What is psychosis?

Psychosis is a syndrome that affects your brain. It disrupts your normal:

• thinking
• emotions
• behaviour

Psychosis can be very frightening. During a 'psychotic episode', you can't tell what is and what isn't real. You may have difficulty with the way you interpret the world around you.

About 1 in every 200 adult Australians will have a psychotic illness each year. A first episode of psychosis is most likely to happen from your teens to mid-thirties.

What symptoms are related to psychosis?

If you are having thoughts of self-harm or suicide and are in immediate danger, call triple zero (000). For help and support, call Lifeline on 13 11 14.

When you have a psychotic episode, you have difficulty interpreting the real world. You may act inappropriately, such as laughing at sad news or believing the television is talking to you.

Usually, psychosis happens in 'episodes'. These can last anywhere from a few hours to a few months. This depends on the individual and the cause of their psychosis.

Symptoms vary from person to person, and from episode to episode.

Disordered thinking

Disordered thinking is when your thoughts are jumbled. This can be confusing.

If you have disordered thinking, you may notice that:

• your thoughts and speech speed up or slow down
• your sentences are hard to understand
• you have difficulty remembering things

Delusions

Delusions are when you have illogical, unshakeable beliefs about yourself and the world. These beliefs may be unusual for someone else of the same cultural background. Delusions can take different forms, such as:

• paranoia about being watched or singled out for harm
• believing you have special powers, or are an important religious or political figure
• believing you are guilty of a terrible crime or act or are going to do something terrible

Hallucinations

Hallucinations are when you see, hear, feel, smell or taste something that doesn't exist. Auditory (sound) hallucinations are most common. You may hear voices or other sounds that are not there.

Disordered behaviour

Disordered behaviour is when you act unusually, such as:

• becoming agitated and upset suddenly
• showing childlike behaviours
• not responding to others or the environment
• difficulty having conversations
• feeling inactive or slower than usual

You may also struggle to communicate how you are feeling. Disordered behaviour can make it hard to manage your day-to-day life, such as:

• self-care, like personal hygiene
• school
• work

Thoughts of self-harm or suicidal thoughts

If you are having thoughts of self-harm or suicide and are in immediate danger, call triple zero (000). For help and support, call Lifeline on 13 11 14.

In severe cases, someone with psychosis may be at risk of:

• self-harm
• suicide
• harming others

What causes psychosis?

The causes of psychosis are complex. It's thought to be caused by a mix of:

• genetic factors
• environmental factors
• biochemical factors
• physical factors

It's likely that some people are more likely to get a psychotic illness. Certain things can trigger your first episode. Common triggers include:

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

Some people are more likely to develop psychosis, such as those with:

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

Some medical conditions have also been known to cause psychosis. These include:

• head injuries
• epilepsy
• encephalitis, caused by infections such as HIV and AIDS, malaria and syphilis
• autoimmune conditions such as lupus and multiple sclerosis
• endocrine conditions such as thyroid dysfunction
• brain tumours

Some neurological conditions may lead to the development of psychosis, such as:

• Alzheimer's disease
• Lewy body dementia
• Parkinson's disease
• stroke

Large deficiencies of some vitamins may lead to psychosis, such as:

• folate (Vitamin B9)
• vitamin B12
• vitamin B3
• vitamin B1

Research also shows that too much dopamine may be linked to psychosis. Dopamine is a chemical messenger in your brain. Having high levels of dopamine may interrupt the pathways in your brain responsible for:

• memory
• emotion
• social behaviour
• self-awareness
• mobility and movement

When should I see my doctor?

If you are showing symptoms of psychosis, see a doctor. This can keep you and others from harm.

You can also contact a mental health crisis support team, such as at your local hospital.

The best outcomes happen when psychosis is found and treated early.

Your doctor may refer you to a psychologist or psychiatrist.

Your healthcare provider can:

• work to find the cause of your psychosis
• tell you if it's likely to happen again
• advise you on how to lower your chances of another psychotic episode
• help you be aware of and manage your triggers and symptoms

How is the cause of psychosis diagnosed?

A mental health professional will complete an assessment which includes a:

• mental health assessment
• physical examination
• neurological examination

They may also ask to speak to a relative or close friend for more information.

The purpose of these assessments is to find out:

• if you have psychosis
• what might be causing it, such as an underlying mental illness or physical health condition
• your relevant family and medical history
• the best course of treatment for you

Different tests may be needed to work out the diagnosis. These tests may include:

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

Your doctor or other health professional might also ask to watch you, at home or in hospital.

How is psychosis treated?

Treatments and support are available for psychosis. Treatments can help improve your symptoms and allow you to live a fulfilling life.

Medicine, psychological therapy and community support can help improve symptoms.

Treatment usually involves a combination of:

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

Self-care at home

If you have psychosis, there are things you can do to keep yourself safe.

Learning to recognise signs of a psychotic episode is important so you know when to get help. Having a safe person who can help you recognise signs is important too.

You can also:

• eat well, exercise regularly and make sure you get enough sleep
• plan times during your day to do something you enjoy
• make sure that you rest — you can try relaxation techniques
• avoid using drugs and alcohol
• learn ways tocope with stress
• set yourself small tasks throughout your day to have a sense of achievement
• keep track of your emotions — this helps you notice the impact of your emotions

Medicine

You may be prescribed antipsychotic medicines. These medicines work by changing the chemicals in your brain, including dopamine.

Antipsychotics usually take several weeks to reduce symptoms. But they may immediately produce a calming effect and help you get to sleep.

Antipsychotic medicines may cause side effects. So, it's important to find the right medicine or combination of medicines for you.

It's also important to take any other medicines as directed. Taking them incorrectly or mixing them with alcohol or other substances can increase your chance of psychosis.

Psychological therapy

There are several psychological treatments available to treat psychosis, depending on your needs. These include:

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

Community support programs

Mental health services can offer practical support such as:

• stable accommodation
• social support
• setting goals for employment or education

If you have long-term psychosis, you may benefit from rehabilitation.

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.

What are the complications of psychosis?

The longer psychosis is untreated, the poorer the outcomes are. These may include:

• slower recovery
• impact on social and psychological development
• poorer response to treatment and more chance of relapse

Relapse may cause a higher chance of:

• problems with work, study, and relationships
• depression
• suicide

If the cause of psychosis is left untreated, other complications may arise.

These may depend on the underlying condition. For example, psychosis caused by Vitamin B12 deficiency, can lead to cognitive impairment.

Can psychosis be prevented?

Some causes of psychosis can't be prevented.

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

• practicing self-care
• learning to recognise triggers
• learning to recognise early symptoms

Early treatment such as psychotherapy can help prevent psychosis if you are experiencing a decline in your mental health.

Resources and support

If you 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. You can call them on 1800 187 263.

Beyond Blue supports people with depression and anxiety, and their friends, family and colleagues. Call 1300 22 4636 or visit their website to chat online.

Black Dog Institute has information and support for people affected by mood disorders.

Lifeline helps anyone having a personal crisis. You can call 13 11 14 for crisis support or to chat online.

The Suicide Call Back Service gives assistance to anyone thinking about suicide. You can call 1300 659 467.

You can read the Mental Health First Aid Australia fact sheet to help people with psychosis.

For advice and to get connected to local mental health services, call Medicare Mental Health on 1800 595 212.

If you are a young person, you can visit a headspace centre without a referral. Headspace offers mental health services to 12 to 25-year-olds. Centres are located across Australia.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.