Psychosis

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KEY POINTS

• Psychosis is a loss of contact with reality. You cannot tell the difference between what is real and what is unreal.
• Treatment may include medicines, therapy, and learning ways to manage stress. In severe cases, you may need to be treated in the hospital.

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What is psychosis?

Psychosis is a loss of contact with reality. You cannot tell the difference between what is real and what is unreal. This may last for a short time, or may be long-term.

What is the cause?

The exact cause of psychosis is not always known. The brain makes chemicals that affect thoughts, emotions, and actions. Without the right balance of these chemicals, there may be problems with the way you think, feel, or act. People who have psychosis may have too little or too much of some of these chemicals.

Psychosis can be brought on by:

• Brain tumors, epilepsy, head injuries, a severe lack of sleep, or infections such as meningitis
• A mental disorder such as schizophrenia, bipolar disorder, or severe depression
• Drugs such as marijuana, speed, or LSD, or withdrawal from substances such as alcohol

What are the symptoms?

Symptoms may include:

• Hearing voices that no one else can hear, seeing people or objects that are not there, or feeling something that is not there
• Having false beliefs or ideas that are not true. For example, you might believe there is a plot against you by powerful people, or that you have special powers no one else has.
• Feeling strange and cut off from the world, with everything moving in slow motion. Mood swings are common, so you may feel very excited and then very depressed. Or you may feel or show almost no emotion.
• Behaving differently than the way you usually do. You may be very active, or just sit around all day. You may get angry or aggressive without apparent cause.
• Having trouble concentrating, following a conversation or remembering things. Your thoughts may seem to speed up or slow down. You feel confused and what you say may not make sense.

How is it diagnosed?

Your healthcare provider or a mental health therapist will ask about your symptoms, medical and family history, and any medicines you are taking. He will make sure you do not have a medical illness or drug or alcohol problem that could cause the symptoms. You may have tests or scans to help make a diagnosis.

If no medical cause can be found, you may be referred to a mental health professional for further testing.

How is it treated?

Treatment depends on the cause. Medicines are usually the most important part of the treatment. Several types of medicines can help treat psychosis. Your healthcare provider will work with you to select the best medicine. You may need to take more than one type of medicine. These medicines may cause side effects, but you and your healthcare provider will watch for them. Your healthcare provider may change how much or how often you take your medicine, or change the medicine you have been taking.

It is important to stay on your medicine to keep your symptoms under control. If you are thinking about stopping your medicine, talk to your provider first. Antipsychotics should not be stopped suddenly or without your provider's okay.

Cognitive behavioral therapy (CBT) focuses on thinking and behavior. The therapist helps you learn how to:

• Test the reality of your thoughts
• Cope with stress
• Replace negative thoughts with positive thoughts
• Identify early warning signs that symptoms are getting worse

Psychosis may make it hard to organize your thoughts, solve problems, and make decisions. You may have trouble taking care of yourself or telling others what you need. You may need a therapist or case manager to help you manage your daily needs.

You may need to spend some time in a hospital if you are thinking about hurting yourself or someone else, or if you are unable to take care of yourself.

How can I take care of myself?

• Get support. Talk with family and friends. Consider joining a support group in your area.
• Learn to manage stress. Ask for help at home and work when the load is too great to handle. Find ways to relax. For example take up a hobby, listen to music, watch movies, or take walks. Try yoga, meditation, or deep breathing exercises when you feel stressed.
• Take care of your physical health. Try to get at least 7 to 9 hours of sleep each night. Eat a healthy diet. Limit caffeine. If you smoke, quit. Avoid alcohol and drugs, because they can make your symptoms worse. Exercise according to your healthcare provider's instructions.
• Check your medicines. To help prevent problems, tell your healthcare provider and pharmacist about all of the medicines, natural remedies, vitamins, and other supplements that you take. Take all medicines as directed by your provider or therapist. It is very important to take your medicine even when you are feeling and thinking well. Without the medicine, your symptoms may not improve or may get worse. Talk to your provider if you have problems taking your medicine or if the medicines don't seem to be working.
• Contact your healthcare provider or therapist if you have any questions or your symptoms seem to be getting worse.

Get emergency care if you or a loved one has serious thoughts of suicide or self-harm, violence, or harming others.

For more information, contact:

• National Alliance on Mental Illness (NAMI)
  800-950-6264
  http://www.nami.org
• Mental Health America
  800-969-6642
  http://www.mentalhealthamerica.net/