PSYCHOSIS

Psychosis is a clinical term used to describe a mental state in which a person experiences a disconnection from reality. This may involve hallucinations, delusions, disorganized thinking, and/or impaired insight, which significantly interfere with a person’s perception, cognition, and behavior.

Psychosis is not a diagnosis itself, but a syndrome or set of symptoms that can occur across a variety of psychiatric, neurological, and medical conditions.

Core Symptoms of Psychosis:

  1. Hallucinations

    • Sensory perceptions that occur in the absence of an external stimulus.

    • Most commonly auditory (e.g., hearing voices), but can also be visual, tactile, olfactory, or gustatory.

  2. Delusions

    • Strongly held false beliefs that are resistant to reason or contrary evidence.

    • Examples include paranoid delusions (“someone is trying to harm me”), grandiose delusions (“I have special powers”), or somatic delusions (“my body is rotting from the inside”).

  3. Disorganized Thinking and Speech

    • Often observed as incoherent or tangential speech, “word salad,” or loose associations, reflecting impaired cognitive organization.

  4. Negative Symptoms (in some cases)

    • These include diminished emotional expression, avolition (lack of motivation), and social withdrawal, particularly in psychotic disorders like schizophrenia.

Etiology and Associated Conditions:

Psychosis can be caused by a wide range of conditions, including:

  • Primary psychiatric disorders:

    • Schizophrenia spectrum disorders

    • Bipolar disorder (particularly manic or mixed episodes)

    • Major depressive disorder with psychotic features

  • Substance-induced psychosis:

    • Triggered by intoxication or withdrawal from drugs like amphetamines, cannabis, alcohol, or hallucinogens

  • Medical or neurological conditions:

    • Delirium, brain tumors, epilepsy, autoimmune encephalitis, infections (e.g., syphilis, HIV), or neurodegenerative diseases

Psychosis may be acute (sudden onset) or chronic, depending on its cause. In some individuals, psychosis is transient and resolves with treatment of the underlying condition. In others—such as those with schizophrenia—it can be part of a long-term disorder requiring ongoing management.

Management of psychosis depends on the underlying cause but typically includes:

  • Antipsychotic medications:

    • First-line treatment for primary psychotic disorders; includes both first-generation (e.g., haloperidol) and second-generation (e.g., risperidone, olanzapine) antipsychotics

  • Psychosocial interventions:

    • Cognitive Behavioral Therapy for psychosis (CBTp), social skills training, and supported employment or housing

  • Hospitalization:

    • Often necessary during acute episodes to ensure safety and stabilization

  • Treatment of co-occurring conditions:

    • Including mood disorders, substance use, and medical illnesses

Early intervention, especially during the first episode of psychosis (FEP), is critical and improves long-term outcomes. Recovery is possible, though some individuals may experience recurring episodes or persistent symptoms requiring long-term support.