Understanding Your Loved One’s Psychosis: Family Support Through Diagnosis and Treatment

Psychosis is a troubling and distressing state of mind, a set of symptoms, and often a reaction to something. It is not, in itself, a mental illness. Some mental illnesses cause psychosis, including schizophrenia and bipolar disorder, but the term psychosis describes characteristic symptoms.

This is a state in which a person has lost touch with reality to some extent. They may see or hear things that aren’t real, believe things that are false, feel detached from themselves or others, and behave and speak in strange ways. Think of psychosis as a disruption in perceptions and thoughts that makes it difficult to determine what is real and what isn’t.

An episode of psychosis may be a one-time incident, triggered by drugs or a traumatic event, or it may be a recurring set of symptoms caused by a mental illness or brain injury.

To better help your loved one who is struggling, it’s essential that the rest of the family understands what psychosis looks like. This will help you recognize an episode, whether it is an acute state or a relapse of an ongoing mental illness. The most characteristic signs of psychosis are:

• Hallucinations. A hallucination is a sensation that feels real but isn’t. Your loved one may hear, see, feel, and even smell or taste things that are not real. They are likely to be confused and unsure when something is real or not.
• Delusions. A delusion is a persistent false belief. Even in the face of evidence to the contrary, someone who is delusional believes something to be true. Paranoia and suspicious beliefs, for instance, are typical. Someone may think the government is listening to their conversations or that someone is trying to hurt them.

To be diagnosed with psychosis, an individual must have experienced at least one of these. There are other symptoms, though, including disordered thoughts and rambling speech, unusual and inappropriate behaviors and reactions, and feelings of detachment or depersonalization.

There can also be other signs that are not always caused by psychosis. But, these may be early warnings of an episode:

• Unusual changes in behaviors, like a drop in school or work performance
• Difficulty concentrating, getting things done, or thinking
• Neglecting hygiene and other aspects of self-care
• Suspicious thoughts and behaviors
• Spending an unusual amount of time alone
• Extreme changes in emotions, either stronger emotions or flat, emotionless expression

Keep in mind that while it may be unsettling to watch a loved one go through these experiences, for them it is distressing and scary. Be patient and calm as you try to get them help.

A common cause of psychosis is a mental illness. Bipolar disorder and depression can cause psychosis. Schizophrenia and related conditions, which include delusional disorder, brief psychotic disorder, and schizoaffective disorder, also typically cause psychotic symptoms.

Other causes can include trauma and severe stress, head injuries, and certain medical conditions like Alzheimer’s disease, Parkinson’s disease, lupus, and brain tumors. Abuse of drugs or alcohol may also trigger psychosis. A substance-induced episode is usually short-term, ending when the drug or alcohol is out of the system.

Any signs of psychosis should be taken seriously. In some cases, a psychotic episode causes a crisis, in which the individual is extremely distressed or even at risk of harming themselves or someone else. In other instances, the signs are more subtle.

Psychosis, however, is not something that will simply go away, no matter how mild or severe. Even if there is recovery, such as after drug use, recurrences are common. And, the underlying problem that caused the episode in the first place needs to be identified and treated, whether it’s a mental or physical illness.

Sometimes treatment comes before the diagnosis, especially in cases of crisis. If you are facing a loved one going through a mental health emergency with signs of psychosis, it’s important to handle the situation safely. Keep these tips from experts in mind as you talk to someone in psychosis:

• Don’t dispute their delusions and hallucinations, but don’t reinforce them either. You cannot talk them out of those false beliefs or sensations, but playing along also doesn’t help.
• Instead of referencing the hallucination or delusion, address their feelings. Assure your loved one that you know they feel frightened and confused. Validate their feelings; these are real.
• Be calm and patient, and listen to their thoughts and fears without judgement.
• Respond in the way your loved one needs in the moment. For instance, if they feel suspicious, give them physical space and avoid eye contact. If they are paranoid you’ll leave them, stay close while calling for help.
• If you believe your loved one may hurt themselves or someone else, call for emergency assistance.

It is important that you take all possible steps to get your loved one into treatment. Most people experiencing psychosis will not seek help on their own.