An Overview of Psychosis

Q: What is psychosis? 
A: The word psychosis is used to describe conditions that affect the mind, where there has been some loss of contact with reality. When someone becomes ill in this way it is called a psychotic episode. During a period of psychosis, a person’s thoughts and perceptions are disturbed and the individual may have difficulty understanding what is real and what is not.  Symptoms of psychosis include delusions (false beliefs) and hallucinations (seeing or hearing things that others do not see or hear). Other symptoms include incoherent or nonsense speech, and behavior that is inappropriate for the situation. A person in a psychotic episode may also experience depression, anxiety, sleep problems, social withdrawal, lack of motivation, and difficulty functioning overall.

Q: What causes psychosis?
A: There is not one specific cause of psychosis. Psychosis may be a symptom of mental illness, such as schizophrenia or bipolar disorder, but there are other causes, as well. Sleep deprivation, some general medical conditions, certain prescription medications, and the abuse of alcohol or other drugs, such as marijuana, can cause psychotic symptoms. Because there are many different causes of psychosis, it is important to see a qualified health care professional (e.g., psychologist, psychiatrist, or trained social worker) in order to receive a thorough assessment and accurate diagnosis. A mental illness, such as schizophrenia, is typically diagnosed by excluding all of these other causes of psychosis.

Q: How common is psychosis?
A: Approximately 3 percent of the people in the U.S. (3 out of 100 people) will experience psychosis at some time in their lives. About 100,000 adolescents and young adults in the U.S. experience first-episode psychosis each year.

Q: What is the connection between psychosis and schizophrenia?
A: Schizophrenia is a mental illness characterized by periods of psychosis. An individual must experience psychotic symptoms for at least six months in order to be diagnosed with schizophrenia. However, a person may experience psychosis and never be diagnosed with schizophrenia or any other mental health condition. This is because there are many different causes of psychosis, such as sleep deprivation, general medical conditions, the use of certain prescription medications, and the abuse of alcohol or other drugs.

Q: What are the early warning signs of psychosis? 
A: Typically, a person will show changes in their behavior before psychosis develops. The list below includes behavioral warning signs for psychosis.

  • A worrisome drop in grades or 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, overly intense new ideas, strange feelings or having no feelings at all
  • A decline in self-care or personal hygiene
  • Difficulty telling reality from fantasy
  • Confused speech or trouble communicating

Any one of these items by itself may not be significant, but someone with several of the items on the list should consult a mental health professional. A qualified psychologist, psychiatrist or trained social worker will be able to make a diagnosis and help develop a treatment plan. Early treatment of psychosis increases the chance of a successful recovery. If you notice these changes in behavior and they begin to intensify or do not go away, it is important to seek help.

Q: What does “duration of untreated psychosis” mean? 
A: The length of time between the start of psychotic symptoms and the beginning of treatment is called the duration of untreated psychosis or DUP. In general, research has shown that treatments for psychosis work better when they are delivered closer to the time when symptoms first appear. This was the case in the RAISE-ETP study. Individuals who had a shorter DUP when they started treatment showed much greater improvement in symptoms, functioning, and quality of life than those with longer DUP. The RAISE-ETP project also found that average DUP in the United States is typically longer than what is considered acceptable by international standards. Future RAISE-related efforts are working to find ways of decreasing DUP so that individuals receive care as early as possible after symptoms appear.

Q: Do people recover from psychosis?
A: With early diagnosis and appropriate treatment, it is possible to recover from psychosis.  Many people who receive early treatment never have another psychotic episode. For other people, recovery means the ability to live a fulfilling and productive life, even if psychotic symptoms return sometimes.

Q: What should I do if I think someone is having a psychotic episode?
A: If you think someone you know is experiencing psychosis, encourage the person to seek treatment as early as possible. Psychosis can be treated effectively, and early intervention increases the chance of a successful outcome. To find a qualified treatment program, contact your health care professional, or contact one of the national organizations listed on the Patients and Families page. If someone having a psychotic episode is in distress or you are concerned about their safety, consider taking them to the nearest emergency room, or calling 911.

Types of Psychosis

Additional Information

Videos for Understanding Psychosis

Treating Psychosis

  •  Treating First Episode Psychosis: Dr. John Kane discusses treating first-episode psychosis using coordinated specialty care.
  • Implementing Early Treatment of Psychosis: Dr. Lisa Dixon talks about her personal interest in RAISE and about developing first-episode psychosis treatment programs in communities.
  • Antipsychotics, Weight Gain, and How to Keep Kids Healthy: Dr. Christoph Correll, a professor of psychiatry at Hofstra North Shore-LIJ School of Medicine and an expert in pediatric schizophrenia, talks about balancing the benefits of antipsychotic medications with strategies to address their side effects. His core message is simple: encourage healthy living and always begin with the intervention that poses the smallest risk. He also describes more intensive treatments for the weight gain that often accompanies these medications.

Printer-Friendly Fact Sheets and Publications

National Organizations: NIMH does not endorse specific early psychosis clinics, but there are several organizations that may be able to assist you in finding a treatment program in your area. This list may not be comprehensive:

Online Resources

Phone Resources

  • National Alliance on Mental Illness (NAMI) Information Helpline: This information and referral service can be reached at 1-800-950-NAMI (6264), Monday through Friday, 10 a.m.- 6 p.m., EST or by email at info@nami.org.
  • National Suicide Prevention Lifeline: A 24-hour, toll-free, confidential suicide prevention hotline available to anyone in suicidal crisis or emotional distress is available at 1-800-273-TALK (8255)
  • SAMHSA’s 24-hour Referral Helpline: For substance abuse and mental health services, call 1-800-662-HELP (4357)

-National Institute of Mental Health

About Schizophrenia

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