11.2 Psychosis

Psychosis

The term psychosis describes conditions where there is a loss of contact with reality. When a person experiences psychosis, their thoughts and perceptions are disturbed, and the individual has difficulty understanding what is real and what is not real. Symptoms of psychosis include delusions and hallucinations, where the client is seeing, hearing, or experiencing other sensations and experiences that aren’t real. Other symptoms of psychosis include incoherent or nonsensical speech and behavior that is inappropriate for the situation. A person experiencing a psychotic episode may also experience depression, anxiety, sleep problems, social withdrawal, lack of motivation, and overall difficulty functioning. When someone experiences this condition, it is referred to as a psychotic episode.^[1] Approximately 3 percent of the people in the United States experience psychosis at some point in their lives. About 100,000 adolescents and young adults in the US experience their first episode of psychosis each year.^[2]

Psychosis can be a symptom of various mental illnesses, such as schizophrenia, bipolar disorder, severe depression, or severe anxiety, but there are also other potential causes. Sleep deprivation, medical conditions such as hyperglycemia and hyperthyroidism, side effects of some prescription medications, and use of alcohol or other drugs can also cause psychotic symptoms.^[3] 

Early Signs of Psychosis

Typically, a person will show changes in their behavior before psychosis develops. These signs may be present before adulthood. Behavioral warning signs for psychosis include the following^[4]:

• Drop in grades or worsening job performance
• New trouble thinking clearly or concentrating
• Suspiciousness; paranoid ideas or uneasiness with others
• Withdrawing socially; spending a lot more time alone than usual
• Unusual, bizarre new ideas
• Strange feelings or having no feelings at all
• Decline in self-care or personal hygiene
• Difficulty telling reality from fantasy
• Confused speech or trouble communicating

These symptoms can indicate the Prodromal Phase of a psychotic illness such as schizophrenia. If the individual receives a thorough assessment and identification of these symptoms, measures can be taken to assist the person in lessening the risk for a psychotic episode or illness. Interventions include reducing stress or treatment of substance use disorders.^[5] Some benefits are possible through early initiation of antipsychotic medications.

Conditions that Involve Psychosis

Schizophrenia

Schizophrenia is a serious psychiatric disorder with psychotic episodes. This disorder will be explored in-depth in the “Schizophrenia” section of this chapter.

Brief Psychotic Episode

A brief psychotic episode is defined by a psychotic event lasting at least one day but less than one month, with an eventual return to previous level of functioning. It does not include a culturally sanctioned response, such as a person’s response to the death of a loved one. The disturbance is not better explained by a major depressive disorder or bipolar disorder with psychotic features, another psychotic disorder, or the physiological effects of a substance or a medical condition. It is more common in females. The mental health provider may specify if the symptoms are in response to significant stressors (i.e., significant events to anyone experiencing similar circumstances in the individual’s culture) or has a peripartum or postpartum onset (i.e., during pregnancy or within four weeks of delivery). Someone with a brief psychotic disorder must have at least one of the following: delusions, hallucinations, disorganized speech, or grossly disorganized behavior. Prognosis is generally good with treatment. About 9% of patients will go on to meet the criteria for schizophrenia or other chronic condition.^[6]

Schizophreniform Disorder

The characteristics of schizophreniform disorder are identical to those of schizophrenia. The difference between these two conditions is duration of symptoms; schizophreniform symptoms have been present for more than one month but less than six months. If the patient’s symptoms continue past six months, the diagnosis is changed to schizophrenia. Nursing actions are the same for both and will be covered under the “Schizophrenia” section of this chapter.

Review information about treatment for delusions, hallucinations, and disorganized speech in the “Antipychotics” section of Chapter 6.

Treatment of Psychosis

Treatment for psychosis is based on its cause. For example, if psychosis is caused by a medical condition, side effects of medication, or withdrawal from a substance, it will resolve as these conditions are treated. Information about delirium is presented in the “Overview of Disordered Cognition” section of Chapter 17. If psychosis is a symptom of mental illness, treatment typically includes a combination of antipsychotic medicines and psychological therapies. Read more about the treatment of psychosis associated with schizophrenia in the “Schizophrenia” section of this chapter.