Psychosis is a symptom of a mental health condition, medical problem, or substance use that affects a person's ability to distinguish between what is real and what isn't. It affects how a person thinks, feels, behaves, and experiences the world around them. It is not a mental illness on its own.
Psychosis symptoms most often begin during late teens or early adulthood but can happen at any age.
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What Is Psychosis?
Psychosis is a mental health symptom that affects whether a person can distinguish between what is real and what isn’t. A person with psychosis may see, hear, or believe things that aren’t real.
A person experiencing a psychotic episode may:
- Have difficulty organizing their thoughts.
- Have trouble making sense of what is happening around them.
- Struggle to manage everyday life.
Psychosis symptoms may:
- Be part of an adjustment to developmental changes, especially in adolescents or young adults.
- Be related to mental health or medical conditions (diagnosed and undiagnosed).
- Be triggered by extreme stress, trauma, lack of sleep, or substance use.
- Mimic mood disorders, such as depression and anxiety disorders.
Psychosis is treatable. Without treatment, symptoms can become more severe. A combination of acute symptoms may indicate a potentially serious psychotic illness.
What are the stages of psychosis?
Stages of psychosis are:
- Early warning signs — Changes in thoughts, emotions, or behaviors. These changes may develop gradually over weeks or months.
- Active psychosis — Symptoms such as hallucinations, delusions, or confused thinking become more noticeable. These often begin to affect all aspects of a person’s life — from relationships to daily activities.
- Recovery and treatment — May include ongoing treatment, symptom management, and support.
How common is psychosis?
About three out of every 100 people will experience psychosis at some point in their lives, according to the National Institute of Mental Health.
Psychosis in teens and young adults
Early psychosis often begins when a person is in their late teens to mid-20s.
Initial signs may include:
- Altered sleep habits.
- Declining school performance.
- Mood changes.
- Social withdrawal.
- Suspiciousness.
- Unusual thoughts and beliefs.
What causes psychosis?
There is no single cause of psychosis. It can be triggered by a mental health disorder, a medical problem, or substance use. It can happen suddenly or develop slowly over time.
Psychosis Risk Factors
Risk factors can include:
- A family history of psychosis or schizophrenia.
- Alcohol or drug misuse.
- Brain injuries.
- Certain medical conditions that affect the brain, such as dementia, Parkinson’s disease, or stroke.
- Certain mental health conditions, such as bipolar disorder or severe depression.
Psychosis complications
Complications may include:
- Higher risk for hospitalization, substance misuse, self-harm, or suicidal thoughts.
- Increased severity of symptoms over time.
- Potential side effects of antipsychotic medicines.
How can I reduce my risk?
Psychosis cannot always be prevented. In many cases, it develops because of factors that are outside a person’s control.
What Are the Signs and Symptoms of Psychosis?
The first signs can be subtle differences in:
- Behavior
- Daily life
- Mood
- Thinking
During a psychotic episode, symptoms are usually more noticeable.
It is important to seek help if several symptoms appear together, continue, or get worse over time.
Common symptoms of psychosis
Symptoms include:
- Delusions or false beliefs — Holding on to strong beliefs even when there is evidence that they are not true.
- Disorganized thinking and speech — Difficulty organizing thoughts or communicating clearly.
- Hallucinations — Hearing voices, seeing things that others cannot see, or experiencing strange sensations of the skin or within the body.
- Social or emotional difficulties — Social withdrawal and/or diminished expression of emotions; inappropriate expression of emotions (for example, smiling while describing distressing events).
When should I see a doctor about my psychosis symptoms?
See a doctor if you have unusual and ongoing shifts in your thoughts or actions that worry you.
Seek immediate help if a person:
- Appears highly confused.
- Becomes increasingly paranoid or agitated.
- Cannot care for themselves safely.
- Cannot tell what is real and what is not.
- Has thoughts of self-harm or suicide.
- Talks about harming others.
If someone is in immediate danger of harming themselves or others, call 911 or seek emergency medical care right away.
How Do You Diagnose Psychosis?
Psychosis is usually diagnosed by a psychiatrist, psychologist, or other mental health professional. In some cases, a primary care provider, neurologist, or emergency medicine doctor may also be involved.
Providers use interviews, mental health assessments, and medical tests to understand symptoms and look for possible causes. The goal is to confirm whether psychosis is present and identify what may be causing it.
What to expect during your visit
In addition to information about your health history, medicines, and day-to-day life, your provider may ask:
- What symptoms you have and when they began.
- How symptoms are affecting everyday life.
- Whether alcohol, drugs, or medicines could be contributing to symptoms.
- Whether there is a family history of mental health conditions.
- Whether you have experienced hallucinations or unusual beliefs.
Tests to diagnose psychosis
Your provider may recommend testing to rule out medical causes, including:
- A physical exam.
- Laboratory testing.
- Imaging studies, such as an MRI or CT scan, to identify possible underlying causes.
Psychosis prognosis/outlook
The outlook for psychosis depends on the cause, severity of symptoms, and how quickly treatment begins. Some people experience only one psychotic episode.
How Do You Treat Psychosis?
Treatment depends on the cause of psychosis and each person’s needs.
The goals of treatment are to:
- Address the underlying cause when possible.
- Reduce symptoms and prevent them from worsening.
- Return to school, work, or relationships.
People may benefit from a combination of:
- Family support.
- Medicine.
- Practical help with day-to-day activities.
- Therapy.
Lifestyle changes
Your provider may recommend that you:
- Avoid alcohol and recreational drugs.
- Follow your treatment plan.
- Get regular sleep.
- Keep regular medical and mental health appointments.
- Manage stress in healthy ways.
- Stay connected with supportive family and friends.
Medicine to treat psychosis
Antipsychotic medicines may reduce symptoms such as hallucinations, delusions, and confused thinking.
Other medicines may also be used to treat depression, bipolar disorder, anxiety, or sleep problems.
Therapy and supportive treatments for psychosis
Therapy and support services are an important part of care.
They include:
- Individual therapy — Helps people understand their symptoms, build coping skills, and work toward personal goals.
- Family education and support — Helps family members understand psychosis and learn how to support recovery.
- Case management and care coordination — Connects individuals and families with treatment, community resources, and support services.
- Coordinated specialty care — A team-based approach often used for early psychosis. Care may include psychiatry, therapy, family support, education support, and case management.
What happens during treatment?
Some people receive outpatient care. Others may need more intensive treatment during periods of severe symptoms, including hospitalization.
How effective is treatment?
Psychosis is very treatable, and people can improve with appropriate care.
How long does it take to recover after treatment for psychosis?
Some people notice improvement within weeks of starting treatment. Others may need ongoing treatment and support over a longer period.
When should I see a provider for psychosis?
Seek professional help if you notice ongoing changes in thinking, behavior, emotions, or daily life. Seek immediate psychiatric help if you or someone you know is at risk for self-harm or having suicidal thoughts.
Do not wait for symptoms to become severe. Getting help early often leads to better outcomes.
What questions should I ask my provider about psychosis?
You may want to ask:
- What may be causing my symptoms?
- Do I need additional testing?
- What treatment options do you recommend?
- How long will treatment last?
- What are the common side effects of medicine for psychosis?
- What should I do if symptoms worsen?
- Is it safe for me to continue daily activities while undergoing treatment?
- Are there resources available for family members or caregivers?
Why Choose UPMC for Psychosis Care?
When you choose UPMC for psychosis care, you will receive:
- Specialized services for early psychosis — Services for the Treatment of Early Psychosis (STEP) is an outpatient program to support people experiencing early psychosis.
- Access to multidisciplinary care — Our mental and behavioral health experts partner with medical specialists to provide the best treatment plan for your psychosis.
- Family-centered care and support — We partner with families and caregivers throughout treatment, providing education, guidance, and support to help them understand psychosis and participate in recovery when appropriate.
- A full range of treatment options — We use the latest therapies and approaches to provide comprehensive care, including medicine, psychotherapy, or a combination of treatments.
- Specialized medication treatment programs — We offer expert care for people who may benefit from long-acting injectable antipsychotic medications, which can be given every few weeks or months rather than pills or tablets that are taken daily. We also provide specialized clozapine treatment and monitoring for people whose psychotic symptoms have not improved with standard medications.
