualified healthcare professionalresponsible for your care. Suddenly stopping prescription medication could trigger a returnof your symptoms (relapse). When its time for you to stop taking your medication, it will be done gradually and under close observation. Psychological treatment Psychological treatment can help reduce the intensity and anxiety caused by psychosis. Some possible psychological treatments are discussed below. Cognitive behavioural therapy Cognitive behavioural therapy (CBT) for psychosis is based on an understanding of how people make sense of their experiences and why some people become distressed by them. The aim of CBT is to identify unhelpful thinking patterns and emotions that may be causing your unwanted feelings and behaviours. Its then possible to learn to replace this thinking with more realistic and balanced thoughts. A CBT therapist may encourage you to consider different ways of understanding whats happening to you. The aim is to help you achieve goals that are meaningful and important to you, such as reducing your distress, returning to work or university, or regaining a sense of control. Family therapy Family therapy is known to be an effective form of treatment for people with psychosis. Its a way of helping both you and your family cope with your condition. After having an episode of psychosis, you may rely on your family members forcare and support. While most family members are happy to help, the stress of caring for somebody can place a strain on any family. Family therapy involves a series of informal meetings that take place over a period of six months. Meetings may include: discussing your conditionand how it might progress, plus the available treatments exploring ways of supporting someone with psychosis deciding how to solve practical problems caused by psychosis, such asplanning how to manage future psychotic episodes Self-help groups If youre experiencing episodes of psychosis, you may benefit from being around other people whove had similar experiences. Complications Someone experiencing a psychotic episode may self-harm. Suicidal thoughts and an increased risk of suicide are also common. Self-harm Self-harming behaviour is a relatively common complication in people with psychosis. A study found 1 in 10 people with psychosis also had a history of self-harm. The risk of self-harm is thought to be highest in people who are experiencing their first episode of psychosis butarent receiving treatment. See your GPif youre self-harming. You can also call the Samaritans on 08457 90 90 90 for support. If you think a friend or relative is self-harming, look out for signs of unexplained cuts, bruises or cigarette burns, usually on the wrists, arms, thighs, and chest. People who self-harm may keep themselves covered upat all times, even in hot weather. A personwhos self-harming may feel deep shame and guilt, or they may feel confused and worried by their own behaviour. Its important to approach them with care and understanding. They may not want to discuss their self-harming behaviourwith you, but you could suggest they speak totheir GP ora counsellor ona support helpline. Suicide People with psychosis also have an increased risk of suicide . Its estimated 1 in 5 people with psychosis will attempt suicide at some point in their life, and 1 in 25 people with psychosis will kill themselves. If youre feeling suicidal, you can: callthe Samaritans support service on 08457 90 90 90 go to your nearest accident and emergency (A&E) department and tell the staff how youre feeling contactthe NHS 24 111 service speak toa friend, family member, or someone you trust make an urgent appointment to see your GP,psychiatrist, or care team Read more about getting helpif youre feeling suicidal . If youre worried that someone you know may be considering suicide, recommend that they contact one or more of the organisations above and encourage them, in a non-judgemental way, to talk about how theyre feeling. If the person has previously been diagnosed with a mental health condition, such as depression , you can speak to a member of their care team for help and advice. Read more about the warning signs of suicide and supporting someone whos feelingsuicidal . Antipsychotics Using antipsychotics on a medium- to long-term basis can cause a number of complications. Some of the more commoncomplications are discussed below. Weight gain Weight gain is a complication of many commonly used antipsychotics. There are two main reasons why weight gain is thought to occur. Antipsychotics can: lead to an increase in appetite make you less active Youll probably be advised to take more exercise tohelp burn off the excess fat. Read about getting started with exercise and how to lose weight safely . Metabolic syndrome Metabolic syndrome is a term describing a number of related conditions linked to weight gain, such as: high blood sugar (hyperglycaemia) high cholesterol high blood pressure (hypertension) obesity These health conditions can also increase your risk of developing type 2 diabetes , heart disease and, most seriously, heart attack or stroke . Because ofthe risk of metabolic syndrome, youll usually need to haveregular blood tests and blood pressure tests while taking antipsychotics. If your test resultsshow you have an increased risk of developing a condition such as heart disease, a number of preventative treatments, such as statins ,are available to help lower cholesterol levels. Tardive dyskinesia (TD) Tardive dyskinesia (TD) is another common complication of long-term antipsychotic use. TD is a movement disorder where a person experiences involuntary movements, such as twitching, tics, grimaces, tremors, and spasms. It usually starts in the face and mouth before spreading to the rest of the body. In some cases, stopping taking an antipsychotic will provide relief from TD symptoms, but in other cases it makes the symptoms worse. However, stopping medication isnt always safe andhastobe balanced against the risk of having a relapse. In some cases, TD can be a permanent condition. There are also a number of treatments that can sometimes improve thesymptoms of TD, including: clonazepam a medication used to treat epilepsy , a condition that affects the brain and causes seizures or fits vitamin E supplements check with the doctor in charge of your care before taking vitamin supplementsas theyre not safe or suitable for everyone Source: NHS 24 - Opens in new browser window Last updated: 27 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. 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