Psychosis usually starts subtly, often in the late teens or early 20s, with a gradual decline in functioning and unusual thoughts (prodrome phase) before clear symptoms like hallucinations or delusions appear, triggered by stress, trauma, significant life changes, lack of sleep, substance use (cannabis, stimulants), or certain medical conditions, influenced by genetic vulnerability and brain chemistry.
But in general, 3 main symptoms are associated with a psychotic episode:
Psychosis is triggered by a combination of factors, including genetic vulnerability, severe stress or trauma, lack of sleep, significant life changes, and certain substances like cannabis, amphetamines, and hallucinogens; it can also stem from underlying medical conditions or reactions to specific prescription medications, leading to a break from reality, hallucinations, or delusions.
Psychosis can come on suddenly or can develop very gradually. The symptoms of psychosis are often categorized as either “positive” or “negative.”
Psychosis involves experiencing something that is not really happening and having a difficult time distinguishing what is real. The three stages of psychosis are prodome, acute and recovery. Psychotic disorders can last for a month or less and only occur once, or they can also last for six months or longer.
However, a person will often show changes in their behavior before psychosis develops. Behavioral warning signs for psychosis include: Suspiciousness, paranoid ideas, or uneasiness with others. Trouble thinking clearly and logically.
The good news, however, is that it is possible to heal and return to normal after psychosis. This happens most reliably when the required support system is present. With medication and additional therapy, some patients quickly recover. Others may continue experiencing less acute symptoms of psychosis.
In cases of hyperactive delirium, symptoms are often mistaken for those of a psychosis—typically schizophrenia or mania. In hypoactive cases of delirium, symptoms may lead to a misdiagnosis of severe depression.
Brief psychotic disorder is triggered by extreme stress, such as a traumatic accident or loss of a loved one. It is followed by a return to the previous level of function. The person may or may not be aware of the strange behavior. This condition most often affects people in their 20s, 30s, and 40s.
Around the year 2000, psychiatric neuroscience research revealed that psychosis destroys brain tissue and causes brain atrophy (4) due to neuroinflammation and free radicals (5) both of which damage gray and white matter. Brain structure and function deteriorate with every psychotic relapse.
Some people find distractions helpful when experiencing psychosis. This could include watching TV, listening to music, or going to sleep. Distractions could involve a hobby such as a physical activity, gardening or drawing. You could try drawing or writing about what you're hearing, thinking or experiencing right now.
They may hear voices, become paranoid, or believe someone they are watching on television is sending them special messages. Their speech may become jumbled and no longer make sense. Psychotic episodes are more common than most people realize.
But knowledge of what is happening in the brain in a psychosis might be more helpful in reducing stigma. It is suggested that psychosis is due to an affection of the supplementary motor area (SMA), located at the centre of the Medial Frontal Lobe network.
Almost always, a psychotic episode is preceded by gradual non-specific changes in the person's thoughts, perceptions, behaviours, and functioning. The first phase is referred to as the prodrome (or prodromal) phase.
Schizophrenia changes how a person thinks and behaves.
The first signs can be hard to identify as they often develop during the teenage years. Symptoms such as becoming socially withdrawn and unresponsive or changes in sleeping patterns can be mistaken for an adolescent "phase".
There appears to be a potential link between anxiety and psychosis, particularly when anxiety is persistent or severe. Research from 2022 shows that persistently high levels of anxiety during childhood and adolescence could be a potential risk factor for psychosis.
The sudden onset of psychotic symptoms, such as delusions, hallucinations, or disorganized speech, defines this mental health condition. Symptoms last for at least one day but less than one month, often triggered by a stressful event, and usually resolve independently.
Drugs known to trigger psychotic episodes include:
Early psychosis rarely happens suddenly. It usually happens gradually and can last for months. You may start to notice small changes in your thoughts, or you might find it hard to figure out what's going on around you.
Initially, some of the symptoms that are apparent in the acute phase may linger in the recovery phase but with appropriate treatment most people successfully recover and return to their normal, everyday lives.
The "25 rule" (or "rule of quarters") in schizophrenia suggests that outcomes fall into four roughly equal groups: 25% recover fully, 25% improve significantly with some ongoing support, 25% improve somewhat but need considerable help, and 25% have a poor outcome with chronic illness or suicide risk, highlighting the varied nature of schizophrenia's long-term course, though some sources use a "rule of thirds" with similar proportions for different outcomes.
It is defined as the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives.
The impacts of untreated psychosis
First-episode psychosis (FEP) can result in a loss of up to 1% of total brain volume and up to 3% of cortical gray matter.
Oral antipsychotic medicines – namely aripiprazole, chlorpromazine, haloperidol, olanzapine, paliperidone, quetiapine, risperidone – should be offered for adults with a psychotic disorder (including schizophrenia), carefully balancing effectiveness, side-effects and individual preference.
Given the high heritability of psychotic experiences [8], one likely risk factor is having a family history of psychosis.