Psychosis

Overview

Psychosis is not a condition by itself but a set of symptoms that affect how your mind processes what is real and what is not. If you are experiencing psychosis, you may see, hear, believe, or feel things that others do not. It can be frightening, but it is treatable, and many people recover with the right support.

Psychosis is more common than many people think. It affects about 3 in every 100 people at some point in their lives.

Psychosis can affect anyone. It often begins in late adolescence or early adulthood, particularly in the late teens to mid-20s. It can also affect older adults, especially if linked to dementia or other medical conditions.

Symptoms

Common symptoms

• Hallucinations — seeing, hearing, or feeling things that are not really there. Hearing voices is the most common.
• Delusions — strong beliefs that are not real or based on facts, such as believing you are being followed or that you have special powers.
• Disorganised thinking or speech — jumping between ideas, speaking in a confused way, or stopping mid-sentence.
• Changes in behaviour — becoming withdrawn, less active, or acting in a way that seems out of character.

Symptoms in children

• It can be harder to spot in children. Look for a sudden drop in school performance, increased mistrust, or talking about imaginary experiences that seem very real to them.
• They may become unusually fearful, confused, or withdraw from friends and family.

Symptoms in older adults

• In older adults, psychosis may be linked to dementia, delirium, or medical illness. It can show as suspicion, paranoia, or seeing or hearing things that are not there.
• It may also be the first sign of a mental health condition, or caused by infections, medicines, or dehydration.

Causes

Main causes

• Mental health conditions such as schizophrenia, bipolar disorder, or severe depression.
• Substance use — particularly cannabis, amphetamines, cocaine, or alcohol withdrawal.
• Extreme stress, trauma, or sleep deprivation.
• Physical conditions such as brain injury, infections, hormonal imbalances, or dementia (especially in older adults).
• Reactions to certain medicines or medications — but talk to a healthcare provider about any concerns.

Risk factors

• Family history of psychosis or mental illness.
• Use of illicit drugs, especially cannabis or stimulants, during adolescence or early adulthood.
• Experiencing severe stress, abuse, or trauma.
• Social isolation or lack of support.

When to see a doctor

See a doctor urgently if:

• If you or someone you know is experiencing hallucinations, delusions, or confused thinking for the first time, seek help the same day.
• If there is any risk of harm to self or others, call emergency services immediately.

Book a routine appointment if:

• If you notice changes in thinking, mood, or perception that concern you or your family — even if you are unsure — make an appointment with your GP.

Diagnosis

A doctor cannot diagnose psychosis with a single test. A GP will usually refer you to a specialist mental health team who will talk with you in detail, listen to your experiences, and check for any physical causes.

Tests that may be done

• Physical examination and basic blood tests to rule out medical or hormonal causes.
• A detailed mental health assessment — you will be asked about your thoughts, feelings, and experiences.
• Checking of medication – any current medicines or drugs may be reviewed.
• Sometimes brain imaging or an electrocardiogram (ECG) may be arranged if the specialist thinks it is needed.

What to expect at your appointment

The assessment is not a judgement. You will be listened to, and you can ask questions. It may take more than one visit to get a full picture, and the specialist team will agree a care plan with you.

Treatment

Treatment for psychosis depends on the cause, but most people are treated in the community with a combination of medication and talking therapies. Early support works best.

Self-care at home

• Take any prescribed medication exactly as agreed with your healthcare team — never stop suddenly.
• Avoid recreational drugs and limit alcohol.
• Prioritise sleep and keep a regular routine.
• Learn and use calming techniques like breathing exercises or mindfulness.
• Keep in touch with people you trust; let them know how they can help.

Medical treatments

Medical treatment is usually prescribed by a psychiatrist. Antipsychotic medications help reduce or stop hallucinations and delusions. They are not a cure, but they can significantly control symptoms. In addition, talking therapies like cognitive behavioural therapy (CBT) for psychosis help you make sense of and cope with your experiences. Family intervention may also be offered to support those close to you.

Living with this condition

Living with psychosis is a long-term journey for some people. With the right treatment and support, many people manage symptoms, go to work or study, and enjoy relationships. It helps to build a daily structure and to have a trusted team around you.

Lifestyle tips

• Keep a mood or symptom diary to notice early warning signs.
• Stay involved in activities you enjoy, in small steps.
• Join a peer support or recovery group if available.
• Have a written crisis plan with your care team.

Diet and exercise

A balanced diet and regular physical activity can improve mood, energy, and overall health. There is no special psychosis diet, but eating well and getting some daily movement, even a short walk, can help stabilise your wellbeing.

Mental health and emotional wellbeing

Psychosis can be very distressing and isolating. It may affect how you see yourself and how others see you. It is common to feel anxious, depressed, or ashamed. These feelings are part of the illness and deserve care, just like any other symptom.

Prevention

Psychosis cannot always be prevented, but reducing risk factors can help. Avoid street drugs, manage stress, keep a healthy sleep routine, and get help early if you start to feel different in your thinking or perception.

Complications

If left untreated

• Self-harm or suicidal behaviour.
• Harm to others if delusions or commands feel urgent.
• Substance misuse as a way to cope.
• Social withdrawal, relationship difficulties, and difficulty keeping a job.
• Worsening of the underlying mental health condition.

Long-term outlook

With early and consistent treatment, the outlook for psychosis is far better than often assumed. Many people have a full recovery, and others learn to live well with manageable symptoms. There is real hope, and you are not alone.

Find support

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