Talking about psychosis is not the same as talking about schizophrenia. Psychosis is a set of symptoms that can arise in many situations, with different causes, course and treatment.
What psychosis is
Psychosis refers to a significant change in the way a person perceives, thinks about and interprets what is happening around them, to the point where it becomes hard to distinguish what comes from inner experience from what is shared by other people.
Often, the person going through psychosis does not recognise these changes as symptoms. That is why the perspective of those close to them is often important. Psychosis may occur only once or recur, and may develop suddenly or gradually. With appropriate assessment and treatment, many people recover and return to their usual lives.
How psychosis can present
- perceptions that other people do not share, such as hearing voices or seeing things others do not see;
- beliefs that are very hard to question, for example of being followed, watched or the target of special messages;
- more disorganised thinking or speech, hard to follow;
- significant changes in behaviour, unusual for the person;
- withdrawal, mistrust or distancing from friends and family;
- significant deterioration in functioning at school, at work or in self-care.
Before a first episode there may be subtler signs over weeks or months: changes in sleep, difficulty concentrating, irritability or loss of interest.
Different causes of psychosis
Psychosis can be part of very different situations: psychotic disorders such as schizophrenia or schizoaffective disorder, brief episodes triggered by intense stress, episodes of bipolar disorder or severe depression , substance use (such as cannabis, stimulants or alcohol), some medicines and medical or neurological illnesses. It can also occur after childbirth or, in older people, in association with dementia or states of confusion.
Identifying the cause is essential, because treatment and outcome depend on it.
Assessment
The psychiatric assessment reconstructs the clinical history and the course of the symptoms: when they appeared and how they have changed. It also considers physical health, medication, substance use, family history and the impact on daily functioning.
When necessary, blood tests, brain imaging or other tests are requested to rule out medical causes. Whenever the person agrees, hearing from family or someone close helps complete the picture.
Treatment
Treatment is tailored to each person and to the cause of the psychosis. It may include:
- medication, usually antipsychotic, chosen taking into account effectiveness and possible side effects;
- psychological intervention, such as cognitive behavioural therapy for psychosis;
- psychoeducation, to understand what is happening and recognise warning signs;
- family support and involvement of the people close to them;
- other measures, such as regularising sleep, reducing or stopping substance use and supporting a return to school or work.
Starting treatment early is associated with a better outcome.
Follow-up
Regular follow-up makes it possible to assess the response, adjust medication, monitor side effects and physical health, and prevent relapses. The length of treatment depends on the cause and the course, and is decided together.
When to seek help quickly
Call 112 or go to the nearest emergency department in case of:
- a sudden and marked change in behaviour;
- risk to the person or to others, including suicidal thoughts;
- inability to look after themselves, eat or keep themselves safe;
- intense confusion, fever or other associated physical symptoms;
- severe agitation or threats.
Frequently asked questions
Is psychosis the same as schizophrenia?
No. Schizophrenia is one of the situations in which psychosis can occur, but there are many other causes, some of them temporary. A psychotic episode does not, by itself, mean a diagnosis of schizophrenia.
Is it possible to recover from psychosis?
Yes. Many people recover from a psychotic episode, especially when treatment starts early. In other situations the course is longer, and follow-up helps maintain stability and quality of life.
How can I help a family member?
Stay calm and avoid confrontation, avoid arguing about the person's beliefs and encourage a medical assessment. If there is immediate risk, call 112.
References
- National Institute for Health and Care Excellence. Psychosis and schizophrenia in adults: prevention and management (CG178). 2014, updated.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed., text revision (DSM-5-TR). 2022.
- World Health Organization. Schizophrenia, fact sheet. 2022.
This page is for information only and does not replace an individual medical assessment. Clinical review: Pedro Zuzarte, psychiatrist · Published and reviewed: .