What is psychosis?

People with psychosis cannot tell what is real and what is not. They have difficulty with the way they interpret the world around them, and their thinking can be confused. They may experience hallucinations, such as hearing voices that aren’t there, or delusions, where they have false beliefs about themselves or the world around them.

In severe cases, someone with psychosis may be at risk of self-harm, or harming others. About 1 in every 200 adult Australians will experience a psychotic illness each year. A first episode of psychosis is most likely to happen in a person's late teens or early adult years.

Treatment is available for people with psychosis. Medicine, psychological therapy and community support can help reduce symptoms, allowing people to live a normal life. It’s important to talk to a doctor if you think you may have symptoms of psychosis.

What are the symptoms of psychosis?

When someone is having a psychotic episode, they have difficulty with the way they interpret the real world.

Symptoms vary from person to person and from episode to episode. They may include:

• disordered thinking: thoughts don’t join up properly, causing confusion. A person’s thoughts and speech may speed up or slow down, their sentences may be unclear and hard to understand, and they may have difficulty following a conversation or remembering things
• delusions: the person may hold beliefs that are unusual for someone of the same cultural background. This can take different forms, such as paranoia (thinking they are being watched or singled out for harm), grandiosity (believing they have special powers or are an important religious or political figure) or depressive (believing they are guilty of a terrible crime)
• hallucinations: the person may see, hear, feel, smell or taste something that doesn’t actually exist. Auditory hallucinations are the most common form: hearing voices or other sounds that are not there
• disordered behaviour: the person might become agitated or childlike, they might mutter or swear, or they might not respond to others around them. They might find it hard to manage their day to day life, like looking after their personal hygiene
• thoughts of self-harm or suicidal thoughts: the person may have feelings of wanting to harm themselves. Significant suicidal risk is a medical emergency so please call triple zero (000) or go to the closest hospital emergency department

Sometimes a person with psychosis can act inappropriately, such as laughing at sad news or becoming angry for no apparent reason. Associated agitation or apparent aggression can occur and must be managed under the supervision of a healthcare team to prevent harm to themselves and others.

What causes psychosis?

The causes of psychosis are complex, and researchers are still trying to understand them fully. However, psychosis is thought to be caused by an interaction between genetic and environmental factors.

It's likely that some people are born with a predisposition to develop this kind of illness and that certain things — for example, stress or the use of drugs such as marijuana, LSD or speed or medications — can trigger their first episode.

The main categories of causes of psychosis are:

• mental illness: psychosis can be caused by a mental illness, such as schizophrenia, bipolar disorder, or severe depression.
• genetics: people with a family history of psychotic disorders such as schizophrenia have a slightly increased chance of developing psychosis. There is no single gene that causes psychosis, but a number of different genes may increase the likelihood of developing it.
• recreational drugs: psychosis can be triggered by the use of drugs, including cannabis, amphetamines (including speed and ice), LSD (acid), magic mushrooms, ketamine, ecstasy and cocaine.

Some medical conditions have been known to cause psychosis, although this is rare. These include:

• head injuries
• HIV and AIDS
• malaria or taking malaria medications
• syphilis
• Alzheimer’s disease and Lewy body dementia
• Parkinson’s disease
• lupus
• Lyme disease
• postnatal depression
• multiple sclerosis
• stroke
• some types of epilepsy
• brain tumours
• some types of hormone disorders
• some dietary deficiencies

There’s also research showing that too much dopamine may be associated with psychosis. Dopamine is one of the chemicals in the brain that sends information from one brain cell to another. Having high levels could interrupt the pathways in the brain responsible for memory, emotion, social behaviour and self-awareness.

Although the causes are still being uncovered, psychosis is treatable. With medicine and support, people with psychosis can recover from their illness.

How is psychosis diagnosed?

The first step towards finding out if you or someone else is experiencing psychosis is to see a doctor or to contact a community mental health team via your local hospital.

Young people can visit a headspace centre. Headspace provides early intervention mental health services to 12 to 25-year-olds. Centres are located across metropolitan, regional and rural areas of Australia.

A health professional will do a complete mental health assessment through an interview and may also wish to speak to a relative for more information. The purpose of the assessment is to find out:

• if the person is experiencing psychosis
• what might be causing it
• if there's an underlying mental illness
• the relevant family and medical history
• the best course of treatment

When someone has an episode of psychosis, a full medical examination is required. The person will need to be observed by a team of mental health professionals, either at home or in hospital.

Different tests may be required to work out the diagnosis and any underlying causes. Tests may include:

• medical tests: there are a range of tests the doctor may perform, such as blood tests for abnormal electrolytes, hormone levels or infections. These tests can help work out the cause of the psychosis
• drug checks: some drugs, such as LSD, marijuana and amphetamines, can cause psychosis. It’s important for a health professional to understand whether symptoms are associated with drug use
• brain scans: sometimes doctors will scan the brain, using an MRI to check for any abnormalities

How is psychosis treated?

Recent advances in therapies mean that psychosis is now more treatable than ever before.

Treatment usually involves medicine, education about the illness, counselling, family support and practical support. Avoiding drugs, reducing stress and learning ways to cope with stress can help prevent psychosis symptoms from coming back.

Treatment may require a team of mental health professionals including a psychiatrist, mental health nurses, occupational therapists or psychologists. Treatment for illnesses that cause psychosis can last 2 to 5 years, or sometimes longer.

• Early intervention: Research has suggested the best outcomes for treatment occur when psychosis is detected and treated early, before the illness has a chance to develop.
• Medicine: A person with psychosis may be prescribed antipsychotic medicines. Treatments work by altering chemicals in the brain, including dopamine. Antipsychotics usually take several weeks to reduce symptoms, such as hallucinations or paranoia. But they may immediately produce a calming effect and help the person to sleep. Antipsychotic medicines may cause side effects, so it is important to find the right medicine for each person.
• Psychological therapy: There are several psychological treatments available to people who are experiencing psychosis, depending on their individual needs. These include supportive psychotherapy, cognitive behaviour therapy (CBT), family therapy and self-help groups.
• Community support programs: Mental health services can also provide practical support for people with psychosis. Stable accommodation, financial security, social support and having a meaningful role in society are essential components of recovery. People suffering from long-term psychosis may require rehabilitation and assistance to find suitable work.

If someone is experiencing psychosis, their doctor can help put them in touch with the best people to treat the psychosis and support them through treatment. Professional help will make managing the symptoms much easier.

If there is a risk of the person causing harm to themselves or others, then seek urgent medical help with a doctor or at a local hospital emergency department. Any risk of suicide must be treated as a medical emergency and an ambulance should be called by dialling triple zero (000).