Psychosis is often a misunderstood mental health condition associated with damaging stereotypes like “that person’s crazy,” “they’ve lost their mind,” or “they have no idea what’s going on.” The stigma around people with psychosis leads to a societal divide, and a lack of understanding towards a population would significantly benefit from compassion. When we demonstrate an understanding of others who have different experiences and sufferings, we can express concern and offer support in addressing mental health most effectively. Psychosis often leads one to experience distorted thoughts and a skewed perception and may demonstrate abnormal behavior. Psychosis includes hallucinations, delusions, catatonia or a frozen appearance, impulsive behavior, ungroomed appearance, and negative symptoms like a lack of interest in activities or emotional expression. Signs of psychosis include difficulty communicating, concentrating, thinking clearly, decreased engagement in school or work, feelings of paranoia and suspicion of others, isolation from their support system, and trouble differentiating fantasy from reality. A common delusion expressed is a persecutory delusion, when people believe they are a target, even when there is clear evidence they are not at risk.
Nonetheless, when in a delusional state, innocent actions or coincidences are misperceived as suspicious or even harmful to them. Variations of hallucinations include hearing or seeing something that is not there. The feeling of skin crawling, tingling, or pressure sensations is a tactile hallucination. According to the Center for Addiction and Mental Health, 3 in 100 people will experience a psychotic episode in their life which is more of a reason to expand our knowledge and shift our perspective from “they’re out of their mind” to “I can see how much pain they’re in and I hope they get the help they need soon.”
Psychosis presents more commonly in psychiatric disorders such as schizophrenia, bipolar disorder, major depressive disorder, and drug-included disorders. When someone with the conditions listed above is diagnosed with psychosis, it often presents as a symptom of their existing condition. Common onset characteristics include extreme stress, illness, traumatic brain injuries, alcohol, drugs (specifically stimulants and hallucinogens), or none of these, and psychosis appears on its own. Often the causes are unknown; there are genetic predispositions that make people significantly more likely to demonstrate psychotic features. Since psychosis affects how an individual functions, it’s helpful to differentiate between positive and negative symptoms. Positive symptoms are usually absent and add to or change a person’s typical functioning (delusions, hallucinations, distorted speech). Negative symptoms involve features that have been negatively impacted or lost (decreased emotional affect, reduced facial expressions, challenges with generating thoughts or beginning tasks). The combination of both biological and genetic factors places someone at the most significant risk for a psychotic episode. For example, suppose you have a family history of psychosis from your paternal grandmother and also choose to explore cocaine recreationally. In that case, this person is at a high risk of experiencing psychosis. It’s helpful to be mindful of a family history of mental health conditions/features (even undiagnosed) to make conscious decisions regarding substance use. Additional symptoms may be present with psychosis, including executive and cognitive functioning, mood changes, sleep disruptions, and suicidal behavior. Recognizing the presence of any of these symptoms allows the individual to gain access to appropriate resources and treatment sooner.
The development of psychosis is often multi-faceted, including the presence of trauma. Complex trauma during a child’s developmental years may increase their risk of developing psychosis due to the adverse impact of physical, emotional, and sexual abuse or an unstable neglectful environment. Abusive households will negatively impact brain development, chemical levels, and one’s internal nervous system. An imbalance of dopamine and serotonin levels contributes to vulnerability and may lead to a psychotic episode. Additional facets may include exposure to a natural disaster, combat, or extreme violence, which may lead to the onset of post-traumatic stress disorder (PTSD), which entails nightmares, intrusive thoughts, dissociation, and, when severe, the development of psychotic symptoms. Trauma is often complex and exacerbates underlying vulnerabilities, resulting in additional features which may resemble psychotic features, such as dissociation. When an individual experiences dissociation to cope with trauma, they detach from their thoughts, feelings, or complete sense of self. They may present in an emotionally detached or catatonic state which resembles psychotic symptoms making it challenging to diagnose at times.
Mental health professionals will complete an evaluation, reviewing a list of criteria better to understand the presence and severity of psychotic symptoms. Questions may include: “Do familiar surroundings sometimes seem strange, confusing, threatening, or unreal to you?”, “Have you often been confused with something you experienced was real or imaginary?” “Have you seen things that others can’t see or don’t seem to see?” Professionals will also assess the length of the psychotic episode and the intensity of psychotic features. Symptoms are known to last from a few hours up to several months; often, early intervention associates with the highest success rates regarding treatment. Successful treatment options for psychosis may include antipsychotic medication to help reduce distressing symptoms, prevent a relapse of symptoms, and block dopamine receptors. Consistent medication management paired with cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT) will help manage any psychotic symptoms that continue to present on a low level. Psychotherapy will allow an individual to become psycho-educated on their condition, their specific thoughts and beliefs, an understanding of their symptomatology, ways to recognize changes or triggers, and tangible skills to manage distress. When an individual learns to make sense of their experiences and demonstrate emotional regulation or distress tolerance skills, they will significantly improve their quality of life.
Family or community support is crucial for one’s success post-psychotic episode or diagnosis with a psychotic disorder. Support systems allow them to feel accepted, understood, and loved despite their condition. Emotional support is a proactive method of demonstrating involvement in their lives without judgment or pressure. Community members and family support can also advocate for their loved ones to medical professionals ensuring their needs are met. They can also ensure accountability for them to attend appointments, take medications, provide a safe environment, structured routine, and overall, a reduction of stress associated with managing severe mental health conditions. Providing this level of supported care to a loved one is taxing. They, too, will need active peer support and sufficient self-care to support members. The community of individuals diagnosed with psychosis needs our willingness to learn, compassion, and empathy to ensure they receive the utmost respect and care. Promoting education and awareness within the community, fostering an environment of inclusion and acceptance, and creating equal opportunities for employment and housing brings us a few steps closer to embracing severe mental health within our community.