Psychosis is a symptom that distorts a person's thoughts and perceptions, making it difficult for them to distinguish what's real from what's not.

Psychosis can be triggered by things like stress, substance use and hormonal shifts in the peripartum period, or physical health conditions like a bladder infection. A primary psychotic disorder is a chronic condition involving diagnoses such as schizophrenia and schizoaffective disorder.

People experiencing psychotic symptoms require immediate attention. Often, long-term treatment is necessary for individuals experiencing psychosis.

“Being in a psychotic state of mind is not good for your brain,” says psychiatrist Riley Machal, MD. “And the longer you stay in psychosis, the harder it is to pull you out of it. So, it’s important to get help as soon as possible.”

Psychosis symptoms

Symptoms of psychosis are categorized into two groups: positive and negative.

• Positive symptoms are characterized by hallucinations, delusions and disorganized thinking. These symptoms are often responsive to medications.
• Negative symptoms include social withdrawal, decreased speech output, decreased pleasure in everyday activities and fewer facial expressions.

People experiencing psychosis related to substance use or physical health conditions are more likely to experience only positive symptoms. They often hallucinate things that are not there and have delusions that are paranoid or grandiose.

“Delusion can range through many topics, but a common one is someone, often a government entity, is trying to get you or hurt you,” says psychiatrist Riley Machal, MD. “It’s a really terrifying experience for people and makes them run away from people who are trying to help.”

In addition, people with positive symptoms may not make sense when they speak, using the wrong words or saying them in the wrong order.

Those with a primary psychotic disorder are more likely to experience both positive and negative symptoms.

“They might not want to be around other people; they may stop talking as much and feel less motivated to do things,” Dr. Machal says. “They receive less pleasure from things like walking outside and feeling the sun on their face. That might be blunted for them.”

Dr. Machal notes that while people with negative symptoms may show less emotion in their facial expressions, it’s a misperception that they’re not feeling emotions.

Treatment

Psychosis treatment often includes medication and psychotherapy. Case management and support programs are also important aspects of treatment.

Antipsychotic medications, which can be taken orally or via long-acting injections, are often used to treat psychosis. Clinicians work with patients and their families to determine the best individualized treatment plan for them.

Treatment programs

Nebraska Medicine offers a variety of supports for individuals who have experienced psychosis and their families. These include:

• Active Support for Psychosis in Recovery, or ASPIRE, which offers the following programs:
  • Initial Management of Psychosis through Assertive Collaborative Treatment, or IMPACT: The IMPACT program provides support to individuals as young as 16 who have experienced their first episode of psychosis and their families.
  • Individual therapy
  • Behavioral family therapy: ASPIRE is the first U.S. team trained to provide this gold-standard treatment.
  • Group therapy
  • Group occupational therapy: Occupational therapy students work with groups to help build skills related to daily activities.

In addition, an intensive outpatient program for comprehensive physical and mental health care is in development.

Act now

If you suspect you or someone you love is experiencing psychosis, prompt treatment is necessary.

“If there is a concern that someone is in danger, either they might harm themselves or someone else, or they are so disorganized that they could accidentally hurt themselves, that person should be brought to the emergency department,” Dr. Machal says.

After the acute phase, early psychosis intervention, like the Nebraska Medicine IMPACT program, is crucial, Dr. Machal says.

“My number one recommendation for people early on is to get them into an actual first-episode program as opposed to just seeing any psychiatrist. It is imperative.”