What Is Psychosis? A Comprehensive Guide

Psychosis is a state of mind in which a person has trouble telling the difference between what’s real and what’s not. It’s not an illness on its own, according to experts at Columbia University in New York City; rather, it’s a symptom of certain health conditions.

“To give you an analogy, the term psychosis is kind of like having a cough or a sneeze. You could have the flu, or you could have a cold, or you could have COVID,” explains Joshua Kantrowitz, MD, the director of the Columbia Schizophrenia Research Center at Columbia University Irving Medical Center in New York City. “There are lots of different causes.”

In other words, a variety of mental and physical illnesses can disrupt an individual’s thoughts and perceptions and trigger a psychotic episode. A psychotic episode is commonly marked by delusions (beliefs that are clearly false) or hallucinations (seeing or hearing things that others don’t), according to the National Institute of Mental Health (NIMH).

While psychosis can be distressing for the affected person and their loved ones, the good news is that its symptoms are usually treatable with medications and other therapies.

“The vast majority of psychotic conditions can be managed effectively and safely,” says David Brendel, MD, PhD, a psychiatrist in private practice in Belmont, Massachusetts, who specializes in treating complex mental health conditions, including bipolar disorder, major depression, and anxiety.

What Are the Signs and Symptoms of Psychosis?

The signs and symptoms of psychosis vary from person to person, but usually involve changes in mood, thinking, and behavior, explain experts at the Yale School of Medicine in New Haven, Connecticut.

These symptoms often fall into the following five categories, say Yale experts:

  • Delusions A delusion is a false belief that someone strongly insists is true despite clear evidence otherwise. For example, people with delusions may insist that others are trying to harm them when there’s no reason to believe that’s true.
  • Hallucinations People with hallucinations sense things that don’t exist outside of their mind. For instance, they may see or hear voices that aren’t there.
  • Confused Thinking Someone experiencing psychosis has a hard time thinking or speaking clearly, concentrating, following along in a conversation, or remembering things. Their mind may race, or it may process information very slowly.
  • Changed Feelings During a psychotic episode a person may experience mood swings, unusual excitement or depression, or less emotion than normal.
  • Changed Behavior Someone experiencing psychosis may act differently than they typically do. For example, they may be very active or sluggish, laugh at inappropriate moments, or become upset or angry for no apparent reason.

People with psychosis may show several of the following warning signs, according to the NIMH:

  • An abrupt decline in job or school performance
  • Difficulty concentrating
  • Paranoia
  • Withdrawal from social situations
  • Unusual or inappropriate thoughts, feelings, or ideas
  • No emotions at all
  • Trouble separating reality from fantasy
  • Problems speaking or communicating with others
  • A sudden decline in self-care or personal hygiene
  • Sleep problems
  • A lack of motivation
  • Depression or anxiety

Causes and Risk Factors for Psychosis

There’s no one specific cause of psychosis, according to the NIMH. “Psychosis is not really something that just happens on its own,” explains Dr. Kantrowitz. “It’s mostly found in people with certain medical conditions or a mental health disorder.”

According to Cleveland Clinic, these underlying causes may include:

  • Schizophrenia and related disorders
  • Major depression
  • Bipolar disorder (characterized by alternating episodes of mania and depression)
  • Alzheimer’s disease or other types of dementia
  • Infections that affect the brain or spinal cord, such as meningitis or encephalitis
  • A brain tumor
  • Stroke, Parkinson’s disease, or other neurological conditions
  • Multiple sclerosis
  • Lupus
  • Lyme disease
  • An overactive or underactive thyroid
  • Hormonal conditions, such as Addison’s disease or Cushing’s disease
  • Postpartum psychosis
  • A vitamin B1 or vitamin B12 deficiency
  • A severe head injury
  • Stress, anxiety, or lack of sleep

“Psychosis could also be precipitated by substances or drugs,” adds Kantrowitz. For instance, misusing certain prescription medications, alcohol, or other drugs such as marijuana, can cause psychosis, according to the NIMH.

Having a family history of psychotic disorders, such as schizophrenia or schizoaffective disorder, is another strong predictor of psychosis, according to the National Alliance on Mental Illness (NAMI).

Additionally, children born with certain genetic mutations may be at increased risk for developing a psychotic disorder such as schizophrenia, according to research published in February 2016 in World Psychiatry.

Imbalances in certain brain chemicals, including dopamine, glutamate, gamma-amino-butyric acid (GABA), or acetylcholine, may play a role in triggering psychosis symptoms, according to an article published in July 2022 in StatPearls.

In addition, certain environmental factors — such as maternal stress, complications during pregnancy, or child abuse — may also increase a person’s chances of developing psychosis later on, according to a study published in April 2022 in Dialogues in Clinical Neuroscience. Trauma and physical injuries may also play a role in triggering psychosis, note Columbia University experts.

Types of Psychosis

Since psychosis is a symptom of various other health conditions, doctors don’t formally categorize different types of psychosis, according to Cleveland Clinic.

However, there are a few conditions that still use the terms “psychosis” or “psychotic” in their names. They include:

  • Brief Psychotic Disorder This describes a sudden psychotic episode triggered by extreme stress or trauma, such as an accident or the death of a loved one, according to MedlinePlus. Symptoms last longer than a day but less than a month.
  • Postpartum Psychosis This type of psychosis, which is triggered by childbirth, happens to approximately 1 in 500 mothers, usually within the first two weeks after birth, say experts at the U.K. National Health Service (NHS).
  • Substance- or Medication-Induced Psychotic Disorder This diagnosis refers to psychosis symptoms caused by substances, such as drugs or alcohol, according to experts at Sheppard Pratt, a national provider of psychiatric services.

How Is Psychosis Diagnosed?

A qualified psychiatrist, psychologist, or clinical social worker can diagnose psychosis. Typically, one of these health professionals will perform a thorough exam that includes analyzing the person’s symptoms, and asking about personal and family health history, according to experts with the Early Psychosis Intervention (EPI) program in British Columbia, Canada.

If a provider suspects that psychosis is related to another physical or mental health condition, they may run other tests, such as an MRI scan of the brain or blood tests, to narrow down a potential cause.

How Is Psychosis Treated?

Detecting and treating psychosis early offers the best prognosis, lowers the risk for suicide, boosts the odds of successful treatment, and reduces work or academic disruptions, according to Yale School of Medicine.

However, NIMH experts note, it’s common for people to have symptoms of psychosis for more than a year before receiving treatment.

Treatment depends on what is triggering the symptoms of psychosis. “Many times, treating the underlying medical condition will help,” says Kantrowitz. “So, if a person’s symptoms are caused by a brain tumor, surgery to remove the tumor might also help the psychosis.”

Potential treatment options include:


Antipsychotic medicines — which work by altering brain chemistry — are the most common and most effective treatment for people who experience psychosis. Many medications fall into this category; providers recommend one based on a person’s health history and symptoms.

“These medicines broadly treat psychosis across many conditions,” Kantrowitz explains. “Usually, they’re effective in lessening at least some of the symptoms.”

In fact, antipsychotic medications may make certain symptoms, such as agitation or hallucinations, go away within days of starting treatment, according to the NIMH.

In some cases, doctors may also prescribe other types of medications — such as benzodiazepines, mood stabilizers, or antidepressants — to treat psychosis, say NIMH experts.

Cognitive Behavioral Therapy

According to experts at Stanford Medicine in California, cognitive behavioral therapy for psychosis (CBTp) — which involves teaching people how to change unhelpful thought and behavior patterns into more constructive ones — has emerged as an effective treatment intervention for psychosis when used alongside medication. One study, published in Schizophrenia Research, found CBT to be specifically effective in treating auditory hallucinations and delusions.


Supervised inpatient treatment in a hospital or a similar medical facility is sometimes necessary to ensure people with severe psychosis can recover in a safe environment, according to Cleveland Clinic.

Supportive Care

Programs that help people with psychosis navigate social, work, and family life can be an important part of treatment. For instance, interventions that help treat alcohol use disorder can also help alleviate psychosis symptoms in people with that concurrent condition, according to Cleveland Clinic.

Healthcare providers or case managers can help people with psychosis find these types of resources.

What Are the Potential Complications and Consequences of Psychosis?

Most people who experience psychosis can successfully recover with treatment. However, “Without appropriate treatment, people can suffer extreme harm,” Dr. Brendel says.

Untreated psychosis, he notes, can lead to:

  • Job loss
  • Failure at school
  • Damaged relationships
  • Financial trouble
  • Violent behavior
  • Hospitalization
  • Incarceration
  • Suicide

About 1 in 5 people with psychosis will attempt suicide at some point in life, and 1 in 25 people with psychosis will die by suicide, according to the NHS. People with psychosis are also much more likely to have alcohol- or drug-related issues.

How to Help a Loved One With Psychosis

Helping a family member or friend with psychosis can be emotionally challenging. The first step, says Kantrowitz, is to acknowledge and understand what your loved one is going through. “Psychosis is often caused by a legitimate medical condition. It’s not something that they’re doing on purpose,” he explains.

If someone close to you is experiencing symptoms of psychosis, refrain from judging or arguing with your loved one, but do encourage them to seek help from a medical professional, Kantrowitz says. Another way to offer support is to encourage them to take their medications as prescribed, say NAMI experts.

You should contact a doctor or call 911 if you’re worried that your loved one may harm themselves or others, Brendel adds. While you wait for emergency medical help, “stay calm, convey respect, and communicate your support clearly,” he advises. “Focus on ensuring safety.”

Research and Statistics on Psychosis

As many as 3 in 100 people will have an episode of psychosis at some point in their lives, NAMI reports.

While psychosis can affect anyone, the risk of developing it is higher among teens and young adults due to hormonal changes that happen in the brain during puberty. About 100,000 young people in the United States experience psychosis each year, according to NAMI.

About 25 percent of individuals who’ve had a psychotic episode will never have another one, according to Yale School of Medicine. However, 50 percent of people who’ve had a psychotic episode may have another one later on while still going on to live normal lives. Other people with psychosis may need continual support and treatment, Yale experts add.

Resources We Love

Psychotic episodes can be unpredictable and scary for both the affected person and those around them. Certain resources can provide educational tools, opportunities to connect with others, or in some cases, lifesaving assistance.

Here are our top resources for people living with psychosis:

988 Suicide and Crisis Lifeline

Formerly known as the National Suicide Prevention Lifeline, the 988 Suicide and Crisis Lifeline provides free, 24/7 confidential support for people in distress. If you call or text 988, you’ll be connected with a trained crisis worker who can help you get the help you need.

Early Assessment and Support Alliance (EASA)

EASA is an organization that helps create opportunities for young people affected by psychosis. It provides a directory of early psychosis programs around the country to help people get the early intervention they need.

Early Psychosis Intervention Network (EPINET)

An early learning healthcare system for people with early psychosis, EPINET offers educational and support resources for people with psychosis and their loved ones.

National Institute of Mental Health (NIMH)

The NIMH is the lead federal agency for research related to mental health conditions. The NIMH provides credible information about psychosis, as well as resources for patients to find help.

National Alliance on Mental Health (NAMI)

This organization offers information about psychosis, treatment options, and finding support. If you or a loved one needs mental health help, consider calling the NAMI HelpLine at 1-800-NAMI (6264). You can also reach the HelpLine by texting 62640, emailing helpline@nami.org, or visiting nami.org/help.

Prodrome and Early Psychosis Program Network (PEPPNET)

PEPPNET shares a national network of programs that provide services to people at risk for experiencing early psychosis.

Substance Abuse and Mental Health Services Administration (SAMHSA)

SAMHSA provides resources for locating mental health treatment programs in your area.

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