Few experiences are more frightening—for the person going through it or for those who love them—than
watching reality slip away. An episode of psychosis is when a person has a break from reality and often
involves seeing, hearing, and believing things that aren’t real.¹ These experiences represent a profound
disruption in how the brain processes and interprets the world.
Approximately 3 in 100 people will experience an episode of psychosis during their lives.¹ Young adults
are placed at an increased risk to experience an episode of psychosis because of hormonal changes in the
brain that occur during puberty, but a psychotic episode can occur at any age.¹
At The Horizon Behavioral Health in Worcester, we understand the urgency and fear that surrounds
psychosis. We also know that with proper treatment, recovery is possible. Early intervention dramatically
improves outcomes, and our experienced team provides the specialized care that psychotic disorders
require.
Psychosis: A Symptom, Not a Diagnosis
One of the most important things to understand about psychosis is that it is not an illness, but a symptom.¹
A diagnosis identifies an illness, and symptoms are components of an illness.¹ Just as fever indicates
something is wrong in the body without specifying what, psychosis signals a disruption in brain function
that can have many underlying causes.
A psychotic episode can be the result of a mental or physical illness, substance use, trauma, or extreme
stress.¹ Sometimes psychosis occurs as an isolated episode that never returns; other times it’s part of a
chronic condition requiring ongoing management. Identifying and addressing the root cause is essential
for effective treatment.
Recognizing Psychosis: Core Symptoms
Symptoms of a psychotic episode can include incoherent speech and disorganized behavior, such as
unpredictable anger.¹ However, psychosis typically involves one of two major experiences:¹ ²
Hallucinations
Hallucinations involve seeing, hearing, or physically feeling things that aren’t actually there.¹ While many
people associate hallucinations with seeing things that aren’t there, auditory hallucinations—hearing
voices or sounds—are actually most common in psychotic disorders.² These voices may comment on theperson’s behavior, carry on conversations, or issue commands. They feel completely real to the person
experiencing them, not like imagination or daydreaming.
Hallucinations can also involve other senses. Some people feel physical sensations like being touched
when nothing is there. Others smell or taste things that have no external source.
Delusions
Delusions are strong beliefs that are unlikely to be true and may seem irrational to others.¹ These aren’t
simply mistakes or misunderstandings—they’re convictions that feel absolutely certain to the person
experiencing them, even when they seem impossible to everyone else.
Common types of delusions include:²
Paranoid delusions — believing others are watching, following, or plotting harm
Grandiose delusions — believing you have special powers, importance, or connections
Referential delusions — interpreting random events as personally meaningful messages
Somatic delusions — beliefs about the body, such as that organs are missing
Early Warning Signs: The Prodrome Period
Most people think of psychosis as a sudden break from reality.¹ While acute episodes can feel that way,
there are often warning signs that precede an episode of psychosis.¹ This prodromal period offers a crucial
window for intervention. Knowing what to look for provides the best opportunity for early intervention.¹
Some early indications are:¹
A worrisome drop in grades or job performance
Trouble thinking clearly or concentrating
Suspiciousness or uneasiness with others
A decline in self-care or personal hygiene
Spending a lot more time alone than usual
Strong, inappropriate emotions or having no feelings at all
If you notice these warning signs in yourself or someone you care about, seeking evaluation promptly can
make an enormous difference. Early intervention programs for psychosis have transformed outcomes,
helping many young people avoid the most severe manifestations of psychotic illness.³
What Causes Psychosis?
Psychosis results from complex interactions between genetic vulnerability, brain development and
function, and environmental factors. Several factors can contribute to psychosis:¹ ² ³
Genetic Factors
Many genes are associated with the development of psychosis, but just because a person has a gene
doesn’t mean they will experience psychosis.¹ Having a close relative with schizophrenia substantially
increases risk, though most people with family history never develop the condition themselves.²Trauma and Stress
A traumatic event such as a death, war, or sexual assault can trigger a psychotic episode.¹ Extreme stress
can precipitate psychotic episodes, particularly in people with genetic vulnerability.
Substance Use
The use of marijuana, LSD, amphetamines, and other substances can increase the risk of psychosis in
people who are already vulnerable.¹ Cannabis use, particularly during adolescence, has been linked to
increased risk for developing psychotic disorders.³
Physical Illness or Injury
Traumatic brain injuries, brain tumors, strokes, HIV , and some brain diseases such as Parkinson’s,
Alzheimer’s, and dementia can sometimes cause psychosis.¹ This is why medical evaluation is essential
when psychosis first appears.
Getting an Accurate Diagnosis
Psychosis is a symptom, not an illness.¹ A diagnosis identifies an illness, and symptoms are components
of an illness.¹ Health care providers draw on information from medical and family history along with a
physical examination to make a diagnosis.¹
If causes such as a brain tumor, infection, or epilepsy are ruled out, a mental illness might be the cause.¹
Conditions that can include psychosis as a symptom include:² ³
Schizophrenia — A serious mental illness affecting how a person thinks, feels, and behaves,
characterized by chronic psychotic symptoms along with negative symptoms (reduced motivation,
emotional expression) and cognitive difficulties.
Schizoaffective Disorder — Combines symptoms of schizophrenia with mood disorder symptoms—
either depression or bipolar-type mood episodes.
Brief Psychotic Disorder — Sudden onset of psychotic symptoms lasting between one day and one
month, often in response to extreme stress.
Bipolar Disorder or Major Depression with Psychotic Features — Mood disorders that can include
hallucinations or delusions during severe episodes.
Substance-Induced Psychosis — Psychotic symptoms caused by intoxication or withdrawal from drugs
or alcohol.
The Critical Importance of Early Intervention
Identifying and treating psychosis as early as possible leads to the best outcomes.¹ Early intervention is
always the best approach to treating a mental health condition, because there is a chance of preventing the
illness from progressing.¹
Research consistently shows that the sooner treatment begins after psychotic symptoms emerge, the better
the long-term outcome.³ The period between when symptoms first appear and when treatment begins—
called the “duration of untreated psychosis”—directly predicts how well someone will recover.³There are many specialized centers that focus exclusively on psychosis and crisis treatment in youth.¹ The
American Psychiatric Association, your state chapter of the APA, primary care doctor, insurance carrier,
and the state or county mental health authority are resources that can help find help.¹
At The Horizon Behavioral Health, we emphasize early intervention and work to connect individuals
showing warning signs with appropriate evaluation and treatment as quickly as possible.
Comprehensive Treatment for Psychotic Disorders
Treatments for psychosis can include a combination of psychotherapy, medication, complementary health
approaches, or even hospitalization.¹ It’s important to work with a mental health care professional to
determine the right treatment path.¹
Antipsychotic Medication
Antipsychotic medications remain the foundation of psychosis treatment. These medications help control
hallucinations, delusions, and disorganized thinking, often providing significant relief within weeks.²
Modern “atypical” antipsychotics have fewer movement-related side effects than older medications,
though all antipsychotics can have side effects that require monitoring.² Finding the right medication and
dose often takes time and collaboration between patient and provider. Long-acting injectable medications
offer an alternative to daily pills for some individuals.³
Psychotherapy
Therapy provides essential support and skill-building for people with psychotic disorders. Cognitive
Behavioral Therapy for psychosis (CBTp) helps individuals examine and challenge delusional beliefs,
develop coping strategies for hallucinations, and address the depression and anxiety that often accompany
psychotic illness.²
Family therapy educates loved ones about psychotic disorders and improves communication and
problem-solving within the family system. Family support dramatically improves outcomes.³
Psychosocial Rehabilitation
Recovery from psychotic disorders involves rebuilding life skills, relationships, and roles in the
community. Supported employment and education programs help individuals return to work or school.
Social skills training addresses interpersonal difficulties. Case management connects people with housing,
benefits, and community resources.³
Coordinated Specialty Care
The most effective approach for early psychosis combines all these elements into coordinated specialty
care (CSC) programs. These team-based programs provide integrated medication management, therapy,
family support, case management, and rehabilitation services. Research demonstrates dramatically better
outcomes with CSC compared to traditional treatment approaches.³
Supporting a Loved One with Psychosis
Watching someone you love experience psychosis can be terrifying and heartbreaking. Understanding the
condition and knowing how to help makes an enormous difference.Remember that the person experiencing psychosis is not choosing their symptoms. Hallucinations and
delusions feel completely real to them. Arguing about whether their experiences are real usually isn’t
helpful and can damage trust.
Instead, focus on expressing care and concern. Let them know you’re worried about them and want to
help. Encourage professional evaluation without ultimatums. Learn about psychotic disorders so you can
be a more effective support.
If your loved one is in crisis—expressing thoughts of harming themselves or others, unable to care for
basic needs, or behaving dangerously—seek emergency help immediately.
Frequently Asked Questions About Psychosis
Is psychosis the same as schizophrenia?
No. Psychosis is a symptom that can occur in many different conditions, including schizophrenia, bipolar
disorder, severe depression, substance use, and medical conditions.¹ Schizophrenia is one specific illness
characterized by chronic psychotic symptoms along with other features.
Can someone recover from psychosis?
Yes. Many people who experience psychotic episodes recover fully and never have another episode.³
Others experience recurring episodes but live full lives between them with proper treatment. Even chronic
psychotic conditions like schizophrenia have much better outcomes than historically believed, particularly
with early intervention.
Does psychosis mean someone is dangerous?
The vast majority of people with psychotic disorders are not violent.² In fact, they’re more likely to be
victims of violence than perpetrators. While acute psychotic episodes can occasionally involve agitation
or confusion, proper treatment effectively manages these risks.
Can substance use cause permanent psychosis?
In some cases, yes. While many substance-induced psychotic episodes resolve when the substance clears
the system, some individuals develop persistent psychotic symptoms, particularly with heavy or
prolonged use of certain substances.¹ ³ Cannabis use during adolescence appears to increase risk for
chronic psychotic disorders.
What should I do if I think someone is developing psychosis?
Encourage professional evaluation as soon as possible. Early intervention dramatically improves
outcomes.¹ If the person is resistant, involve other trusted people in expressing concern. If they’re in
immediate danger or unable to care for themselves, seek emergency assistance.
There Is Hope
A psychosis diagnosis can feel like the end of everything—dreams, plans, the future as you imagined it.
But psychosis is treatable, and recovery is possible. Many people who experience psychotic episodes go
on to complete education, build careers, form relationships, and live meaningful lives.At The Horizon Behavioral Health in Worcester, MA, we’ve witnessed this recovery many times. Our
experienced team provides the specialized, compassionate care that psychotic disorders require. We
believe in early intervention, comprehensive treatment, and the possibility of recovery for everyone who
walks through our doors.
Ready to take the first step?
If you or someone you love is experiencing symptoms of psychosis, please don’t wait. The sooner treatment begins, the better the outcome. Help is available right here in Central Massachusetts.
Schizophrenia & Psychotic Disorders
Psychosis—experiencing hallucinations, delusions, or disconnection from reality—affects approximately
3 in 100 people at some point in their lives. Whether symptoms are just emerging or have persisted for
years, early intervention and specialized treatment dramatically improve outcomes. Our team provides
expert, compassionate care to help you or your loved one find stability and build a path to recovery.
[Read More →]
References
1. 2. 3. 4. 5. National Alliance on Mental Illness. (2015). Psychosis Fact Sheet. NAMI.
https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Psychosis
American Psychiatric Association. (2022). What Is Psychosis? APA.
https://www.psychiatry.org/patients-families/psychosis/what-is-psychosis
National Institute of Mental Health. (2024). Understanding Psychosis. NIMH.
https://www.nimh.nih.gov/health/publications/understanding-psychosis
SAMHSA (Substance Abuse and Mental Health Services Administration). (2024). Early Serious
Mental Illness. SAMHSA. https://www.samhsa.gov/serious-mental-illness/early-psychosis
National Alliance on Mental Illness. (2024). Schizophrenia. NAMI. https://www.nami.org/About-
Mental-Illness/Mental-Health-Conditions/Schizophrenia
Word Count: ~2,100 words Last Updated: January 2025 Medical Review: Content based on current
clinical guidelines and peer-reviewed sources