What is psychosis?

Psychosis is an experience that people have when they find it hard to tell the difference between what is real or what is not real. That is, their mind plays tricks on them. Psychosis is a mental health condition that requires treatment.

Symptoms of psychosis?

Common symptoms of psychosis include "delusions" and "hallucinations."

Delusions are unusual beliefs that most people around the individual having delusions don't think are real. These unusual beliefs make it hard for the individual to do the activities and work toward the goals that are important for the individual. An example of a common delusion is paranoia — the individual feels unsafe and thinks someone is out to specifically harm them or is following or monitoring them.

Hallucinations occur when an individual experiences any of the five senses (hear, see, smell, taste or touch) when there is not anything to trigger the senses. These hallucinations make it hard for the individual to do the activities and work toward the goals that are important for the person. An example of a hallucination is hearing mumbling, whispering or voices when there is no one talking.

People experiencing psychosis may also have other symptoms that are common in many other mental health conditions. These include difficulties with motivation, focus and emotional expression and/or struggling to have fun and spend time with others.

Individuals with psychosis also sometimes have trouble talking or expressing their thoughts, and they may either stop talking or have very long pauses before answering questions. Some individuals have "word salad," when the words they use come out very jumbled and difficult for others to understand. Patients with psychosis may also have other unusual behaviors that are difficult for others to understand and are different from what the person used to do.

When someone demonstrates symptoms of psychosis, we say they are having a psychotic episode.

How to know if my child has experienced psychosis

Here are signs and symptoms of psychosis your child may have experienced:

  • Feeling unsure whether or not something is real
  • Feeling paranoid or suspicious of people, places or experiences
  • Behaving in ways that are not typical for the young person
  • Withdrawing from friends and family
  • Feeling low levels of motivation
  • Having confusing thoughts
  • Communicating in confusing ways, or in ways that are not typical for the individual
  • Hearing or seeing things that others do not
  • Finding it hard to concentrate
  • Not wanting to do things that once brought your child joy
  • Changes to sleep and appetite

How is psychosis diagnosed?

The symptoms of psychosis often start between the ages of 15 to 25 years old. It often takes several assessments with a mental health professional over time to make the diagnosis. There is no blood or brain imaging test to diagnose psychosis. Psychosis commonly occurs in conditions like schizophrenia and the severe type of bipolar (bipolar 1) and can occur in other mental health conditions, too.

What causes psychosis?

There is not one specific cause of psychosis. For some individuals, psychosis may be a symptom of a mental illness, like schizophrenia or bipolar disorder. However, other individuals may experience psychosis and never be diagnosed with an additional mental health disorder.

In some cases, psychosis can also be triggered by a traumatic experience, extreme stress or sleep deprivation, drug or alcohol misuse, side effects of a prescription medication, or a physical condition, such as a brain tumor. Before a mental illness is diagnosed, these other possible causes are excluded.

What is the treatment for psychosis?

Treatment of psychosis can include medication, talk therapy, education and employment support, and family education and support.

Coordinated Specialty Care for Psychosis (CSC) incorporates all of these treatment types and helps individuals experiencing psychosis achieve the best outcomes.

Receiving appropriate treatment for psychosis is important because people with a history of psychosis are at risk of misusing drugs or alcohol as a way of coping with psychotic symptoms. People with psychosis have a higher-than-average risk of self-harm and suicide.

At Children’s Hospital of Philadelphia (CHOP), psychosis is treated by professionals in the Department of Child and Adolescent Psychiatry and Behavioral Sciences. CHOP’s First Episode Psychosis Program was created to support young people who are experiencing a first episode of psychosis or who have had a first episode of psychosis within the last year.

Outlook for those with psychosis

Most individuals who experience psychosis, even severe cases, can recover when they receive the proper treatment, such as therapy and medication. Recovery is easier, and individuals’ lives are disrupted less, when they receive treatment as soon as possible.

The timeframe for recovery also varies greatly. For some people, symptoms go away quickly; others require longer-term therapy, several weeks or months. Some individuals will require medication for extended periods, even for the rest of their lives. Others will be able to decrease medication over time.

Individuals who have successfully been treated for psychosis — including ongoing treatment for any underlying mental illness — go on to live full, happy lives.