What is psychosis?

People with psychosis (also known as a 'psychotic episode') cannot tell what is real and what is not. They have difficulty with the way they interpret the world around them, and their thinking can be confused. They may experience hallucinations, such as hearing voices that aren't there. They may also have delusions — false beliefs about themselves or the world around them.

Psychosis can be very frightening for the person experiencing it. In severe cases, someone with psychosis may be at risk of self-harm, or harming others.

About 1 in every 200 adult Australians will experience a psychotic illness each year. A first episode of psychosis is most likely to happen in a person's late teens or early adult years.

Treatment is available for people with psychosis. Medicine, psychological therapy and community support can help reduce symptoms. Treatment allows people to live a fulfilling life. It's important to talk to a doctor if you or someone you know may have symptoms of psychosis.

What are the symptoms of psychosis?

When someone is having a psychotic episode, they have difficulty with the way they interpret the real world.

Symptoms vary from person to person, and from episode to episode. They may include:

• Disordered thinking — when a person's thoughts don't join up properly, causing confusion. A person's thoughts and speech may speed up or slow down. Their sentences may be unclear and hard to understand. They also may have difficulty following a conversation or remembering things.
• Delusions — when a person has illogical, unshakeable beliefs that are unusual for someone of the same cultural background. Delusions can take different forms, such as:
  • paranoia— thinking they are being watched or singled out for harm
  • grandiosity — believing they have special powers, or are an important religious or political figure
  • depressive — believing they are guilty of a terrible crime or act
• Hallucinations — when a person sees, hears, feels, smells or tastes something that doesn't actually exist. Auditory hallucinations are the most common This is when a person hears voices or other sounds that are not there.
• Disordered behaviour — when a person becomes agitated or childlike. They might mutter or swear, or they might not respond to others around them. They might find it hard to manage their day-to-day life, such as personal hygiene, school or work.
• Thoughts of self-harm or suicidal thoughts — where the person may have feelings of wanting to harm themselves.

Sometimes a person with psychosis can act inappropriately, such as laughing at sad news or becoming angry for no apparent reason. They may also act in an agitated or aggressive way. If someone close to you in acting in this way, seek medical advice team to prevent harm to the person or to others.

Usually, psychosis occurs in 'episodes'. These can last from anywhere from a few hours to a few months. This depends on the individual and the cause of their psychosis. If you or someone you care about has experienced a first episode of psychosis, ask a health professional if it is likely to happen again, and what you can do to reduce the chances of another psychotic episode.

What causes psychosis?

The causes of psychosis are complex. However, psychosis is thought to be caused by an interaction between genetic and environmental factors.

It's likely that some people are born with a predisposition to develop this kind of illness and that certain things can trigger their first episode. Common triggers include:

• stress
• use of drugs such as marijuana, LSD, speed or others
• certain prescription medicines

People with particular risk factors are more likely to develop psychosis, including:

• mental illnesses such as schizophrenia, bipolar disorder, or severe depression
• a family history of psychotic disorders, such as schizophrenia
• a history of illegal drug use

Some medical conditions have been known to cause psychosis, although this is rare. These include:

• head injuries
• infections such as HIV and AIDS,
• malaria, syphilis and Lyme disease
• neurological conditions such as
• Alzheimer's disease, Lewy body dementia,
• Parkinson's disease and stroke
• autoimmune conditions such as lupus and multiple sclerosis
• some types of epilepsy
• brain tumours

Some types of hormone disorders and dietary deficiencies can also cause psychosis.

Research also shows that too much dopamine may be associated with psychosis. Dopamine is one of the chemicals in the brain that sends information from one brain cell to another. Having high levels of dopamine could interrupt the pathways in the brain responsible for memory, emotion, social behaviour and self-awareness.

How is psychosis diagnosed?

The first step if you think you or someone else is experiencing psychosis is to see a doctor urgently or to contact a community mental health team via your local hospital.

Young people can visit a headspace centre. Headspace provides early intervention mental health services to 12 to 25-year-olds. Centres are located across metropolitan, regional and rural areas of Australia.

A mental health professional will do a complete mental health assessment through an interview. They may also ask to speak to a relative or close friend for more information. The purpose of the assessment is to find out:

• if you are experiencing psychosis
• what might be causing it
• if there's an underlying mental illness
• the relevant family and medical history
• the best course of treatment for you

A doctor will also perform a full medical examination to help find out what might be causing the psychosis. Your doctor or other health professionals might also ask to observe you, either at home or in hospital.

Different tests may be needed to work out the diagnosis and any underlying causes. Tests may include:

• medical tests, including blood tests for electrolyte levels (minerals and salts), hormone levels or infections
• drug testing to identify any drugs that could be causing or contributing to the psychosis
• imaging scans to check for any abnormalities, especially in the brain

When should I see my doctor?

If you or someone close to you is experiencing symptoms of psychosis, you should seek immediate medical attention.

Early intervention

Research has shown the best outcomes occur when psychosis is detected and treated early, before the illness has a chance to worsen.

Risk of self-harm

How is psychosis treated?

Treatment usually involves a combination of:

• medicine/s
• education about the illness (psychoeducation)
• psychotherapy or counselling
• community support programs
• family support
• practical support

Medicine

A person with psychosis may be prescribed antipsychotic medicines. These medicines work by altering chemicals in the brain, including dopamine. Antipsychotics usually take several weeks to reduce symptoms such as hallucinations or paranoia. But they may immediately produce a calming effect and help the person with difficulties getting to sleep.

Antipsychotic medicines may cause side effects, so it is important to find the right medicine or combination of medicines for each person.

Psychological therapy

There are several psychological treatments available to people who are experiencing psychosis, depending on their individual needs. These include:

• supportive psychotherapy
• cognitive behaviour therapy (CBT)
• family therapy and peer support groups

Community support programs

Mental health services can also provide practical support for people with psychosis. Essential components of recovery include:

• stable accommodation
• financial security
• social support
• having a meaningful role in society

People suffering from long-term psychosis may benefit from rehabilitation and assistance to find suitable work.

Many mental illnesses are best treated by a team of different health professionals working together, including:

• psychiatrists
• psychologists
• mental health nurses
• occupational therapists

Treatment for illnesses that cause psychosis may last for several years.

Can psychosis be prevented?

Some causes of psychosis, such as certain mental illnesses, can't be prevented.

If you have experienced psychosis in the past, you can reduce the chance of recurrence by:

• avoiding drugs and alcohol
• following your doctor's advice, including taking any medicines as prescribed
• reducing stress
• getting enough sleep
• learning ways to cope with stress

Resources and support

If you need help, would like to find out more or talk to someone, here are some organisations that can help:

• SANE Australia provides information and support for people living with a mental illness and their loved ones — call 1800 187
• Beyond Blue supports people with depression and anxiety, as well as friends, family and colleagues. Call 1300 22 4636 or chat online.
• Black Dog Institute has information and support for people affected by mood disorders.
• Lifeline provides help to anyone having a personal crisis — call 13 11 14 for 24/7 crisis support or chat online.
• The Suicide Call Back Service provides assistance to anyone thinking about suicide — call 1300 659 467.
• Mental Health First Aid Australia fact sheet — for mental health first-aid for people with psychosis.