What do you think of when you hear the word “psychotic?” Some people are scared of psychosis because of the way it’s shown on TV or in the movies. In real life, though, psychosis is a serious and disabling mental health condition—but it is treatable and many people recover after only one episode when they get proper treatment.
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Psychosis is often described as a “loss of reality” or a “break from reality” because it makes you experience or believe things that aren’t real. It can change the way you think, act, feel or sense things. Psychosis can be very scary and confusing, and it can significantly disrupt your life. In fact, the World Health Organization (WHO) ranks psychosis as the third-most disabling medical condition in the world.
Psychosis is a syndrome or group of symptoms. Psychosis itself isn’t a disease or disorder—it’s usually a sign that something else is wrong.
You may experience vague warning signs before the symptoms of psychosis begin. Warning signs can include depression, anxiety, feeling “different” or feeling like your thoughts have sped up or slowed down.
There are two different kinds of psychosis symptoms: positive symptoms and negative symptoms.
Positive symptoms “add” things like thoughts or behaviours.
Delusions are a strong belief in something that isn’t true. A common delusion is the belief that someone is following you or watching you.
Hallucinations are things you sense that aren’t really there. You can experience a hallucination with any of the five senses (hearing, sight, taste, touch, smell). The most common hallucination is hearing another voice talking that others can’t hear.
Speech is so jumbled or illogical that no one can understand it.
You have a hard time organizing or completing tasks, or you don’t act the way you used to. You might have a hard time with daily tasks like cooking or getting dressed, or you might suddenly laugh when someone tells a sad story.
Your movements are very slow, awkward and rigid or are very fast.
Negative symptoms take something away. You might not being able to show emotions, talk much (or at all) or be motivated to do anything. Negative symptoms often aren’t as distinct as positive symptoms, and they can look like symptoms of a mood disorder like depression or the side effects of medication.
The symptoms of psychosis generally depend on the cause of psychosis, so different people may have very different symptoms. Someone living with schizophrenia may experience many positive and negative symptoms while someone living with a brain injury may only experience hallucinations or delusions. The most important thing to remember is that all symptoms are treatable.
About 3% of the population will experience psychosis at some point. Psychosis usually starts to affect people in their late teens and early twenties. It affects men and women equally, though men usually experience symptoms at a slightly earlier age than women. Risk of psychosis seems to run in families, and people seem to be more vulnerable if a family member has a psychotic disorder like schizophrenia or a personality disorder like paranoid personality disorder.
Mental illness—Schizophrenia is the most common cause of psychosis. Other psychotic disorders include schizoaffective disorder. People with severe mood disorders like depression or bipolar disorder may also experience psychosis.
Substance use—Some substances cause psychosis. Cocaine, amphetamines (speed), marijuana, PCP, hallucinogens and sedatives can cause psychosis when you use those substances. Alcohol, sedatives and hypnotics (sleep medication) can cause psychosis when you suddenly stop using them. Most regular methamphetamine (meth) users experience psychosis at some point.
Other health problems—Certain physical injuries, diseases or health conditions such as brain injury or lupus can cause psychosis.
Stress—Intense stress can cause psychosis. In this particular cause, there may be no other conditions or diseases involved. This kind of psychosis lasts for less than one month. Stress can also trigger symptoms in people who are particularly at risk for psychotic disorders.
While psychosis looks different from person to person, it always causes changes in your abilities and personality. Because it is so different in each person, you may experience some or all of the symptoms below.
I’m hearing voices that other people don’t hear
My thoughts take a long time to form, come too fast together, or don’t form at all
I’m convinced I’m being followed
I’m having trouble remembering things, concentrating and making decisions
I act differently or I have a hard time completing basic tasks
I don’t feel like talking much anymore, or people say they can’t understand what I’m saying
I get confused easily
If you are experiencing any of these symptoms it’s important that you talk to your doctor. These symptoms could also be signs of other mental or physical health problems, and your doctor can help figure out what is causing them. Often, people living with psychosis also experience symptoms of anxiety and depression.
Psychosis is much easier to treat if it’s treated early. People who receive treatment during their first episode of psychosis often recover faster, experience fewer related problems like depression, spend less time in the hospital and have fewer school, work or social problems. With treatment, many people never experience psychosis again after they recover from their first episode.
Treatment for psychosis usually includes medication and counselling. Some people need to stay in the hospital for assessment or treatment.
Medications—Most people with psychosis can be treated with medications called antipsychotics. Antipsychotics have improved in the last few years. They are more effective and have fewer side-effects than they used to. These newer antipsychotics are also called ‘atypical antipsychotics.’ Other medication like antidepressants or mood stabilizers may help mood problems that go along with psychosis.
Counselling—Supportive counselling can offer emotional support. Cognitive-behavioural therapy (CBT) is a promising type of counselling for psychosis. It teaches how behaviours and thoughts affect mood. Family therapy may help the entire family cope with a family member’s psychosis.
Education—Education is a very import part of a psychosis treatment plan and it should include patients and their families. Helpful psychosis education explains what psychosis is and what we know about it, treatment options and coping skills, how to avoid relapse and how to access services.
Stress management—Stress can worsen symptoms, make it harder to function and even trigger a relapse, so it’s important to learn positive ways to deal with stress. This might include learning problem-solving skills, coping skills and relaxation skills.
Self-care—Self-care strategies like eating well, getting enough sleep and keeping in touch with family and friends can also help.
Social and life skills support— Someone living with psychosis might need help with skills like finding a job and managing their finances. A professional like an occupational therapist or social worker can help with day-to-day living and connect people with community services or government programs.
In addition to talking to your family doctor, check out the resources below for more information about psychosis:
Early Psychosis Intervention (EPI)
EPI programs help people who have recently started to experience psychosis symptoms. The Early Psychosis website can help you find services or programs in BC. They also offer information about psychosis, assessments, managing psychosis, and supporting someone who experiences psychosis. For more, visit www.earlypsychosis.ca
BC Schizophrenia Society
Visit www.bcss.org or call 1-888-888-0029 (toll-free in BC) or 604-270-7841 (in Greater Vancouver) for resources and information on schizophrenia and psychosis.
Kelty Mental Health
Contact Kelty Mental Health at www.keltymentalhealth.ca or 1-800-665-1822 (toll-free in BC) or 604-875-2084 (in Greater Vancouver) for information, referrals and support for children, youth and their families in all areas of mental health and addictions.
BC Partners for Mental Health and Addictions Information
Visit www.heretohelp.bc.ca for info sheets, and personal stories about psychosis. You’ll find more information, tips and self-tests to help you understand many different mental health problems.
Resources available in many languages:
*For each service below, if English is not your first language, say the name of your preferred language in English to be connected to an interpreter. More than 100 languages are available.
www.healthlinkbc.ca to access free, non-emergency health information for anyone in your family, including mental health information. Through 811, you can also speak to a registered nurse about symptoms you’re worried about, or a pharmacist about medication questions.
Crisis lines aren’t only for people in crisis. You can call for information on local services or if you just need someone to talk to. If you are in distress, call 310-6789 (do not add 604, 778 or 250 before the number) 24 hours a day to connect to a BC crisis line, without a wait or busy signal. The crisis lines linked in through 310-6789 have received advanced training in mental health issues and services by members of the BC Partners for Mental Health and Addictions Information.
About the author
The Canadian Mental Health Association promotes the mental health of all and supports the resilience and recovery of people experiencing a mental illness through public education, community-based research, advocacy, and direct services. Visit www.cmha.bc.ca.