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Psychosis/psychotic episode

What is psychosis?

Psychosis is a medical condition that affects the mind. It prevents you from thinking clearly and makes you susceptible to suffering from delusions or false beliefs. It can also have serious knock-on effects for behaviour. In severe cases you can become completely out of touch with reality, not knowing what is real and what is part of your delusion.

Episodes of psychosis are brief in some people, or they can last longer or become recurring. Psychosis does not mean you are necessarily a danger to yourself or others; in fact, people with psychosis are likely to be withdrawn and prefer to be alone. Psychosis, like many other illnesses, can be treated.

Who is likely to suffer from psychosis?

Three in every 100 people will experience a psychotic episode during their lifetime, and almost anyone can be affected. A first episode of psychosis does not mean the person will necessarily have a second episode. There are different forms of psychosis.

Brief psychotic disorder (psychosis lasting less than a month) can occur after a stressful event, mostly in younger people, but this is quite rare. If the psychotic episode recurs it may be part of a longer term mental illness such as schizophrenia or bipolar disorder.

What causes psychosis?

All psychotic illnesses largely remain a puzzle. What seems to be true is some people are more susceptible to psychotic and mental illness than others, and this may be partly hereditary, so there may be a family history of similar illness. However, a family history of psychosis does not mean you too will become unwell. It seems to require a particular level of stress to trigger psychosis - but this level of stress might be lower in susceptible people than in the general population. More recent research shows psychosis is common in those who have experienced abuse or trauma during childhood - this could include loss of a parent, bullying by peers, or sexual, emotional and physical abuse.

Excessive use of alcohol or the use of illicit drugs such as cannabis or pure methamphetamine ('P') can trigger a first episode of psychosis, during or after their use, in susceptible individuals.
Some women experience psychosis after giving birth (one or two in every 1000 births), and this can be complicated by postnatal depression or other mood disorders. Delusional disorder, another rare type of psychosis, tends to occur in older adults who have a particular false belief, but otherwise function well and behave normally.

How do you identify psychosis?

Most often, friends or family are first to notice and voice concern that there is a problem - rather than the person with psychosis. This is because if you have psychosis you will have little or no awareness of your condition; you believe wholeheartedly in things that are not true and perceive such things to be real, even when evidence to the contrary is pointed out by others. Psychosis can become apparent through your behaviour and the things you say and feel.

Psychosis affects people differently but it can cause:

  • confused thinking that affects conversation and daily tasks
  • difficulty concentrating or remembering things
  • false beliefs/delusions, such as relationships with famous people
  • hallucinations - a false sense of smell or taste, or hearing sounds/voices or seeing things that are not there
  • blunted emotions or an inability to express emotions - feeling empty, flat or withdrawn (feeling unable to participate in what once were enjoyable events)
  • feelings of depression
  • irrational behaviour determined by the types of symptoms, delusions or hallucinations that occur - if the delusion means you feel in danger you may run away or call the police.

The changes often develop slowly and become more obvious over time. Family and friends will be worried by these changes, and will want to understand you, but they may not know how to react to this new development. It is important to seek help without delay - psychosis is treatable once the precise problem has been pinpointed, but too often it is ignored for too long. If psychosis is allowed to carry on unchecked it can worsen and the risk of self-harm or suicidal thoughts increases.

How do I recover from psychosis?

Like many mental conditions, psychosis is treated with a combination of medication and talking therapies such as family therapy or cognitive behaviour therapy (CBT).

CBT aims to help you manage problems by looking at the way you think, how your thoughts affect your feelings and actions, and how your actions affect your thoughts. The therapy can help you change how you think and what you do to make you feel less distressed. CBT addresses today’s problems and difficulties, rather than only looking into the past, as some other forms of therapy do.

Family therapy includes a series of informal meetings with you and your family. The purpose of this kind of therapy is to help you and your family learn to cope with your condition.

There are several antipsychotic medications available which - if started early in an episode of psychosis - will allow you to feel better and regain control of your life. Seeking medical help early on improves the chances of a quicker and more complete recovery. It also helps you avoid the disruptions that can follow extended illness, such as problems stemming from missing too much work or study. Whenever possible you will be allowed to remain at home or with family/whanau during your treatment.

The drugs used to treat psychosis have improved over the years and many of the side effects that were a problem (eg, restlessness, involuntary tics and insomnia) are now often avoided. If you find you are not tolerating a particular treatment, it is important you talk about other options with your doctor or psychiatrist rather than just stopping the treatment, which might undo the improvements made so far.
Recovery from psychosis also requires ongoing support from family, friends, your GP and a psychiatrist, and counsellors and support groups working within the community. Even though no one knows what psychosis is like unless they have experienced it, it is important you feel able to talk about your concerns with at least some of the people who are there to help you during your recovery.

What can I do to help myself?

  • Understand psychosis is a medical condition - do not feel you are to blame for it
  • Agree with your doctor on a plan for staying well and stick with it
  • Exercise - half an hour a day helps physical and mental wellbeing
  • Control stress - techniques such as yoga and massage may help
  • Make use of support organisations around the country 
  • Avoid illicit drugs and alcohol - attend counselling if necessary
  • Avoid feeling isolated by talking about how you feel
  • Educate those closest to you about psychosis so they can be there for you when you need it - there are early warning signs for psychotic episodes which, if spotted, can allow you to get help and prevent any serious consequences.

Support groups

See the support organisations (which include helplines) under Further information and support below.

Original material compiled by everybody, 2004. Updated by Health Navigator August 2014.

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