Psychosis

Psychosis is when your perception of reality is changed and you find it hard to know what is real. This means that psychosis may cause you to misinterpret or confuse what is going on around you.

Key points

  1. Psychosis is quite common (3 in 100 people will experience psychosis at some stage in their life). It can be treated and most people make a full recovery.
  2. There are several types of psychosis; it may be part of a mental illness, a response to major stress or triggered by drug use.
  3. Psychosis alters your reality and changes the way you behave, think, feel and see the world.
  4. Symptoms vary from person to person and may interfere with day-to-day life. Signs of psychosis may be mild at first and become more serious over time.
  5. Getting treatment and support early makes a good recovery more likely.
  6. Research shows that cannabis use increases the risk of developing a psychotic illness.
  7. There are different issues, resources and services for young people with psychosis.

What is psychosis?

Psychosis is when the way you perceive reality changes and you find it hard to know what is real. Experiencing the symptoms of psychosis is often referred to as having a psychotic episode.

During a psychotic episode, you may have trouble thinking straight, experience delusions (false beliefs or ideas) and/or hallucinations (seeing, hearing, smelling, sensing things that others can’t). You may feel disconnected from who you normally are, and from others around you. Your behaviour and mood can change. You might feel very sad or very happy. 

A psychotic episode is most likely to first happen in your teenage years or early twenties. Because psychosis can be distressing and can distort your reality, it’s important to get help early. There is a range of treatments available, including medication, psychological therapies and social support. After recovering from the first episode many people never have an episode again, but others may experience a number of relapses. See also our page on psychosis in young people.

If you are worried that you or someone else is at immediate risk of self-harm, call 111. If there is no immediate risk, contact your family doctor.


Who is at risk of psychosis?

Psychosis usually first affects people in their late teens or early twenties, but older adults may also experience a first or subsequent episodes of psychosis. It affects men and women equally, though men usually experience symptoms at a slightly younger age than women.

What causes psychosis?

There is no one cause of psychosis. But there are certain risk factors that can make you more vulnerable to psychosis. 

  • Mental illness – psychosis can be a symptom of different conditions, eg, schizophrenia or severe mood disorders like depression or bipolar disorder.
  • Substance use – some substances can cause psychosis eg, cocaine, amphetamines (speed), marijuana, methamphetamine (meth), PCP, hallucinogens and sedatives. Alcohol, sedatives and hypnotics (sleep medication) can cause psychosis when you suddenly stop using them.
  • Other health problems or a medical condition – physical injuries, diseases or health conditions such as brain injury or lupus can cause psychosis.
  • Stress – intense stress can cause or contribute to psychosis.​

What are the symptoms of psychosis?

Symptoms of psychosis vary from person to person and may interfere with day-to-day life. Signs of psychosis may be mild at first and become more serious over time. Symptoms include:

  • delusions and confused thinking – beliefs that people from your background don’t usually believe.
  • hallucinations – hearing, seeing, smelling, tasting or touching something that isn’t actually there.
  • suspicion or paranoia.
  • lack of initiative and interests.
  • preoccupation with unusual ideas or beliefs.
  • change in function at school, work or home.
  • change in relationships.
  • changes in mood, irritability or anger.
  • avoidance of normal activities and social contact, isolation.
  • changes in self-care (ie, personal hygiene).

People who experience psychosis are rarely violent. They are more often frightened, confused and despondent (low, down on themselves).

What should I do if I experience symptoms of psychosis?

Talk to your doctor if you are experiencing any signs of psychosis. These could be signs of mental or physical health problems, and your doctor can help you figure out what is causing them.

With treatment, many people never experience psychosis again after they recover from their first episode. Because psychosis can change your behaviour and make you do or say things you wouldn’t normally do, it can affect your relationships, your performance at work or study and your general sense of wellbeing. Starting treatment as early as possible can help limit these effects.

Treatment for psychosis usually includes medication and counselling. The treatment plan may be overseen by a GP or a specialist mental health service. Some people need to stay in hospital for assessment or treatment.

How is psychosis diagnosed?

Your doctor will ask about:

  • any recent major or stressful events
  • physical and mental health history
  • drug and alcohol use
  • any family history of mental illness.

They may also ask for blood and urine tests, an X-ray and for you to see a mental health specialist.

To make a diagnosis they will follow criteria in the Diagnostic and Statistical Manual (DSM-5) or the International Statistical Classification of Diseases and Related Health Problems (ICD-10).

What are the different types of psychosis?

There are several types of psychosis, depending on what has caused it.

Drug-induced psychosis – using or withdrawing from drugs, especially cannabis and amphetamines, can cause psychotic symptoms that last for short or long periods.
Brief reactive psychosis – psychotic symptoms that appear suddenly after a major stress in your life. Recovery is often quick.
Schizophrenia – an illness in which the symptoms of psychosis have continued for at least six months. Many people with schizophrenia lead happy and fulfilling lives, and many make a full recovery. Read more about schizophrenia.
Bipolar disorder – this condition involves major changes including extreme highs and lows. You can experience psychotic symptoms as part of this disorder. Read more about bipolar disorder.
Depression – psychotic symptoms can occur in people with very severe depression. Read more about severe depression

What is the treatment for psychosis?

The aim of treatment is to help you regain your normal perception of reality. Treatment usually includes antipsychotic medicines, counselling and social support. With appropriate treatment, most people recover from psychosis.

Your treatment plan may be overseen by your GP or a specialist mental health service. Some people need to stay in hospital for assessment or treatment.

Your care team

Your treatment is likely to involve a team of mental health professionals working together. This may include a psychologist, a social worker, a psychiatric nurse and your GP or psychiatrist. You may be assigned a case manager to help coordinate everything from accessing self-help groups and managing crisis situations to getting help with job hunting and housing.

For Māori, Western models of mental health and mental healthcare will not always be appropriate. An approach based on a Māori model of health has a more holistic understanding of wellbeing. For example, the four cornerstones (or sides) of Māori health in the Te Whare Tapa Whā model of health are: 

  • whānau (family health)
  • tinana (physical health)
  • hinengaro (mental health)
  • wairua (spiritual health).

You can find a health practitioner who has a kaupapa Māori approach to wellbeing in this directory

Your treatment may include:

Medicines

Antipsychotic medicines can help reduce feelings of anxiety associated with psychosis within a few hours. Other psychotic symptoms such as hallucinations and delusions may take several days or weeks to improve. Other medicines like antidepressants or mood stabilisers may also be used.

Counselling and psychological therapy

Psychological treatment can help reduce the intensity and anxiety caused by psychosis. Some possible psychological treatments are discussed below.

  • Cognitive-behavioural therapy (CBT) teaches how behaviours, thoughts and mood influence each other.
  • Family therapy is a way of helping both you and your family cope with your condition.
  • Social skills training – this focuses on improving your communication and social interactions and your ability to fully participate in daily activities.

Social support

  • Social and life skills support –Occupational therapists or social workers can help with day-to-day issues or connect you with community services that can. They can also help you prepare for, find and keep jobs.
  • Support groups – If you're experiencing episodes of psychosis, you may benefit from being around other people who've had similar experiences. 

What can I do to help myself?

You can help yourself by:

  • having a plan for who to contact if you start to feel unwell and so others know what you need from them
  • asking your friends and family to support you
  • learning about what psychosis is, treatment options, coping skills, how to avoid relapse and how to access services – check out the links on this page
  • taking medicines as agreed with your doctor
  • looking after your self by eating well, getting enough sleep and keeping in touch with family and friends
  • avoiding illegal drugs or alcohol
  • avoiding stressful events and situations and learning how to cope with stress
  • getting plenty of sleep and eating well
  • keeping up with your normal activities as much as you are able to.

What support is available?

For ongoing support, see your family doctor, your contact person at community mental health services or your psychiatrist or psychotherapist. There are also support groups around the country . See also Supporting Families, who provide support for families and whānau to provide the best possible quality of life and recovery to their loved one who has a mental illness and to their own self-care.

If you need urgent help, phone:

  • Lifeline 0800 543 354 (available 24/7), or
  • Healthline 0800 611 116, who can give you the phone number for your local mental health crisis line.

Learn more

Understand psychosis Talking Minds, NZ
Hearing Voices Network For people who hear voices or have visions or other unusual perceptions

References

  1. Early intervention for psychosis in New Zealand The New Zealand Medical Journal, 2004
  2. Psychosis – diagnosis and management Patient Info, UK, 2016
  3. McGorry PD, Goldstone S. Is this normal? Assessing mental health in young people Aust Fam Physician. 2011 Mar;40(3):94-7.
  4. Lee HE, Jureidini J. Emerging psychosis in adolescents Aust FamPhysician. 2013; 42(8):624-627.
  5. What is psychosis and the effects on mental health headspace, Australia
  6. Psychosis treatment NHS, UK, 2016
Credits: Health Navigator Editorial Team. Reviewed By: Gillian Hawke, Clinical psychologist Last reviewed: 18 Apr 2019