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What is it?
Psychosis is often described as a "loss of reality" or a "break from reality" because 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.
Psychosis is a syndrome or group of symptoms. Psychosis itself isn't a disease or disorder—it's usually a sign of a health problem.
Before an episode of psychosis begins, you will likely experience early warning signs. Warning signs can include depression, anxiety, feeling "different" or feeling like your thoughts have sped up or slowed down. These signs can be vague and hard to understand, especially in the first episode of psychosis. Some people only experience a few warning signs while others can experience signs for many months.
Acute or active signs of psychosis can be very frightening and confusing. The exact symptoms vary based on the cause of psychosis and other factors, and if you experience symptoms, you may experience them more severely or less severely than others. Symptoms include:
Delusions: 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: 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.
Disorganized thinking and speech: Disorganized thinking means that it's hard to keep your thoughts in order and focused. To others, it looks like you are having difficulty communicating and expressing yourself clearly. For example, people may be too distracted to finish a complete thought or have a hard time directly answering a question. Like all symptoms, disorganized thinking is on a spectrum. Someone with milder symptoms may only seem a bit scattered or illogical to others. Someone who experiences very severe symptoms may be hard to understand at all.
- Changes in movement: People who experience psychosis may move differently. Movements can become slow, awkward, or very fast.
Cognitive abilities: You may experience a slowing of thought and action and have problems with attention, learning, memory, thinking abstractly and carrying out complex tasks. You may also find it hard to understand social cues, such as recognizing emotional reactions of other people.
Negative symptoms: Negative symptoms are symptoms that "take away" some aspects of normal thinking or feeling. You might not be able to feel or show emotions, connect with family and friends, or be motivated to do anything. These symptoms can look like symptoms of a mood disorder like depression or the side effects of medication.
With early treatment from a well-trained team, you may not experience any further episodes of active psychosis after your first episode. This is why it's important to seek help early, even if you aren't exactly sure what's going on. Long delays in getting proper help may worsen outcomes over the long term.
Who does it affect?
About 3% of people will experience psychosis at some point.
Age and gender—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.
Family history—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—Psychosis is most common in people who experience schizophrenia spectrum and other psychotic disorders. This group of symptoms includes schizophrenia, schizoaffective disorder, schizophreniform disorder, and schizotypal personality disorder. People with bipolar disorder, depression, and some personality disorders may experience psychosis.
Substance use—Some substances cause psychosis including stimulants (like cocaine and meth), cannabis/marijuana, PCP, and hallucinogens. Alcohol and sedatives and hypnotics (sleep medication) can cause psychosis when you suddenly stop using them.
Other health problems—Certain physical injuries, diseases or health conditions such as a brain injury or dementia like Alzheimer's disease can cause psychosis. Going without sleep for long periods of time can also lead to psychosis. For this reason, doctors may do tests to rule out physical health problems if you experience 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 bring on symptoms in people who are particularly at risk for psychotic disorders.
Cannabis and psychosis
You may have heard that cannabis causes psychosis. While most people who use cannabis don't develop psychosis, cannabis can increase risk for people who already have high risk factors for psychosis, including their family history, health conditions, and life experiences. If you experience symptoms of psychosis during or after you use cannabis, it's important to seek help. If you're diagnosed with psychosis and use cannabis, it's important to tell your mental health care team so they can give you the best care for your needs.
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.
Could I have psychosis?
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. These symptoms may be easier for someone else to notice.
I'm hearing voices or seeing things that other people don't hear or see
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 or watched
I'm having trouble remembering things, concentrating and making decisions
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
If you are experiencing any of these symptoms, it’s important that you talk to your family doctor or local EPI (Early Psychosis Intervention) program right away. 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.
What can I do about it?
Psychosis is more likely to come up in youth or early adulthood when people are in high school or transitioning to further education, training, or work. This timing can create a lot of disruptions in your life, which can really affect how you feel about yourself and your abilities. Even if you don't know exactly what you or a loved one might be experiencing, it's always better to talk to a doctor or other mental health professional as soon as possible rather than wait to see what happens.
It can take time for mental health professionals to fully see what's going on and how it affects your life and come to an accurate diagnosis. The name of your diagnosis may change over time, or you may eventually receive a diagnosis that is very different than you originally thought. It's important to keep up good communication with your health care team so they have as much information as possible. Regardless of where you are in the diagnosis and treatment process, you will receive treatment for the symptoms you experience so you can start working towards recovery as soon as possible.
It is much easier to treat psychosis early. People who receive treatment during their first episode of psychosis often recover faster, spend less time in the hospital, and experience fewer problems associated with psychosis like depression, school, work or social problems. With treatment early on, some people may never experience psychosis again after they recover from their first episode.
Treatment for psychosis usually includes medication and counselling. You need to stay in the hospital for assessment or treatment.
Medications—Psychosis is usually treated with medications called antipsychotics. Other medication like antidepressants or mood stabilizers may help mood problems that go along with psychosis. It can take time to find the right medication or combination of medications, so it's important to be patient and talk to your doctor if side effects or other problems come up.
Psychotherapy—Psychotherapies like cognitive-behavioural therapy (CBT) or dialectical behaviour therapy (DBT) may help you manage psychosis, but more research is needed to see how these approaches compare to other treatments. Family therapy may help your entire family support a loved one with psychosis.
Education—Education is a very important part of a psychosis treatment plan and it should include people who experience psychosis as well as their loved ones and caregivers. 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.
Self-management—Self-management strategies like eating well, getting enough sleep, exercising, managing stress, and keeping in touch with family and friends can also help. Talk to your mental health care team about self-care strategies you can try at home. The Dealing With Psychsisis workbook at www.earlypsychosis.ca/resources-and-downloads/ is a great resource to help you learn more, manage symptoms, and keep track of your progress.
Social and life skills support—If you need extra support to live more independently, professionals like occupational therapists and social workers can help with day-to-day living and connect you with services or supports in your community.
Where do I go from here?
In addition to talking to your family doctor, check out the resources below for more information about psychosis:
Early Psychosis Intervention
Early psychosis intervention or EPI programs help people recognize and receive appropriate treatment for psychosis as early as possible. In BC, EPI programs are offered by your local health authority. Visit www.earlypsychosis.ca to find and connect with local programs. You'll also find more information on psychosis, treatment and recovery, and supports for family and other loved ones.
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 for family members on schizophrenia and psychosis.
Kelty Mental Health Resource Centre
Visit www.keltymentalhealth.ca or call 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, including psychosis.
BC Partners for Mental Health and Substance Use Information
Visit www.heretohelp.bc.ca for info sheets, workbooks and personal stories about psychosis. You'll find more information, tips and self-tests to help you understand many different mental health problems. You'll also find resources in our Q&A section on what to do if a person in your life who might be experiencing psychosis refuses help.
Call 811 or visit 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 talk with 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.
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.