Psychosis refers to a cluster of psychological symptoms impacting an individual’s perceptions and thoughts about reality. Psychosis is an abnormal mental condition characterized by a severely altered state of consciousness. Most often, psychosis occurs after late adolescence, though it can occur at any age.
Three out of every 100 people will undergo at least one psychotic episode within their lifetime. Unlike many other mental conditions, there is no empirical test to diagnose psychosis directly. Therefore, a diagnosis of psychosis requires patient observation and analysis by a health professional, such as a psychologist or psychiatrist.
Psychosis is not itself a disorder, but a cluster of symptoms from some given cause. Because of this, psychosis is often associated with some other disorder or condition, such as the following:
- Severe major depression
- Post-traumatic stress disorder
- Childhood trauma
- Schizophrenia
- Bipolar disorder
- Acute toxicity
- Drug abuse and withdrawal
Curiously enough, psychotic episodes can have ordinary causes, such as sleep deprivation, hypnagogic and hypnopompic hallucinations, and bereavement following the death of a loved one.
Psychosis Warning Signs and Symptoms
Some early warning signs prior to a first psychotic episode include the following:
- Decreased performance at school or work
- Difficulty concentrating
- Suspiciousness of others
- Obsessive behavior
- A decline in personal hygiene or self-care
- Increased aloneness or solitude
- Intense, unprovoked emotions
- Emotional inconsistency
- Lack of emotions altogether
During the first episode, a person may experience a flurry of ideas or beliefs regarding their self or the world around them that seem abnormally unshakable or chaotic. For this reason, the experience of psychosis may be difficult to express to others, and understanding others can also be challenging.
Moreover, a person may hear sounds or voices that other people cannot or see objects, beings or odd visual distortions that aren’t really there. A person experiencing psychosis may also sense that their body or thoughts are being controlled by someone else, and behaviors that seem strange both to oneself and others are common. The first episode of psychosis can be incredibly frightening, particularly when it manifests as a hallucination.
Symptoms of psychosis include the following:
- Depressed mood
- Insomnia
- Sleeping too much
- Anxiety
- Paranoia
- Social withdrawal
- Diminished emotional expression
- Decreased motivation
- Poverty of speech
- Disorganized thought, speech patterns, or motor behavior
- Obsessive behavior
- Hallucinations
- Delusions
- Unconventional beliefs
- Catatonia
- Suicidal thoughts or actions
Psychotic symptoms can be immediate and temporary, or they can have a long-term onset and be seemingly intractable. Furthermore, an individual may experience only one brief psychotic episode with no further complications, while others may experience many short- or long-lived episodes with different degrees of intensity. Because of the irregularity of psychosis, treatment options vary greatly and depend on the established cause of psychotic symptoms.
What Causes Psychosis?
Psychosis has multiple causes. Traumatic events often either trigger psychosis or predispose a person to experience it later on. Genetics also plays a role, with research suggesting that having a relative diagnosed with a psychotic disorder indicates an increased likelihood of experiencing psychotic symptoms. For individuals with a history of psychosis, exposure to stress appears to be a significant precipitating factor in further episodes.
Psychosis can likewise be caused by sources as varied as extreme lack of sleep to untreated spider or snake bites. Other medical illnesses such as encephalopathy or head injury can produce psychotic symptoms as well. The use of a psychoactive substance can also trigger a psychotic episode.
Drug-Induced Psychosis
Drug-induced psychosis (also referred to as substance-induced psychotic disorder) can include any psychotic episode that is associated with the abuse of an intoxicant.
This event can occur after taking too much of a certain substance, experiencing an adverse reaction from the combination of drugs and alcohol, or during withdrawal from a substance. Psychosis may also manifest partially as a result of an underlying health condition, such as bipolar disorder or schizophrenia.
Moreover, taking a drug or drugs is unlikely to be the catalyst for a serious mental illness in the absence of a psychiatric disorder, but the use of a substance might be a trigger for someone who is predisposed to psychotic episodes, such as those sometimes associated with bipolar disorder.
Substance Abuse and Drug-Induced Psychosis
Psychosis can develop by the misuse of prescription medications. Rarely, however, people sensitive to certain psychoactive substances may suffer from psychosis as a side effect of regular prescription drug doses.
Prescription medications known to include possible psychotic side effects include:
- Antihistamines
- Antidepressants
- Antihypertensive medications
- Analgesics
- Anticonvulsants
- Antiparkinson medications
- Cardiovascular medications
- Chemotherapy agents
- Corticosteroids
- Muscle relaxants
Illicit Drugs
Hallucinogens such as LSD, DMT, and psychotropic mushrooms can contribute to psychotic-like symptoms, such as delusions or paranoia, in addition to visual and auditory hallucinations. This effect is not the same as true psychosis, however.
The use of other illegal drugs, such as cocaine and amphetamines, can also cause similar illusionary and perceptual symptoms when used excessively for a significant period of time.
But the true essence of psychosis is evidence that a mental “break” has occurred.
Moreover, when the person experiencing the strange effects is no longer aware that the hallucinations and perceptions are not real. This is the hallmark of a very serious condition that puts both the person suffering and others around him or her in danger.
LSD, DMT, and psychotropic mushrooms can, in some instances, cause a psychotic break, especially if overused. Alcoholism can also cause psychosis, but it usually takes long periods, even years for this to occur. It is typically the result of alcohol’s damaging effects on the brain and a lack of thiamine (B1) in the body, which can result in a condition known as Wernicke-Korsakoff syndrome.
An extreme form of alcohol withdrawal syndrome called delirium tremens can also cause psychosis, as well as confusion, delirium, seizures, and hallucinations. Delirium tremens is a life-threatening medical emergency.
Psychosis can also follow withdrawal from the long-term use of a psychoactive substance, including amphetamines, cocaine, opioids, and even inhalants. Among methamphetamine users, psychosis can spontaneously appear in people who have been clean for several years.
Treatment for Psychosis and Addiction
Psychosis is a symptom of an underlying mental health condition (whether drugs are present or not) but is often temporary and may last for only a few hours. Despite its transient nature, drug-induced psychosis is a medical emergency, and a person experiencing this state may attempt to harm themselves or others.
The first step in the treatment of drug-induced psychosis is to ensure the patient stops taking the substance or is treated for withdrawals if the removal of the substance appears to be causing the psychosis.
But helping someone enable sobriety in the face of addiction, however, isn’t always that easy. Sometimes family and friends have to intervene, as well as emergency medical responders and addiction specialists.
Patients who are experiencing drug-induced psychosis often must undergo a medical detox in either a hospital or recovery center. During this process, the patient is supervised by medical professionals around-the-clock for several days and is administered medication to ease withdrawals in addition to the symptoms of psychosis and other mental health conditions.
After detox, patients should participate in a complete rehab program, either in an inpatient (residential) or intensive outpatient format. Both tracks involve therapy, counseling, and support groups to help patients learn the skills needed to maintain long-term sobriety and wellness.
After rehab, former patients (alumni) can benefit from aftercare planning services, which help them connect with resources such as psychiatrists, psychologists, counselors and other mental health professionals for ongoing recovery support and the treatment of a co-existing mental health condition if present.