Understanding Psychosis

Psychosis can feel frightening, confusing, and deeply disorienting both for the person experiencing it and for the loved ones trying to understand what’s happening. While often associated with disorders like schizophrenia, psychosis is actually a symptom, not a condition itself. It can appear in a wide range of psychiatric, medical, and substance-related situations. Learning about the different types of psychosis and what causes them can make seeking help feel more manageable.

Current data suggests that about three in every 100 people will experience psychosis at some point in their lives, and many recover fully with appropriate care. Early recognition matters, and informed support can make a meaningful difference.

What Psychosis Looks Like

Psychosis disrupts your ability to tell what’s real from what isn’t. For some, it’s short-lived. For others, it becomes a recurring challenge. Two main symptoms define psychosis:

• Hallucinations: Sensing something that isn’t actually present—such as hearing voices, seeing things others can’t, or feeling sensations without a physical cause.

• Delusions: Firmly held beliefs that persist despite clear evidence to the contrary.

Other possible signs include:

• Disorganized speech, where thoughts jump rapidly and incoherently

• Catatonia, which involves unusual movements or long periods of unresponsiveness

These symptoms can appear differently depending on the underlying cause.

Psychotic Disorders in the DSM-5

Several psychiatric disorders use psychosis as a core part of diagnosis:

• Schizophrenia: Symptoms like delusions, hallucinations, or disorganized behavior lasting more than a month

• Schizophreniform disorder: Similar symptoms lasting less than a month

• Schizoaffective disorder: A combination of schizophrenia symptoms and mood episodes

• Delusional disorder: One or more persistent delusions lasting at least a month

In many cases, early warning signs appear before a full psychotic episode, including withdrawal from others, sudden drops in performance, suspiciousness, or loss of emotional expression.

Other Mental Health Conditions That May Involve Psychosis

Psychosis can also develop as a complication of other disorders, even when it’s not a defining feature. These can include:

• Major depressive disorder

• Bipolar 1 and bipolar 2 disorders

• PTSD

• Borderline personality disorder

• OCD

• Dissociative identity disorder

Not everyone with these diagnoses will ever experience psychosis, but certain episodes—especially severe mood episodes can trigger it.

Medical Conditions That Can Cause Psychosis

Psychosis doesn’t always stem from mental health disorders. In some cases, physical illnesses interfere with brain function enough to cause hallucinations or delusions. Examples include:

• Traumatic brain injuries

• Postpartum psychosis, usually within three months of childbirth

• Alzheimer’s disease and Lewy body dementia

• Multiple sclerosis in later stages

• Stroke or brain tumors

• Viral encephalitis

• HIV or hepatic encephalopathy

• Thyroid storm

• Kidney failure leading to toxic buildup

These instances fall under “Psychotic Disorders Due to Another Medical Condition” in the DSM-5. A key point: treating the underlying medical issue often resolves the psychosis.

Substance- and Medication-Induced Psychosis

Many substances legal and illegal can trigger psychosis during intoxication, long-term use, or withdrawal. These include:

• Cocaine

• Methamphetamine

• Cannabis (particularly heavy or prolonged use)

• LSD, ketamine, and other hallucinogens

• MDMA

• Psilocybin

• Alcohol misuse

Psychosis linked to drugs often comes with distress, confusion, and sometimes suicidal thoughts. In these cases, understanding the substance use history is key to diagnosis and recovery.

How Psychosis Is Diagnosed

Because psychosis has so many potential causes, healthcare providers use a combination of interviews and tests to understand what’s happening. Depending on symptoms, this may include:

• Blood tests for infections

• Toxicology screens

• STI and HIV testing

• Kidney and liver function tests

• Thyroid blood tests

• EEG

• Brain imaging

Comprehensive evaluation helps distinguish between psychiatric and medical causes. Interestingly, research shows that infections like urinary tract infections in older adults can trigger sudden psychosis, highlighting why medical testing is essential.

If symptoms last more than one day but less than a month, and no medical cause is found, the diagnosis may be brief psychotic disorder.

Treatment Options for Psychosis

Treatment depends on the cause, but may include medication, therapy, or both.

Medications

Antipsychotics are often used to stabilize symptoms, prevent recurrence, and help manage long-term psychiatric conditions.

Typical antipsychotics may be used for acute episodes, while atypical antipsychotics are often preferred for ongoing management because they usually produce fewer movement-related side effects. Both types can effectively reduce hallucinations, delusions, and agitation.

A newer option, Cobenfy, combines two medications to help treat positive and negative symptoms of schizophrenia, offering an alternative to traditional antipsychotics.

Therapy

Psychotherapy can support long-term recovery especially for those with schizophrenia or bipolar disorder. Common approaches include:

• Cognitive behavioral therapy (CBT)

• Dialectical behavior therapy (DBT)

Therapy helps individuals understand their symptoms, develop coping skills, and rebuild daily functioning.

In Summary

Psychosis disrupts a person’s sense of reality, but with the right diagnosis and treatment, many people recover or manage their symptoms successfully. Whether triggered by psychiatric conditions, medical issues, or substance use, prompt evaluation and support can make a significant difference.

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