What is a psychotic episode?

According to the Cleveland Clinic, psychosis is a disconnection from reality. People may have false beliefs or experience things that aren’t real. A psychotic episode isn’t a condition. It’s a term that describes a collection of symptoms.

The National Institute of Mental Health (NIMH) states that psychosis refers to a collection of symptoms that affect the mind, where there has been some loss of contact with reality. During an episode of psychosis, a person’s thoughts and perceptions are disrupted and they may have difficulty recognizing what is real and what is not.

Who develops a psychotic episode?

It is difficult to know the number of people who experience psychosis. Studies estimate that between 15 and 100 people out of 100,000 develop psychosis each year.

Psychosis often begins in young adulthood when a person is in their late teens to mid-20s. However, people can experience a psychotic episode at younger and older ages and as a part of many disorders and illnesses. For instance, older adults with neurological disorders may be at higher risk for psychosis.

What are the Signs and Symptoms of Psychosis?

People with psychosis typically experience delusions (false beliefs, for example, that people on television are sending them special messages or that others are trying to hurt them) and hallucinations (seeing or hearing things that others do not, such as hearing voices telling them to do something or criticizing them). Other symptoms can include incoherent or nonsense speech and behavior that is inappropriate for the situation.

However, a person will often show changes in their behavior before psychosis develops. Behavioral warning signs for psychosis include:

  • Suspiciousness, paranoid ideas, or uneasiness with others
  • Trouble thinking clearly and logically
  • Withdrawing socially and spending a lot more time alone
  • Unusual or overly intense ideas, strange feelings, or a lack of feelings
  • Decline in self-care or personal hygiene
  • Disruption of sleep, including difficulty falling asleep and reduced sleep time
  • Difficulty telling reality from fantasy
  • Confused speech or trouble communicating
  • Sudden drop in grades or job performance

Alongside these symptoms, a person with psychosis may also experience more general changes in behavior that include:

  • Emotional disruption
  • Anxiety
  • Lack of motivation
  • Difficulty functioning overall

In some cases, a person experiencing a psychotic episode may behave in confusing and unpredictable ways and may harm themselves or become threatening or violent toward others. The risk of violence and suicide decreases with treatment for psychosis, so it is important to seek help. If you find that you are experiencing these changes in behavior or notice them in a friend or family member and they begin to intensify or do not go away, reach out to a healthcare provider.

What causes a psychotic episode?

There is no one cause of psychosis. Psychosis appears to result from a complex combination of genetic risk, differences in brain development, and exposure to stressors or trauma. Psychosis may be a symptom of a mental illness, such as schizophrenia, bipolar disorder, or severe depression. However, a person can experience psychosis and never be diagnosed with schizophrenia or any other disorder.

For older adults, psychosis symptoms can be part of a physical or mental illness that emerges later in life. Psychosis can also be a symptom of some diseases of older age, including Parkinson’s disease, Alzheimer’s disease, and related dementias.

Other possible causes of psychosis include sleep deprivation, certain prescription medications, and the misuse of alcohol or drugs. A mental illness, such as schizophrenia, is typically diagnosed by excluding these other causes.

A qualified mental health professional (such as a psychologist, psychiatrist, or social worker) can provide a thorough assessment and accurate diagnosis. Find tips to help prepare for and get the most out of your visit. For additional resources, including questions to ask your healthcare provider, visit the Agency for Healthcare Research and Quality.

How is Psychosis treated?

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 better recovery. A qualified psychologist, psychiatrist or social worker can make a diagnosis and help develop a treatment plan.

Treatment of psychosis usually includes antipsychotic medication. There are several different types of antipsychotic medications, and they have different side effects, so it is important to work with a healthcare provider to determine the medication that is most effective with the fewest side effects.

Treatment also often includes other elements. There is substantial research support for coordinated specialty care, which is a multi-element, recovery-oriented team approach to treating psychosis that promotes easy access to care and shared decision-making among specialists, the person experiencing psychosis, and family members. People experience better outcomes from coordinated specialty care if they begin treatment as soon as possible after psychotic symptoms emerge.

Coordinated specialty care is now the standard of care for early psychosis, according to “The American Psychiatric Association Practice Guideline for the Treatment of Patients with Schizophrenia.”

NIMH Research on Coordinated Specialty Care

The Recovery After an Initial Schizophrenia Episode (RAISE) research project, supported by NIMH, established coordinated specialty care as an effective treatment for early psychosis and identified important elements for helping people lead productive, independent lives. Learn more about the RAISE studies.

NIMH continues to prioritize research on and expansion of treatments for early psychosis with the launch of the Early Psychosis Intervention Network (EPINET) in 2019. Through EPINET, NIMH funded awards to establish a national data coordinating center and regional scientific hubs connected to more than 100 coordinated specialty care programs that provide early psychosis treatment in 17 states. The EPINET website provides resources for researchers, health care providers, administrators, and people experiencing psychosis and their families.

Coordinated specialty care consists of multiple components:

  • Individual or group psychotherapy is tailored to a person’s recovery goals. Cognitive and behavioral therapies focus on developing the knowledge and skills necessary to build resilience and cope with aspects of psychosis while maintaining and achieving personal goals.
  • Family support and education programs teach family members about psychosis as well as 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) means tailoring medication to a person’s specific needs by selecting the appropriate type and dose of medication to help reduce psychosis symptoms. Like all medications, antipsychotic medications have risks and benefits. People should talk with a health care provider about side effects, medication costs, and dosage preferences (daily pill or monthly injection).
  • Supported employment and education services focus on return to work or school, using the support of a coach to help people achieve their goals.
  • Case management provides opportunities for people with psychosis to work with a case manager to address practical problems and improve access to needed support services.

People with psychosis should be involved in their treatment planning and consulted in making decisions about their care. Their needs and goals should drive the 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 person feel comfortable. With early diagnosis and appropriate treatment, it is possible to recover from psychosis. Some people who receive early treatment never have another psychotic episode. For other people, recovery means the ability to lead a fulfilling and productive life, even if psychotic symptoms sometimes return.

Clinical Trials Studying Psychosis and Related Disorders

NIMH supports a wide range of research, including clinical trials that look at new ways to prevent, detect, or treat diseases and conditions, such as psychosis, and disorders that involve psychosis (like schizophrenia). The goal of a clinical trial is to determine if a new test or treatment works and is safe. Although people may benefit from being part of a clinical trial, they should know that the primary purpose of a clinical trial is to gain new scientific knowledge so that others can be better helped in the future.

Researchers at NIMH and around the country conduct clinical trials with people experiencing psychosis and healthy volunteers. Talk to a health care provider about NIMH does not endorse specific psychosis clinics or evaluate individual practitioners’ professional qualifications or competencies. However, several organizations are available to assist in finding a treatment program in your area. The following is not a comprehensive list of all programs, and a program’s inclusion on the list does not constitute an endorsement by NIMH.

This article is provided by Dr. Ralph Kueche (Child Psychologist). Dr. Kuechle is a Child and Adolescent Clinical Psychologist who specializes in treating children and their families who may be struggling with mood and behavioral issues. Learn more about Dr. Kuechle.