Understanding Mental Illness
Psychosis
Most people think of psychosis as a break with reality. In a way it is. Psychosis is characterized as disruptions to a person’s thoughts and perceptions that make it difficult for them to recognize what is real and what isn’t. These disruptions are often experienced as seeing, hearing and believing things that aren’t real or having strange, persistent thoughts, behaviors and emotions. While everyone’s experience is different, most people say psychosis is frightening and confusing.
Psychosis is a symptom, not an illness, and it is more common than you may think. In the U.S., approximately 100,000 young people experience psychosis each year. As many as 3 in 100 people will have an episode at some point in their lives.
Early or first-episode psychosis (FEP) refers to when a person first shows signs of beginning to lose contact with reality. Acting quickly to connect a person with the right treatment during early psychosis or FEP can be life-changing and radically alter that person’s future. Don’t wait to take the first step and prepare yourself with information by reviewing these tip sheets:
What is Early and First-Episode Psychosis?
Early Psychosis: What’s Going on and What Can You Do?
Struggling With Symptoms? If you, a family member or friend is experiencing symptoms of psychosis, there is help. NAMI is here to provide you with support and information about community resources for you and your family.
Contact the NAMI HelpLine at 1-800-950-NAMI (6264) or info@nami.org if you have any questions about psychosis or want help finding support and resources.
Symptoms
Early Warning Signs Before Psychosis
Early psychosis or FEP rarely comes suddenly. Usually, a person has gradual, non-specific changes in thoughts and perceptions, but doesn’t understand what’s going on. Early warning signs can be difficult to distinguish from typical teen or young adult behavior. While such signs should not be cause for alarm, they may indicate the need to get an assessment from a doctor.
Encouraging people to seek help for early psychosis is important. Families are often the first to see early signs of psychosis and the first to address the issue of seeking treatment. However, a person’s willingness to accept help is often complicated by delusions, fears, stigma and feeling unsettled. In this case, families can find the situation extremely difficult, but there are engagement strategies to help encourage a person to seek help.
It’s important to get help quickly since early treatment provides the best hope of recovery by slowing, stopping and possibly reversing the effects of psychosis. Early warning signs include the following:
- A worrisome drop in grades or job performance
- Trouble thinking clearly or concentrating
- Suspiciousness or uneasiness with others
- A decline in self-care or personal hygiene
- Spending a lot more time alone than usual
- Strong, inappropriate emotions or having no feelings at all
Signs Of Early Or First-Episode Psychosis
Determining exactly when the first episode of psychosis begins can be hard, but these signs and symptoms strongly indicate an episode of psychosis:
- Hearing, seeing, tasting or believing things that others don’t
- Persistent, unusual thoughts or beliefs that can’t be set aside regardless of what others believe
- Strong and inappropriate emotions or no emotions at all
- Withdrawing from family or friends
- A sudden decline in self-care
- Trouble thinking clearly or concentrating
Such warning signs often point to a person’s deteriorating health, and a physical and neurological evaluation can help find the problem. A mental health professional performing a psychological evaluation can determine if a mental health condition is involved and discuss next steps. If the psychosis is a symptom of a mental health condition, early action helps to keep lives on track.
Psychosis
Psychosis includes a range of symptoms but typically involves one of these two major experiences:
Hallucinations are seeing, hearing or feeling things that aren’t there, such as the following:
- Hearing voices (auditory hallucinations)
- Strange sensations or unexplainable feelings
- Seeing glimpses of objects or people that are not there or distortions
Delusions are strong beliefs that are not consistent with the person’s culture, are unlikely to be true and may seem irrational to others, such as the following:
- Believing external forces are controlling thoughts, feelings and behaviors
- Believing that trivial remarks, events or objects have personal meaning or significance
- Thinking you have special powers, are on a special mission or even that you are God.
Causes
We are still learning about how and why psychosis develops, but several factors are likely involved. We do know that teenagers and young adults are at increased risk of experiencing an episode of psychosis because of hormonal changes in their brain during puberty.
Several factors that can contribute to psychosis:
- Genetics. Many genes can contribute to the development of psychosis, but just because a person has a gene doesn’t mean they will experience psychosis. Ongoing studies will help us better understand which genes play a role in psychosis.
- Trauma. A traumatic event such as a death, war or sexual assault can trigger a psychotic episode. The type of trauma—and a person’s age—affects whether a traumatic event will result in psychosis.
- Substance use. The use of marijuana, LSD, amphetamines and other substances can increase the risk of psychosis in people who are already vulnerable.
- Physical illness or injury. Traumatic brain injuries, brain tumors, strokes, HIV and some brain diseases such as Parkinson’s, Alzheimer’s and dementia can sometimes cause psychosis.
- Mental health conditions. Sometimes psychosis is a symptom of a condition like schizophrenia, schizoaffective disorder, bipolar disorder or depression.
Diagnosis
A diagnosis identifies an illness; symptoms are components of an illness. Health care providers draw on information from medical and family history and a physical examination to diagnose someone. If causes such as a brain tumor, infection or epilepsy are ruled out, a mental illness might be the reason.
If the cause is related to a mental health condition, early diagnosis and treatment provide the best hope of recovery. Research shows that the earlier people experiencing psychosis receive treatment, the better their long-term quality of life.
Related Conditions
Psychosis can be related to several mental health conditions:
- Bipolar Disorder
- Schizoaffective Disorder
- Schizophrenia
- Substance use disorders / Dual Diagnosis
Treatment
Early Or First-Episode Psychosis
Early treatment of psychosis, especially during the first episode, leads to the best outcomes.
Research has shown significant success using a treatment approach called Coordinated Specialty Care (CSC). CSC uses a team of health professionals and specialists who work with a person to create a personal treatment plan based on life goals while involving family members as much as possible.
CSC has the following key components:
- Case management
- Family support and education
- Psychotherapy
- Medication management
- Supported education and employment
- Peer support
SAMHSA maintains an Early Serious Mental Illness (ESMI) Treatment Locator as a source of information for family members who are seeking CSC programs in the US. Portions of their website are available in Spanish.
Psychosis Treatment
Traditional treatment for psychosis involves psychotherapy and medication. Several types of therapy have successfully helped individuals learn to manage their condition. In addition, medication targets symptoms and helps reduce their impact.
Support
If you or a family member or friend is struggling with psychosis, there is help. NAMI is there to provide you with support for you and your family and information about community resources.
Contact the NAMI HelpLine at 1-800-950-NAMI (6264) or info@nami.org if you have any questions about psychosis or finding support and resources.
Mental Health Explained
Anxiety Disorders
If feelings of intense worry or fear become overwhelming and persistent, affecting daily life, it might be an anxiety disorder.
Attention Deficit Hyperactivity Disorder (ADHD)
ADHD makes it hard to stay focused, organized, and still. People with ADHD might lose things often or find it hard to sit still or wait their turn.
Bipolar Disorder
Bipolar disorder leads to severe mood changes, from very upbeat to very sad. These mood swings can affect energy and clarity of thought, with symptom-free periods in between.
Borderline Personality Disorder (BPD)
BPD involves intense emotional ups and downs, problems in relationships, and sometimes impulsive actions and self-harm.
Depression
Depression is not just feeling sad. It’s experiencing weeks of heavy sadness, negative thoughts, and a lack of interest or pleasure in life, which can change sleep, energy, or eating habits.
Dissociative Disorders
These disorders, often related to past trauma, cause problems with awareness, memory, identity, and control over the body, severely disrupting everyday activities.
Eating Disorders
Eating disorders involve serious changes in eating habits that can harm physical health or social life.
Obsessive-Compulsive Disorder (OCD)
OCD is having constant, unwanted thoughts and performing certain routines over and over to try to control them.
Post-traumatic Stress Disorder (PTSD)
PTSD can happen after a terrifying ordeal. It involves ongoing stress and fear, even when there is no immediate danger.
Psychosis
Psychosis affects how a person thinks and perceives the world, making it hard to understand what is real and what is not.
Schizoaffective Disorder
This condition combines schizophrenia symptoms, like hallucinations, with mood disorder symptoms, like depression or mania.
Schizophrenia
Schizophrenia can cause confused thinking, emotional numbness, and difficulties in understanding reality, often through hallucinations or false beliefs.
