Psychosis

Symptoms of psychosis 

Someone who develops psychosis will have their own set of symptoms and experiences.

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

In general, four main symptoms are linked with a psychotic episode:

• hallucinations
• delusions
• confused and disturbed thoughts
• lack of insight and self-awareness

These are outlined below.

Hallucinations 

Hallucinations are where someone sees, hears, smells, tastes or feels things that don't 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 can't smell
• taste – a taste when there is nothing in the mouth

Delusions 

A delusion is where a person has an unshakeable belief in something untrue. There are several types of delusion.

Delusions of persecution 

A person with persecutory delusions may believe an individual or organisation is making plans to hurt or kill them.

Delusions of reference 

This is where a person believes ordinary events, objects, or the behaviour of others has a particular and unusual meaning specifically for them. For example, this could be a delusional belief that people on the radio are talking about, or directly to, the person.

Delusions of control 

This is where a person believes their thoughts, feelings, or behaviour are being controlled by other people. They may feel that thoughts are being put in, or taken from their head.

Grandiose delusions 

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.

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

Lack of insight 

People who have psychotic episodes are often unaware their delusions or hallucinations aren't real. This may lead them to feel frightened or distressed.

Postnatal psychosis 

Postnatal psychosis is a severe form of postnatal depression. This is a type of depression some women experience after having a baby.

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 your GP immediately or GP out of hours service if you think someone you know may have developed postnatal psychosis.

If you think there's an imminent danger of harm, call 999 and ask for an ambulance.

When to seek medical advice 

You should see your GP immediately if you're experiencing symptoms of psychosis. It's important psychosis is treated as soon as possible. Early treatment can be more effective.

Your GP may ask you some questions to help find out what's causing your psychosis.

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

Getting help for others 

If you're concerned about someone you know, you could contact their GP. 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 placing them at possible risk of harm, you can:

• take them to the nearest  emergency department, if they agree
• call their GP or GP out of hours services
• call 999 and ask for an ambulance

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:

• a traumatic experience
• stress
• drug misuse
• alcohol misuse
• side effects of prescribed medication
• a physical condition – such as a brain tumour

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 medication – which can help relieve the symptoms of psychosis
• psychological therapies – the one-to-one talking therapy cognitive behavioural therapy (CBT) has proved successful in helping people with psychosis; 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

After an episode of psychosis, most people who get better with medication need to continue taking medication to prevent symptoms recurring.

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

• Read about mental health services in Northern Ireland

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. 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.

If you are self-harming or having suicidal thoughts, see your GP, of if you can’t wait to see your GP because things are getting worse, contact GP out of hours services.  

If you think a friend or relative is self-harming, look out for signs of unexplained cuts, bruises or cigarette burns.

If you're feeling suicidal, you can:

• call Lifeline on 0808 808 8000 or the Samaritans support service on 116 123
• go to your nearest emergency department and tell the staff how you're feeling
• speak to a friend, family member, or someone you trust
• make an urgent appointment to see your GP or GP out of hours services  psychiatrist, or care team

• Read more about mental health emergency – if you’re in crisis or despair

 Driving 

Having psychosis could affect your ability to drive.

If you've had or currently suffer from a medical condition or disability that may affect your driving you must tell the Driver & Vehicle Agency (DVA).

• Read more about how to tell DVA about a medical condition

• Find out more about psychosis on the NHS website

More useful links

• How to use your health services
• Minding Your Head
• Mental health services
• Mental health emergency - if you're in crisis or despair