Psychosis and mental illness

Around three per cent of people will experience a psychotic episode at some point in their life. In any given 12-month period, just under one in every 200 adult Australians will experience a psychotic illness.

The period of time where people experience psychotic symptoms is known as an ‘episode’ of psychosis. Some people only experience a few episodes of psychosis, or a brief episode that lasts for a few days or weeks. Others will experience symptoms more frequently, in association with a longer-term illness such as schizophrenia.

The first episode of psychosis usually occurs in a person's late teens or early 20s.

Symptoms of psychosis

Symptoms of psychosis include:

• confused thinking
• delusions – false beliefs that are not shared by others
• hallucinations – hearing, seeing, smelling or tasting something that isn't there
• changed behaviours and feelings.

Confused thinking and psychosis

During an episode of psychosis a person’s thoughts become confused. Words and ideas lose their meaning or take on meanings that make no sense.

These disturbances in thinking can affect a person's ability to concentrate, remember things and make plans. Confused thinking can continue, even after the psychotic episode has ended.

You may be able to tell that someone is having an episode of psychosis through changes in their speech. These may include:

• speaking very quickly or slowly
• changing topics frequently
• speaking in muddled-up sentences
• using the wrong words to describe things
• making up words.

Delusions and psychosis

Delusions are false beliefs that are not shared by others. Delusions can take various forms, including:

• paranoid delusion – for example, the person believes they are being watched and singled out for some harmful purpose
• grandiose delusion – for example, the person believes they have special powers or that they are an important religious or political figure
• reference delusion – for example, the person believes they are receiving special messages or codes through media such as TV shows, songs or advertising
• control delusion – for example, the person believes their thoughts are being controlled or influenced by outside forces such as aliens, some real or invented group, an individual or something more vague
• somatic delusion – for example, the person believes something has happened to their body – something is wrong with it, some part of it is missing or dead, they have a disease or are infested with parasites
• depressive delusion – for example, the person believes they are guilty of some terrible crime.

Hallucinations and psychosis

A hallucination is when someone hears, sees, smells or tastes something that isn't there. A common form of hallucination is to hear voices that aren't there. Hallucinations can lead to agitation, distress, frustration and even hostility.

Changed behaviour and psychosis

Psychosis can affect a person’s behaviour. A person with psychosis may experience:

• social isolation or becoming withdrawn
• problems with work, social or family life
• problems with motivation
• problems with increased activity
• laughing at inappropriate times or becoming upset without an identifiable cause.

Changed feelings and psychosis

Psychosis can lead to changes in emotions. How a person feels can change for no obvious reason. Examples may include:

•feeling strange and cut off from the world
•mood swings, feeling unusually excited or depressed
•feeling or showing less emotion
•feeling distanced or detached from one's body or thoughts

Types of psychotic illness

There are a number of mental illnesses where psychotic symptoms can be present. Examples include:

• brief reactive psychosis – psychotic symptoms that arise due to a very stressful event and last less than a month
• drug induced psychosis – caused by drugs such as alcohol, speed, LSD, marijuana, ecstasy or magic mushrooms. The symptoms last until the effects of the drugs wear off (hours or days)
• schizophrenia – most people affected by schizophrenia experience a range of psychotic symptoms and commonly have difficulty organising their thoughts
• bipolar disorder – involves very extreme moods (either very high or very low) that can lead to psychotic symptoms
• psychotic depression – depression can be so intense that it causes psychotic symptoms.

Causes of psychosis

The causes of psychosis are not fully understood. It is likely that psychosis is caused by a number of factors including:

• genetic vulnerability – family history of psychotic disorder
• chemical imbalance in the brain
• substance use, particularly cannabis, speed or ice
• environmental factors
• psychosocial stress – for people who have had an episode of psychosis, significant stress may be a factor in the development of further episodes.

Diagnosis of psychosis

The presence of psychotic symptoms does not automatically mean that someone has a psychotic disorder.

To diagnose a psychotic disorder, a mental health professional will do a comprehensive medical and psychological assessment over time. This can be done either at home or in hospital. They will check for psychosis caused by drugs or other diseases first.

Treatment for psychosis

Treatment can do much to relieve, or even eliminate, the symptoms of psychosis. Treatments include:

• medication – certain medications such as anti-psychotics help the brain to restore its normal chemical balance
• community support programs – ongoing support may be needed to help a person experiencing psychosis to live independently in the community. Support may include help with accommodation, finding suitable work, and the development of social and personal skills
• psychological therapies such as psychotherapy, cognitive-behaviour therapy, family therapy and counselling are aimed at teaching skills and techniques for coping with stress, improving quality of life and helping people to manage their symptoms
• self-help and peer support groups
• lifestyle changes – such as improving general health and reducing stress through activities such as art, music and exercise can support recovery. Avoiding drugs and alcohol and getting good sleep can also help.

Where to get help

• Your GP (doctor)
• Psychiatrist
• Your local mental health service
• SANE Australia offers a range of free digital and telehealth support services Tel. 1800 18 SANE (7263), Monday to Friday, 10am to 8pm
• SANE Forums are full of people who want to talk to you and offer support