Psychosis is a loss of contact with reality. Hallucinations and delusions are the most common symptoms. Psychosis can occur as part of many conditions, including schizophrenia and bipolar disorder.

People with psychosis may experience disruptions in their thoughts and perceptions, which can cause them to see their world differently. Psychosis is a common symptom of many medical and neurological conditions.

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Psychosis affectsTrusted Source a person’s thoughts and perceptions. It changes how they process information, making it difficult for them to tell the difference between what is real and what is not.

People who are experiencing psychosis may hear, see, smell, taste, or feel things that are not there. They might also hold strong beliefs or ideas — for example, they might think that someone is out to get them or that someone is monitoring their activities when this is not the case.

During an episode of psychosis, everything the person is experiencing seems real to them. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) states that a person may not know they are experiencing psychosis. It can be overwhelming and confusing.

Sometimes, the symptoms can cause a person to harm themselves. In rare cases, they may hurt another person.

Psychosis is one of the key symptoms of schizophrenia and other psychotic disorders. According to the DSM-5-TR, psychosis can also co-occur with many mood and substance use disorders.

Psychosis can affect anyone. According to the National Alliance on Mental Illness (NAMI), 100,000 young people in the United States experience psychosis every year, and up to 3 in 100 people will experience an episode of psychosis in their lifetime.

Depending on the cause, psychosis can appear quickly or cause slow, gradual changes in a person’s thoughts and perceptions. It can also be mild or severe.

Sometimes, it may be mild at first but become more intense over time. While psychosis can cause a range of symptoms, it often involves one of two significant experiences.

The sections below provide more details about the early signs of psychosis and these two common symptoms.

Early signs

Early or first-episode psychosis is the period when a person first begins to experience psychosis. The symptoms can be difficult to distinguish from typical behavior but can include:

  • a significant drop in job performance or school grades
  • difficulty concentrating or thinking clearly
  • uneasiness or suspicion around other people
  • strong emotions that may be inappropriate for the circumstances, or a lack of emotions
  • social withdrawal
  • a sudden decline in self-care or personal hygiene

These are the prodromal phase symptoms, which people may mistakenly attribute to depression or substance use.

According to the DSM-5-TR, psychosis involves abnormalities in one of the followingTrusted Source categories or domains:

  • Hallucinations: Hallucinations are false perceptions that a person believes to be real despite the lack of stimulus to cause them.
  • Delusions: Delusions are false beliefs that a person holds despite a lack of evidence or proof.
  • Disorganized thoughts: A person may have thoughts that are illogical, unrelated, or loosely connected. Their thought process may drift away from the topic at hand. Their speech may not make sense to others.
  • Catatonia: The person may become unresponsive or oppose stimuli (negativism), or they may display unintentional movements or activities that lack purpose (catatonic excitement).
  • Disorganized behavior: A person may have unpredictable or inappropriate emotional responses that do not fit the situation.
  • Negative symptoms: They may experience a decline in emotions, words, movements, or motivation (anhedonia).

Hallucinations

Hallucinations may cause a person to see, hear, feel, taste, or smell something that is not there. A person with auditory hallucinations hears things and believes them to be real when they do not exist.

A person may hearTrusted Source incoherent sounds or distinct voices. They may believe that they hear these sounds through their ears, from anywhere external to them, or in their mind.

Hearing voices may be distressing, especially if the voices are commanding, derogatory, haunting, or threatening. This experience can affect a person’s actions and may cause them to harm themselves or others. It may also cause a person to attempt suicide.

Help is out there

If you or someone you know is in crisis and considering suicide or self-harm, please seek support:

  • Call or text the 988 Lifeline at 988 or chat at 988lifeline.org. Caring counselors are available to listen and provide free and confidential support 24/7.
  • Text HOME to the Crisis Text Line at 741741 to connect with a volunteer crisis counselor for free and confidential support 24/7.
  • Not in the United States? Find a helpline in your country with Befrienders Worldwide.
  • Call 911 or your local emergency services number if you feel safe to do so.

If you’re calling on behalf of someone else, stay with them until help arrives. You may remove weapons or substances that can cause harm if you can do so safely.

If you’re not in the same household, stay on the phone with them until help arrives.

Delusions

A person may experience delusions during an episode of psychosis. The most common types of delusions includeTrusted Source:

  • Persecutory delusions: Persecutory delusions cause a person to believe that someone is out to mistreat them or that they are a target of harm.
  • Erotomanic delusions: With erotomanic delusions, a person believes that someone else is in love with them.
  • Delusions of grandeur: These delusions cause a strong belief that the person has a special power or authority.
  • Thought broadcasting: This is the belief that the person is broadcasting their thoughts and that others can perceive them.

A person may alsoTrusted Source experience:

The length of a person’s psychosis varies depending on the type of psychosis.

Substance- or medication-induced psychosis tends to resolve shortly after the substance clears from a person’s system. However, psychosis triggered by amphetamines, phencyclidine (PCP), or cocaine may last for several weeks.

A brief psychotic disorder usuallyTrusted Source lasts for less than a month.

According to the DSM-5-TR, a person may qualify for a diagnosis of schizophrenia if psychotic symptoms have been present a significant portion of the time for 1 month or longerTrusted Source.

Psychosis itself is not a mental health diagnosis. It is often a symptom of another condition. To determine what may be causing the psychosis, a doctor will take a thorough history.

This includes understanding the person’s personal, family, medical, cultural, social, and religious history. The doctor will also ask about the person’s psychotic symptoms, including their course, duration, and severity.

The doctor will conduct a physical examination, including a mental and neurological exam.

If the signs and symptoms suggest an underlying medical condition, a doctor may request tests such as:

The doctor may also consider testing for HIV and syphilis. Brain imaging is often not necessary unless the person has a new, severe headache; recently experienced significant head trauma; or has focal neurological deficits. However, many doctors use brain imaging in case there are abnormal findings unrelated to the typical causes.

They may also order tests to rule out other factors, including:

If the signs indicate a psychiatric cause, the doctor will refer to criteria from the DSM-5-TR to make a diagnosis.

Psychosis can occur as a result of several factors. It may be a symptom of a mental health condition. Psychotic disorders such as delusional disorder and schizotypal disorder share psychosis as a symptom.

A combination of genetic and environmental factors can lead to psychosis. Certain environmental factors may increase a person’s risk of experiencing psychosis, including:

Other possible causes of psychosis includeTrusted Source:

  • brain changes
  • alcohol or substance misuse
  • general medical conditions
  • certain psychiatric and neurological conditions
  • certain prescription drugs
  • changes in levels of sex hormones
  • lack of sleepTrusted Source

A traumatic event such as war, sexual assault, or death can also trigger a psychotic episode.

The mechanisms by which psychosis occurs are not entirely clear, but many studies point to imbalancesTrusted Source in chemicals in the brain.

The positive symptoms of psychosis are associated with excess activity of dopamine (a neurotransmitter related to mood) as well as a decrease in the activity of receptors for glutamate (another neurotransmitter).

Anyone experiencing psychosis should receive urgent medical attention. Treatment can provide both short- and long-term help.

Antipsychotic drugs

Antipsychotic drugs are the primary treatment for psychotic disorders.

These medications can reduce psychosis symptoms in people with mental health conditions such as schizophrenia. However, they do not treat or cure the underlying condition.

Examples of these medications include:

  • haloperidol (Haldol)
  • chlorpromazine (Thorazine)
  • clozapine (Clozaril)

Because these drugs can cause side effects, a person can take them only under the supervision of a doctor.

The doctor will also treat any underlying conditions that are responsible for the psychosis. When possible, family supportTrusted Source can also help.

Acute and maintenance phases of schizophrenia

In schizophrenia, there are two phases of antipsychotic treatment:

  • Acute phase: During the acute phase of schizophrenia, a person may need to stay in a hospital to receive care. Sometimes, a doctor will prescribe rapid tranquilization. The doctor will give the person a fast-acting medication that relaxes them to ensure that they do not harm themselves or others.
  • Maintenance phase: In the maintenance phase, a person does not stay in the hospital, but healthcare professionals will prescribe antipsychotic drugs to help prevent further episodes. Stopping the medication can lead to relapses.

Psychotherapy interventions, including cognitive behavioral therapy (CBT) and supportive counseling, can also be helpful for people with schizophrenia and other psychotic disorders.

Schizophrenia is not the only psychotic disorder that can cause psychosis. According to the DSM-5-TR, the following mental health conditions may also causeTrusted Source psychosis:

  • Schizoaffective disorder: Schizoaffective disorder is similar to schizophrenia but includes periods of mood disturbances.
  • Brief psychotic disorder: Symptoms occur in response to a stressful life event, last less than 1 month, and do not return.
  • Delusional disorder: With delusional disorder, a person strongly believes in something irrational and often bizarre with no factual basis.
  • Bipolar psychosis: Some people with bipolar disorder experience bipolar psychosis during a period of very high or very low mood.
  • Severe depression: When psychosis occurs along with depression, the condition is known as major depressive disorder with psychotic features.
  • Postpartum (postnatal) psychosis: This type of psychosis can present after someone gives birth.
  • Substance-induced psychosis: The misuse of alcohol, some recreational drugs, and certain prescription drugs can cause substance-induced psychosis.

Psychosis can also result from other conditions, such as:

How can a person know if they are experiencing psychosis?

Symptoms such as hallucinations, delusions, and disturbed thoughts may indicate that a person is experiencing psychosis.

How long does a psychotic episode last?

Depending on the cause, a psychotic episode can last as little as a few hours or as long as a few years.

What is the difference between schizophrenia and psychosis?

Psychosis is a symptom of an underlying condition, whereas schizophrenia is a mental health condition that can cause psychosis and other symptoms.

Psychosis is a collection of symptoms that causes a person to lose touch with reality. Hallucinations and delusions often accompany it.

A person may experience psychosis as a result of various causes, such as an underlying mental health condition, trauma, or an infection.

While experiencing a psychotic episode is distressing, treatment can help a person manage the symptoms.

If a person is concerned that someone else may be experiencing psychosis, they should take that person to the emergency room, if possible, or call 911.