UNDERSTANDING PSYCHOSIS

From the NATIONAL INSTITUTE of MENTAL HEALTH

What is psychosis?

The word psychosis is used to describe conditions 

that affect the mind, where there has been some 

loss of contact with reality. When someone 

becomes ill in this way, it is called a psychotic 

episode. During a period of psychosis, a person’s 

thoughts and perceptions are disturbed, and the 

individual may have difficulty understanding what is 

real and what is not.

Who develops psychosis?

Psychosis can affect people from all walks of life. 

Psychosis often begins when a person is in his or 

her late teens to mid-twenties. There are about 

100,000 new cases of psychosis each year in the U.S. 

What causes psychosis? 

There is no one specific cause of psychosis. 

Psychosis may be a symptom of a mental illness, 

such as schizophrenia or bipolar disorder. However, 

a person may experience psychosis and never be 

diagnosed with schizophrenia or any other mental 

disorder. There are other causes, such as sleep 

deprivation, general medical conditions, certain 

prescription medications, and the misuse of alcohol 

or other drugs, such as marijuana. A mental illness, 

such as schizophrenia, is typically diagnosed by 

excluding all of these other causes of psychosis. 

To receive a thorough assessment and accurate 

diagnosis, visit a qualified health care professional 

(such as a psychologist, psychiatrist, or social worker).

Typically, a person will show changes in his or her 

behavior before psychosis develops. Behavioral 

warning signs for psychosis include:

●Sudden drop in grades or job performance

● New trouble thinking clearly or concentrating

●Suspiciousness, paranoid ideas, or uneasiness 

with others

●Withdrawing socially, spending a lot more time 

alone than usual

● Unusual, overly intense new ideas, strange 

feelings, or no feelings at all

● Decline in self-care or personal hygiene

● Difficulty telling reality from fantasy

●Confused speech or trouble communicating

Symptoms of psychosis include delusions (false 

beliefs) and hallucinations (seeing or hearing 

things that others do not see or hear). Other 

symptoms include incoherent or nonsense speech 

and behavior that is inappropriate for the situation. 

A person in a psychotic episode also may 

experience depression, anxiety, sleep problems, 

social withdrawal, lack of motivation, and difficulty 

functioning overall. 

Someone experiencing any of the symptoms on this 

list should consult a mental health professional. 

What are the signs and symptoms of psychosis? 
Studies have shown that it is common for a 

person to have psychotic symptoms for more 

than a year before receiving treatment. Reducing 

this duration of untreated psychosis is critical 

because early treatment often means a better 

recovery. A qualified psychologist, psychiatrist, 

or social worker will be able to make a diagnosis 

and help develop a treatment plan. 

People with psychosis may behave in confusing 

and unpredictable ways and may become 

threatening or violent. However, people with 

psychotic symptoms are more likely to harm 

themselves than someone else. If you notice 

these changes in behavior, and they begin to 

intensify or do not go away, it is important to 

seek help.

Research supports a variety of treatments for 

early psychosis, especially coordinated specialty 

care. In 2008, the National Institute of Mental 

Health (NIMH) launched the research initiative, 

Recovery After an Initial Schizophrenia Episode 

(RAISE) project. RAISE studied coordinated 

specialty care treatments and the best ways to 

intervene after people begin to experience 

psychotic symptoms and to help them return to 

a path toward productive, independent lives. 

Coordinated specialty care involves the 

following components:

●Individual or group psychotherapy is typically 

based on principles of cognitive behavior 

therapy. This therapy is tailored to each 

patient’s needs and emphasizes resilience 

training, illness and wellness management, and 

building coping skills.

●Family support and education teach 

family members about psychosis, coping, 

communication, and problem-solving skills. 

Family members who are informed and 

involved are more prepared to help loved ones 

through the recovery process. 

●Medication management (also called 

pharmacotherapy) helps reduce psychosis 

symptoms. Medication selection and dosing 

are tailored to patients with early psychosis 

and their individual needs. Like all medications, 

antipsychotic drugs have risks and benefits. 

Patients should talk with their health care 

providers about side effects, medication costs, 

and dosage preferences (daily pill or monthly 

injection).

●Supported employment and education

services help patients return to work or school 

and achieve their personal goals. Emphasis is 

on rapid placement in a work or school setting, 

combined with coaching and support, to 

ensure success.

●Case management helps patients with 

problem-solving. The case manager may offer 

solutions to address practical problems and 

coordinate social services across multiple 

areas of need. 

Individuals with psychosis should be involved in 

their treatment planning. Their needs and goals 

should drive their treatment programs, which will 

help them stay engaged throughout the 

recovery process. 

It is important to find a mental health professional 

who is trained in psychosis treatment and who 

makes the patient feel comfortable. 

How is psychosis treated?
National Institute

of Mental Health

NIH Publication No. 20-MH-8110

www.nimh.nih.gov

Behavioral Health Treatment 

Services Locator

The Substance Abuse and Mental Health Services 

Administration (SAMHSA) provides this online 

resource for locating mental health treatment 

facilities and programs. Find a facility in your state 

at https://findtreatment.samhsa.gov. 

For additional resources, visit 

www.nimh.nih.gov/findhelp. 

Talking to Your Health Care Provider 

About Your Mental Health

Communicating well with your doctor or health 

care provider can improve your care and help you 

both make good choices about your health. Find 

tips to help prepare for and get the most out of 

your visit at www.nimh.nih.gov/talkingtips. 

For additional resources, including questions 

to ask your doctor, visit the Agency for 

Healthcare Research and Quality website 

at www.ahrq.gov/patients-consumers.

Finding Help

NIMH does not endorse specific early psychosis 

clinics or evaluate professional qualifications or 

competence of individual practitioners. However, 

there are several organizations that may be able to 

assist you in finding a treatment program in your 

area. This list may not be comprehensive and does 

not constitute an endorsement by NIMH.

●	Early Assessment and Support Alliance (EASA):

EASA offers a National Early Psychosis 

Directory that lists early psychosis programs 

nationwide. The directory is available at 

www.easacommunity.org/national-directory.php. 

For more information about EASA, visit 

www.easacommunity.org. 

●	National Alliance on Mental Illness (NAMI): 

The NAMI HelpLine can connect you with the 

NAMI office in your state and help you find 

programs close to home. Visit www.nami.org/

Find-Support/NAMI-HelpLine. Also, you can

talk with someone at the NAMI HelpLine at 

1-800-950-NAMI (6264), Monday through 

Friday, 10 a.m. to 6 p.m. ET, or through email at 

info@nami.org. 

For more information about NAMI, visit 

www.nami.org. 

●	Prodrome and Early Psychosis Program 

Network (PEPPNET): 

PEPPNET supports a national network of 

programs providing services to people who are 

at risk for or are experiencing early psychosis. 

For more information, visit

https://med.stanford.edu/peppnet.