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Psychosis is when people lose some contact with reality. This might involve seeing or hearing things that other people cannot see or hear (hallucinations) and believing things that are not actually true (delusions).

Symptoms of psychosis
The 2 main symptoms of psychosis are:

  • hallucinations – where a person hears, sees and, in some cases, feels, smells or tastes things that do not exist outside their mind but can feel very real to the person affected by them; a common hallucination is hearing voices
  • delusions – where a person has strong beliefs that are not shared by others; a common delusion is someone believing there's a conspiracy to harm them
The combination of hallucinations and delusional thinking can cause severe distress and a change in behaviour.

Experiencing the symptoms of psychosis is often referred to as having a psychotic episode.

When to seek medical advice
You should see a GP immediately if you're experiencing symptoms of psychosis.

It's important psychosis is treated as soon as possible, as early treatment can be more effective.

The GP may ask you some questions to help determine what's causing your psychosis.

They should also refer you to a mental health specialist for further assessment and treatment.

Find out more about diagnosing psychosis

Getting help for others
If you're concerned about someone you know, you could contact a GP for them.

If they're receiving support from a mental health service, you could contact their mental health worker.

If you think the person's symptoms are severe enough to require urgent treatment and could be placing them at possible risk, you can:

A number of mental health helplines are also available that can offer expert advice.

Causes of psychosis
It's sometimes possible to identify the cause of psychosis as a specific mental health condition, such as:

  • schizophrenia – a condition that causes a range of psychological symptoms, including hallucinations and delusions
  • bipolar disorder – a mental health condition that affects mood; a person with bipolar disorder can have episodes of low mood (depression) and highs or elated mood (mania)
  • severe depression – some people with depression also have symptoms of psychosis when they're very depressed
Psychosis can also be triggered by:

How often a psychotic episode occurs and how long it lasts can depend on the underlying cause.

Treating psychosis
Treatment for psychosis involves using a combination of:

  • antipsychotic medicine – which can help relieve the symptoms of psychosis
  • psychological therapies – the 1-to-1 talking therapy cognitive behavioural therapy (CBT) has proved successful in helping people with psychosis, and family interventions (a form of therapy that may involve partners, family members and close friends) have been shown to reduce the need for hospital treatment in people with psychosis
  • social support – support with social needs, such as education, employment or accommodation
Some people are recommended to take antipsychotics on a long-term basis (and possibly for the rest of their lives). Other people may be able to gradually reduce their dosage and then stop taking them altogether if there is a marked improvement in symptoms.

Do not stop suddenly taking any prescribed medicines as this could trigger a relapse of your symptoms.

If a person's psychotic episodes are severe, they may need to be admitted to a psychiatric hospital for treatment.

Complications of psychosis
People with a history of psychosis are more likely than others to have drug or alcohol misuse problems, or both.

Some people use these substances as a way of managing psychotic symptoms.

But substance abuse can make psychotic symptoms worse or cause other problems.

Self-harm and suicide
People with psychosis have a higher than average risk of self-harm and suicide.

See a GP if you're self-harming.

You can also call the Samaritans, free of charge, on 116 123 for support.

The mental health charity Mind also has some useful information and advice.

If you think a friend or relative is self-harming, look out for signs of unexplained cuts, bruises or cigarette burns, usually on the wrists, arms, thighs and chest.

People who self-harm may keep themselves covered up at all times, even in hot weather.
If you're feeling suicidal, you can:

  • call the Samaritans support service on 116 123
  • go to your nearest A&E and tell the staff how you're feeling
  • contact NHS 111
  • speak to a friend, family member or someone you trust
  • make an urgent appointment to see a GP or your psychiatrist or care team

  1. Treatment
Someone who develops psychosis will have their own unique set of symptoms and experiences, according to their particular circumstances.
But in general, 3 main symptoms are associated with a psychotic episode:
  • hallucinations
  • delusions
  • confused and disturbed thoughts
Hallucinations are where someone sees, hears, smells, tastes or feels things that do not exist outside their mind.
  • sight – seeing colours, shapes or people
  • sounds – hearing voices or other sounds
  • touch – feeling touched when there is nobody there
  • smell – an odour that other people cannot smell
  • taste – a taste when there is nothing in the mouth
A delusion is where a person has an unshakeable belief in something untrue.
A person with persecutory delusions may believe an individual or organisation is making plans to hurt or kill them.
A person with grandiose delusions may believe they have power or authority. For example, they may think they're the president of a country or they have the power to bring people back from the dead.
People who have psychotic episodes are often unaware that their delusions or hallucinations are not real, which may lead them to feel frightened or distressed.
Confused and disturbed thoughts
People with psychosis sometimes have disturbed, confused, and disrupted patterns of thought. Signs of this include:
  • rapid and constant speech
  • disturbed speech – for example, they may switch from one topic to another mid-sentence
  • a sudden loss in their train of thought, resulting in an abrupt pause in conversation or activity
Postnatal psychosis
Postnatal psychosis, also called puerperal psychosis, is a severe form of postnatal depression, a type of depression some women experience after having a baby.
It's estimated postnatal psychosis affects around 1 in every 1,000 women who give birth. It most commonly occurs during the first few weeks after having a baby.
Postnatal psychosis is more likely to affect women who already have a mental health condition, such as bipolar disorder or schizophrenia.
As well as the symptoms of psychosis, symptoms of postnatal psychosis can also include changes in mood:
  • a high mood (mania) – for example, feeling elated, talking and thinking too much or too quickly
  • a low mood – for example, feeling sad, a lack of energy, loss of appetite, and trouble sleeping
Contact a GP immediately if you think you or someone you know may have developed postnatal psychosis as it is a medical emergency. If this is not possible, call NHS 111 or your local out-of-hours service.
If you think there's an imminent danger of harm, call 999 and ask for an ambulance.
Psychosis is not the same as psychopath
The terms "psychosis" and "psychopath" should not be confused.
Someone with psychosis has a short-term (acute) condition that, if treated, can often lead to a full recovery.
A psychopath is someone with an antisocial personality disorder, which means they:
  • lack empathy – the capacity to understand how someone else feels
  • are manipulative
  • often have a total disregard for the consequences of their actions
People with an antisocial personality can sometimes pose a threat to others because they can be violent. Most people with psychosis are more likely to harm themselves than others.

Psychosis can be caused by a mental (psychological) condition, a general medical condition, or alcohol or drug misuse.

Psychological causes
The following conditions have been known to trigger psychotic episodes in some people:

  • schizophrenia – a mental health condition that causes hallucinations and delusions
  • bipolar disorder – a person with bipolar disorder can have episodes of low mood (depression) and highs or elated mood (mania)
  • severe stress or anxiety
  • severe depression – feelings of persistent sadness, including postnatal depression, which some women experience after having a baby
  • lack of sleep
The underlying psychological cause often influences the type of psychotic episode someone experiences.

For example, a person with bipolar disorder is more likely to have grandiose delusions. Someone with depression or schizophrenia is more likely to develop persecutory delusions.

See symptoms of psychosis for more information on delusions.

General medical conditions
The following medical conditions have been known to trigger psychotic episodes in some people:

Alcohol misuse and drug misuse can trigger a psychotic episode.

A person can also experience a psychotic episode if they suddenly stop drinking alcohol or taking drugs after using them for a long time. This is known as withdrawal.

It's also possible to experience psychosis after drinking large amounts of alcohol or if you're high on drugs.

Drugs known to trigger psychotic episodes include:

  • cocaine
  • amphetamine (speed)
  • methamphetamine (crystal meth)
  • mephedrone (MCAT or miaow)
  • MDMA (ecstasy)
  • cannabis
  • LSD (acid)
  • psilocybins (magic mushrooms)
  • ketamine
In rare situations, psychosis can also occur as a side effect of some types of medicine or as a result of an overdose of that medicine.

Never stop taking a prescribed medicine unless advised to do so by a GP or another qualified healthcare professional responsible for your care.

See a GP if you're experiencing psychotic side effects caused by medicine.

The brain
There's been a great deal of research into how psychosis affects the brain and how changes in the brain can trigger symptoms of psychosis.

Researchers believe dopamine plays an important role in psychosis.

Dopamine is a neurotransmitter, 1 of many chemicals the brain uses to transmit information from 1 brain cell to another. It's associated with how we feel whether something is significant, important, or interesting.

Disruption to these important brain functions may explain the symptoms of psychosis.

Evidence for the role of dopamine in psychosis comes from several sources, including brain scans and the fact medicines known to reduce the effects of dopamine in the brain also reduce the symptoms of psychosis.
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