PsychosisWhat is psychosis, how does an episode begin, and do people recover?

12What is psychosis?

A mother says: “My son has started shutting himself in, saying people are watching him from the window, and what he says doesn't hang together.” This is how many stories with psychosis begin: a change the family cannot understand, and a fear the person cannot explain. The reassuring news is that psychosis is a well-understood medical condition with treatment, and that the time that passes before treatment begins makes a big difference.

The U.S. National Institute of Mental Health (NIMH) defines psychosis as a group of symptoms affecting the mind in which there is a loss of some connection with reality, so that a person's thoughts and perceptions are disturbed and it becomes hard to tell what is real from what is not. Doctors call the appearance of these symptoms in a defined period a psychotic episode.

Psychosis is a little like “fever” in internal medicine: a sign that there is a problem, not the name of the problem itself. That is why the doctor's first question is always: what caused this episode? Is it part of a mental illness, the effect of a drug, or a symptom of a physical illness?

13How common is psychosis? Psychosis in numbers

It is hard to count precisely how many people experience psychosis, because many never reach a doctor and because episodes vary in severity and length. But the available figures suggest it is closer to home than we think:

Sources: NIMH, StatPearls, and the study by McGrath and colleagues in the World Health Organization's World Mental Health Surveys (2015). No documented Egyptian figures are available, so we rely on global estimates.

The third figure needs some explanation: most of these experiences were brief, and about a third of people reported that it happened only once in their lives. So hearing a voice once or going through a strange suspicion does not necessarily mean a psychotic illness; it is repeated, persistent experiences that affect your life that call for assessment.

14What does psychosis look like from the inside?

From the outside, a family sees strange behavior, but from the inside the person lives in a world whose rules have changed: voices are as clear as if someone were in the room, coincidences seem like deliberate messages, and the glances of passersby carry a threat. Because all of this seems completely real, fear is the dominant feeling, not the “hallucination” as we imagine it.

“I was certain the neighbors knew everything I was thinking, and that the ads on TV were aimed at me. It never occurred to me that I was ill; I thought everyone was deceiving me.” (An expression that recurs in different forms among many people who have had a psychotic episode, not a quotation from a specific patient.)

This is why many people do not ask for help themselves at first; limited awareness of being ill is part of the condition itself, not stubbornness, and it often improves with treatment. Here, the family's attention becomes the first door to treatment.

15What are the main symptoms of psychosis?

The symptoms of psychosis revolve around three areas named by the NHS: hallucinations, most commonly hearing voices; delusions, most commonly a belief in a plot to harm you; and disorganized thinking and speech. They may be preceded by withdrawal, poor sleep and a decline in study or work, and are sometimes accompanied by “negative” symptoms such as flat emotion and reduced speech. The full details, with early warning signs, are on the page symptoms and signs of psychosis, and we also provide two guides on two of its best-known symptoms: auditory and visual hallucinations and paranoia.

16How does a psychotic episode develop?

The first episode rarely comes out of nowhere. Doctors describe a typical course with many chances to intervene, though each person goes through it at their own pace:

1. Before the episode
   Subtle changes

   Weeks or months of anxiety, isolation, disturbed sleep and declining performance, which the family takes for a “phase” or laziness.

2. The acute episode
   Psychosis becomes clear

   Hallucinations, delusions or disorganized speech; this is when the family realizes that something big has changed.

3. The first weeks of treatment
   Stabilization

   Anxiety settles first, then hallucinations and delusions gradually fade over days to weeks.

4. The following months
   Recovery and return

   A gradual return to regular sleep, study and work, with follow-up to learn the warning signs and prevent relapse.

NIMH points out that shortening the duration of untreated psychosis is decisive, because early treatment often means a better recovery. Every month that passes without assessment prolongs suffering and delays the return to life.

17Why does psychosis happen?

There is no single cause of psychosis; according to NIMH it results from a complex interaction between genetic predisposition, differences in brain development, and exposure to stress or trauma. It may be part of a mental illness such as schizophrenia, the effect of a substance or withdrawal from one, or a symptom of a physical illness, a medication or severe sleep deprivation. We explain these factors, and the role of hashish, trauma and lack of sleep, in detail on the page causes of psychosis; when a substance is the direct cause, the details are in the guide to drug-induced psychosis.

18What is the difference between psychosis, schizophrenia and similar conditions?

Confusion among these terms is common even among educated people, and telling them apart matters because the treatment plan differs. The types of psychotic disorders themselves are covered in detail on the page psychotic disorders:

The short rule: everyone with schizophrenia goes through psychosis, but not everyone who has a psychotic episode has schizophrenia. An episode may be brief and never recur, the effect of a substance, or part of a mood disorder, which is why a diagnosis is not made from a single episode.

19Common myths about psychosis

20Can psychosis be treated? Do patients recover?

Yes. The NHS says psychosis is an acute condition that often ends in full recovery if treated. Treatment is usually based on antipsychotic medication together with cognitive behavioral therapy, family intervention and support in returning to study and work, and some patients may need a short stay in a psychiatric hospital during a severe episode. The course after that varies: some never have another episode, and some have occasional episodes with normal life in between. We explain the options, how long medication is needed and the family's role on the page treatment of psychosis.

21When should you seek a psychological assessment?

Do not wait until you are sure that what is happening is “psychosis”. The purpose of early assessment is to understand what is going on before it gets worse, and it does not mean a verdict of chronic illness. Ask for a consultation if you notice:

• Talk of voices that no one else hears, or of being watched, a plot, or special messages.
• A lasting change in behavior or speech that is not in their nature, with growing isolation.
• Staying up for several nights in a row, or clearly neglecting hygiene and eating.
• Suspicions or hallucinations after using hashish or stimulants, even if they faded after a few days.
• Any talk of harming themselves or others; here help is urgent: ambulance (123) or the mental health support line 16328 (24 hours).

At Eradah, it starts with a confidential consultation with a psychiatrist, and the family can begin on their own if the patient refuses to attend, to learn how to persuade them and how to deal with them until they reach treatment.

22Psychosis guide: everything you need to know

We have gathered everything about psychosis into 5 pages, each answering one question in detail. Choose what you are looking for: