What is psychosis?

• What is psychosis?
• Delusions and paranoia
• Confused and disturbed thoughts
• Hallucinations
• Change of behaviour

What is psychosis?

The word psychosis describes a set of symptoms that include delusions, hallucinations – hearing voices, for example – and confused or disturbed thoughts. When people experience these symptoms, mental health professionals say they are having a psychotic episode. Psychotic episodes can vary in length: they can last for a few days, indefinitely until they are treated, and they can come and go.

When people have a psychotic episode, they are often unaware that they are unwell. They believe what they are experiencing is actually happening – that they are really being followed, at risk, or being threatened, for instance. Mental health professionals call this ‘lack of insight’.

Psychosis is a symptom of schizophrenia, bipolar disorder and schizoaffective disorder. It can also be a symptom of dementia, some forms of personality disorder, epilepsy, Parkinson’s disease and other illnesses. People who abuse drugs and alcohol sometimes experience symptoms of psychosis, and psychosis can occur as a side effect of some types of medication. Psychotic experiences can be triggered by severe stress or anxiety, severe depression or sleep deprivation.

It is best to get advice and treatment for the symptoms of psychosis as soon as people start experiencing them. Talk to your GP who can refer you to specialist services. Most mental health authorities now run Early Intervention services for young people who may be having experiences that may be the precursor of a psychotic episode (see Early intervention services page).

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Delusions and paranoia

Delusions are strong beliefs that are unlikely to be true. However, a person who has psychosis firmly believes them to be true, and as a result may say things that are strange, or behave in an odd way.

Often, someone with psychosis will believe that other people or organisations are out to get them, are spying on them or watching them, are trying to trick them, hurt them or even kill them. These paranoid delusions can be very frightening for the person who is unwell.

Sometimes people believe they have a special power or authority – that they are able to control other people’s thoughts, for example. Sometimes people have religious delusions – they may believe they are the mother or son of God for example (see Paranoia page).

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Confused and disturbed thoughts

During a psychotic episode, people have disturbed and confused thoughts. Their thinking may speed up or slow down, and their mind may be full of different and random ideas. Their jumbled thinking may be reflected in the way they speak.

They may talk very quickly, without stopping, and without listening, or they may suddenly stop talking mid sentence, or refuse to talk at all. They may say things that don’t make sense, or randomly switch from one subject matter to another. If they stop speaking suddenly, it may be that they have lost their train of thought or their mind has gone blank.

Because of this muddled thinking, it may be difficult to follow what a person is saying, and hard to have an ordinary conversation with them.

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Hallucinations

People with psychosis may see, hear, smell, taste or feel things that are not there. They may see people or objects that no one else can see, for example, or feel insects crawling on their skin.

Auditory hallucinations – hearing voices – are very common. These voices are entirely real to the person who is hearing them, so he or she may talk back and hold a conversation with them. Voices may say upsetting, critical, cruel and frightening things to or about the individual.

Some voices tell people what to do – and can sometimes dictate harmful or dangerous actions. Most people try to resist these aggressive commands, but often feel they must obey because they believe the voices are powerful and fear what will happen if they do not.

Imaging techniques have allowed researchers to see what happens inside the brain when people are hearing voices. The reason people who hear voices think they are real is because they hear them through the same system that everyone uses to hear external speech, in a part of the brain called Broca’s area.

Somehow, the brains of people who are hearing voices misidentify these internal words and process them in the same part of the brain that everyone uses for understanding external speech. They therefore experience their thoughts as spoken words coming from the outside world. The next task for researchers is to find out why this happens.

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Change of behaviour

The experiences of psychosis may overwhelm people’s feelings and emotions. Delusions and hallucinations take over the way they see the world and become their reality. As a result, people who are unwell may appear to be different, not the same person as they were before they started having the symptoms of psychosis. They may become very excited or agitated and suspicious of other people. Or they may become miserable and withdrawn, refuse to see people and lose interest in everything they previously did.

It is important to remember psychosis can be very frightening for the person who is experiencing the symptoms. If the symptoms are severe, people can find it impossible to tell the difference between their own experiences and outside reality, to think logically or talk about how they are feeling, or to put their strange thoughts, emotions and fears in context. They may lose concentration and become distraught at not being able to deal with, or stop, what it happening to them.