What is psychosis?

Psychosis is the term used to describe a set of symptoms that indicate someone has experienced a break from reality.[1] It is not a condition in and of itself, and it is possible to experience a one-off episode.[2] However, psychosis is a feature of numerous mental health problems including schizophrenia and bipolar disorder.

The two main symptoms of psychosis are hallucinations and delusions.[3]

Hallucinations

A hallucination is the experience of seeing or hearing something that isn’t actually there. Both auditory and visual hallucinations will seem very real to the person experiencing them. In psychosis, the person will have no insight into the fact that they are hallucinating. This distinguishes it from other types of hallucination where the person knows that what they are experiencing isn’t real, such as the hallucinations that occur during a migraine.[3]

Auditory hallucinations are often described as ‘hearing voices’.[4]

Delusions

Delusions are beliefs that aren’t real, held even in the face of evidence that disproves the belief. The most common kinds of delusion are ‘persecutory’, which means believing that you are being followed, watched or are going to be harmed, for example. Other delusions include believing that you are special or exceptional in some way, or that signs and symbols in the external environment are deliberately designed to communicate a special message to you.[4]

Mental health professionals may make a distinction between bizarre and non-bizarre or ordinary delusions. Ordinary delusions are those that are possible, even though they aren’t actually happening, such as being followed or monitored by the authorities. Bizarre delusions on the other hand are beliefs in things that are impossible. A bizarre delusion might be, for example, a belief that one’s mind or body has been changed or is being controlled by an outside force.[4]

In addition to experiencing hallucinations or delusions (or both) a person having a psychotic episode may also have difficulty thinking clearly, including problems with concentration, memory and decision-making.[5]

What is schizophrenia?

Schizophrenia is a severe mental illness that belongs to a group of mental health problems known as the psychotic disorders. All the psychotic disorders include psychosis as a key part of the condition.

According to the Diagnostic and Statistical Manual of Mental Disorders [4], used by mental health professionals in the US to diagnose mental health problems, people with schizophrenia will experience two or more of the following symptoms, including at least one of the first three, for at least a month (or less if treatment has begun and has been successful):

  • Delusions
  • Hallucinations
  • Disorganized speech, which is usually a sign of disorganized thinking. This includes, for example, switching topics quickly or giving odd answers to questions.
  • Strange behavior. This can range from behaving in a silly, childlike way, to suddenly becoming agitated. Strange behavior also includes ‘catatonia’, which is when someone doesn’t respond to what is happening around them.
  • ‘Negative symptoms’, which is an absence of standard human behavior and interaction. This includes, for example, a lack of emotional expression or a lack of motivation to do anything unless prompted.

In addition, symptoms must have a significant impact on a person’s work, education, relationships or self-care. Overall, for a diagnosis of schizophrenia to be made, the person must have been unwell for at least six months (including a month of the symptoms described above).[4]

Psychosis vs Schizophrenia: Similarities and differences

The distinction between psychosis and schizophrenia is relatively straightforward. Psychosis forms a part of schizophrenia but can occur on its own as a one-off episode or as part of another mental health problem. Schizophrenia includes psychosis but also involves other symptoms. These symptoms, and the impact on someone’s life, must occur for a period of time before a diagnosis of schizophrenia can be made.

The National Institute of Mental Health says that, in the U.S., around 100,000 new cases of psychosis will happen each year.[6] Overall, around three per cent of people will experience psychosis at some point in their lives.[7]

Schizophrenia affects smaller numbers, between 0.3 and 0.7 per cent of the population.[4]

Psychosis vs Schizophrenia: Causes

Psychosis is a feature of numerous different mental illnesses including schizophrenia and bipolar disorder. It can affect people with dementia and brain injuries. It can also be caused by taking certain substances including cannabis, cocaine and meth. Some people experience psychosis when coming off alcohol or certain medications such as sleeping tablets.[7]

Psychosis can be caused by extreme stress or long periods without sleep.[7] People also appear to be at a higher risk of experiencing psychosis if they have a family member with a mental health problem like schizophrenia.

It is believed that schizophrenia is caused by a combination of genetic and environmental factors. Research has found some genes linked to an increased risk of schizophrenia. Studies also suggest that factors relating to pregnancy and birth can increase the risk including the age of the father, stress during pregnancy, when in the year a person was born, low blood oxygen levels, and the mother’s health problems.[4]

Psychosis vs Schizophrenia: Treatment

Both psychosis and schizophrenia can be treated with a combination of psychotherapy and medication.

Medication

The main medication option for both psychosis and schizophrenia is antipsychotics. Antipsychotics can help lessen psychotic symptoms including hallucinations and delusions. They work by affecting the levels of neurotransmitters, which are chemicals in the brain that carry messages. There are many different kinds of antipsychotics, and it may take some time and testing before finding one that is effective.[8]

Therapy

There is a kind of cognitive behavioral therapy (CBT) that has been adapted to help people who have experienced psychosis. CBT helps you understand your emotions and find ways to manage your behavior. CBT for psychosis (CBTp) is specifically designed to help people understand their symptoms and reduce the distress caused by them.[5]

Family therapy may be helpful for both psychosis and schizophrenia. A therapist will work with the person affected as well as their family to help everyone understand mental illness and how the family can support their loved one effectively.[5]

Alternative therapies such as arts therapy can help someone experiencing psychosis or schizophrenia express and understand how they are feeling.

Resources:

  1. Canadian Mental Health Association, BC Division. (2015). What’s the difference between psychosis and schizophrenia?Retrieved December 8, 2022, from https://www.heretohelp.bc.ca/q-and-a/whats-the-difference-between-psychosis-and-schizophrenia
  2. (2020, January). Psychosis. Retrieved December 8, 2022, from https://www.mind.org.uk/information-support/types-of-mental-health-problems/psychosis/about-psychosis/
  3. Arciniegas, D. B. (2015). Psychosis. Continuum, 21(3), 715-736. doi:10.1212/01.CON.0000466662.89908.e7
  4. American Psychiatric Association. (2013, May 27). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5(5th ed.). American Psychiatric Publishing. Retrieved December 8, 2022, from https://psychiatry.org/psychiatrists/practice/dsm
  5. Rethink Mental Illness. (n.d.). Retrieved December 8, 2022, from https://www.rethink.org/advice-and-information/about-mental-illness/learn-more-about-conditions/psychosis/?gclid=CjwKCAiAs8acBhA1EiwAgRFdw89QFn-2SWflOAaUCs1DOnN2BIhi-YCl2_yOtnaWgA9Fhgzk35_TJRoCjIIQAvD_BwE 
  6. National Institute of Mental Health. (n.d.). Understanding psychosis.Retrieved December 8, 2022, from https://www.nimh.nih.gov/health/publications/understanding-psychosis 
  7. Canadian Mental Health Association, BC Division. (2021). Retrieved December 8, 2022, from https://www.heretohelp.bc.ca/infosheet/psychosis
  8. (2020, September). Antipsychotics.Retrieved December 8, 2022, from https://www.mind.org.uk/information-support/drugs-and-treatments/antipsychotics/about-antipsychotics/