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 (believing something that is unlikely to be true – that a group of unknown people are conspiring to hurt them, for example), hallucinations (hearing voices, for example) and confused and disturbed thinking. 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; they can continue indefinitely until they are treated; 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 to them – that they really are being followed, that their life is at risk, or that they are 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 and Parkinson’s disease. 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 the appropriate specialist services. Most NHS mental health trusts now run early intervention services especially for young people who may be having experiences that may be the precursor of a psychotic episode (see Early intervention services page), or who are experiencing psychosis for the first time.

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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 (see Paranoia page).

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. Sometimes people think they are someone historically important, or a celebrity – they may believe they are related to the royal family, or that they are a film star, for example. These sort of beliefs are called 'grandiose ideas'. They can make people feel more cheerful and are not always distressing in themselves. However, the fact that no one else recognises how important they are may cause distress, and sometimes anger.

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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. Sometimes people invent new words, or string words together in an unusual and confusing way.

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 might 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 and this can be very distressing.

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 they fear what will happen to them if they disobey. These kinds of threatening voices are particularly likely to be distressing.

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. They therefore experience their own thoughts as spoken words coming from the outside world.

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Change of behaviour

The experiences of psychosis may feel emotionally overwhelming. Delusions and hallucinations take over the way people see the world and become their reality. As a result, people who are unwell may appear to be different – they may not appear to be 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. They may neglect their self-care. They may lose concentration and become distraught at not being able to deal with, or stop, what it happening to them.

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 the experiences they are having and reality, to think logically or talk about how they are feeling, or to put their strange thoughts, emotions and fears in context.