Psychosis is a condition in which a person may find it difficult to distinguish their experiences and beliefs from what is happening in reality. A first episode of psychosis can begin suddenly or develop gradually. It requires prompt assessment by a psychiatrist, but it does not necessarily mean that the person has schizophrenia.
Possible signs of psychosis
- hallucinations, such as hearing voices or seeing things that other people do not perceive;
- delusional beliefs that feel certain to the person but are not consistent with reality;
- confused thinking or speech that is difficult to follow;
- marked changes in behaviour, intense suspiciousness, fear or agitation;
- withdrawal from other people, loss of motivation, isolation or neglect of everyday needs;
- a marked decline in study, work or the ability to manage usual activities.
Similar experiences can have different causes. A diagnosis cannot be made from a single symptom, an online test or a relative's description alone.
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When urgent help is needed
Seek urgent help immediately if the person may harm themselves or someone else, is severely agitated or confused, cannot meet their basic needs, is physically very unwell, or is deteriorating quickly. In Ukraine, call 103 or 112 or go to the nearest emergency department. A routine online consultation is not a substitute for emergency care in these circumstances.
What can cause psychosis
Psychotic symptoms can occur in different mental health conditions. They can also be associated with severe sleep deprivation, substance use or withdrawal, the effects of some medicines, and certain neurological, endocrine, infectious or other physical conditions. In some cases, the cause becomes clearer only through assessment and follow-up over time.
Assessment
A psychiatrist asks when the symptoms began, how they have changed, and how they affect safety and daily life. The assessment also covers medical and family history, sleep, prescribed medicines, alcohol and other substance use. With the person's consent, information from someone close to them may be helpful.
A physical examination, laboratory tests or other investigations may be recommended when clinically indicated to assess general health and rule out possible physical causes. An MRI scan, blood test or psychological questionnaire cannot confirm psychosis or identify its cause on its own.
Treatment for a first episode of psychosis
The care plan is individual and takes account of symptoms, possible causes, risks, physical health and the person's preferences. NICE recommends offering antipsychotic medication together with psychological interventions for a first episode of psychosis.
- Medication. A psychiatrist recommends an antipsychotic after discussing potential benefits, side effects and monitoring. Do not start, stop or change the dose of prescribed medication without medical advice.
- Cognitive behavioural therapy for psychosis (CBTp). This can help reduce distress, make sense of experiences, develop ways of coping with symptoms and restore everyday functioning.
- Family intervention. This gives relatives information about the condition and helps improve communication, solve practical difficulties and plan what to do during a crisis.
- Physical health monitoring. Care should include monitoring weight, blood pressure, metabolic measures, physical activity, nutrition, smoking and possible medication side effects.
- Recovery support. The plan may include help with returning to education, employment, social contact and usual activities at a pace that is appropriate for the person.
Metacognitive training
Metacognitive training (MCT) may be discussed as an additional group or individual activity that explores common thinking biases. It does not replace prompt psychiatric assessment, medication when indicated, CBT for psychosis, family intervention or other necessary care. Whether it is appropriate should be considered within the person's individual treatment plan.
Recovery and follow-up
The course of a first psychotic episode varies from person to person. Starting comprehensive care early can improve outcomes, but complete or identical recovery cannot be guaranteed for everyone. Regular follow-up helps review treatment response, side effects, physical health, the risk of another episode, and the person's educational, occupational and social support needs.
How relatives and friends can help
Speak calmly, avoid ridicule and do not try to force the person to abandon their experiences or beliefs. Focus on their fear or distress, encourage professional help and, where possible, take part in an agreed support plan. Seek urgent help if there is an immediate danger.
Confidentiality
The clinic maintains confidentiality in accordance with the law and the professional duties of healthcare practitioners. Confidentiality has legal limits, including when there is an immediate risk to the safety of the patient or another person.