A psychotic break, also known as an episode of psychosis, represents a significant disruption in a person’s thinking and perception, leading to a loss of contact with reality. During a psychotic break, individuals may struggle to differentiate between what is real and what is not.
Who is at Risk for a Psychotic Break?
Pinpointing the exact number of people who experience psychosis is challenging. Studies suggest that approximately 15 to 100 individuals out of every 100,000 will develop psychosis annually. While it often manifests during young adulthood, typically between the late teens and mid-20s, psychotic episodes can occur at any age and can be associated with various disorders and illnesses. For example, older adults with neurological conditions have an elevated risk.
Recognizing the Signs and Symptoms of a Psychotic Break
The hallmark symptoms of psychosis include delusions and hallucinations. Delusions are fixed, false beliefs, such as believing that television personalities are sending personal messages or that others intend to harm them. Hallucinations involve sensing things that aren’t actually there, such as hearing voices instructing them to do something or constantly criticizing them. Other signs may encompass incoherent speech and behavior inappropriate to the situation.
However, behavioral changes frequently precede a full-blown psychotic break. These warning signs include:
- Increased suspiciousness, paranoid thoughts, or general unease around others.
- Difficulty thinking clearly and logically.
- Social withdrawal and increased isolation.
- Unusual or overly intense ideas, strange feelings, or a lack of emotional response.
- Neglect of self-care or personal hygiene.
- Disturbed sleep patterns, including insomnia or reduced sleep duration.
- Difficulty distinguishing between reality and fantasy.
- Confused speech or difficulty communicating.
- A sudden decline in academic performance or job productivity.
Alongside these symptoms, a person experiencing a psychotic break may also exhibit more general behavioral changes like:
- Emotional instability
- Anxiety
- Lack of motivation
- Impaired overall functioning
In severe cases, individuals experiencing a psychotic break may exhibit unpredictable and confusing behaviors, potentially leading to self-harm or violence towards others. However, with proper treatment, the risks of violence and suicide decrease significantly. If you recognize these changes in yourself or a loved one, it is crucial to seek professional help immediately.
The National Institute of Mental Health (NIMH) provides resources for finding help and accessing treatment: NIMH Find Help. If you or someone you know is struggling or having thoughts of suicide, call or text the 988 Suicide and Crisis Lifeline at 988 or chat at 988lifeline.org. In life-threatening situations, call 911.
Uncovering the Causes of a Psychotic Break
There isn’t a single, definitive cause of psychosis. Instead, it appears to arise from a combination of genetic predisposition, variations in brain development, and exposure to stressors or trauma. Psychosis can be a symptom of underlying mental illnesses like schizophrenia, bipolar disorder, or severe depression. However, some individuals may experience psychosis without ever receiving a diagnosis of schizophrenia or another mental disorder.
In older adults, psychotic symptoms can be indicative of a physical or mental illness that emerges later in life. Psychosis can also be a symptom of neurodegenerative diseases such as Parkinson’s disease, Alzheimer’s disease, and other forms of dementia.
Other potential causes of a psychotic break include sleep deprivation, certain prescription medications, and substance misuse (alcohol or drugs). A mental health professional typically diagnoses a mental illness like schizophrenia by ruling out these alternative causes.
A qualified mental health professional, such as a psychologist, psychiatrist, or social worker, can provide a comprehensive assessment and accurate diagnosis.
Effective Treatments for a Psychotic Break
Studies indicate that individuals often experience psychotic symptoms for over a year before seeking treatment. Reducing this period of untreated psychosis is vital, as early intervention often leads to improved outcomes. A trained psychologist, psychiatrist, or social worker can provide a diagnosis and develop an appropriate treatment plan.
Treatment for psychosis typically involves antipsychotic medication. These medications come in various forms with varying side effects, so collaboration with a healthcare provider is important to identify the most effective medication with the fewest side effects.
Treatment frequently incorporates additional elements. There is strong research support for coordinated specialty care (CSC), a comprehensive, recovery-oriented team approach to treating psychosis. CSC prioritizes easy access to care and shared decision-making among specialists, the individual experiencing psychosis, and their family members. Coordinated specialty care is most effective when initiated as soon as possible after the onset of psychotic symptoms.
Coordinated specialty care is now the gold standard for early psychosis treatment, according to “The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia.”
Components of Coordinated Specialty Care
Coordinated specialty care encompasses several key components:
- Individual or group psychotherapy: Tailored to the individual’s recovery goals. Cognitive and behavioral therapies focus on developing coping mechanisms, resilience, and skills to manage psychosis while pursuing personal goals.
- Family support and education programs: Provide family members with information about psychosis, coping strategies, communication skills, and problem-solving techniques. Informed and involved family members are better equipped to support their loved ones throughout the recovery process.
- Medication management (pharmacotherapy): Involves customizing medication to a person’s specific needs by selecting the appropriate type and dosage to alleviate psychotic symptoms. Like all medications, antipsychotic medications have risks and benefits. Patients should discuss side effects, medication costs, and dosage preferences (daily pill or monthly injection) with their healthcare provider.
- Supported employment and education services: Focus on helping individuals return to work or school, often with the support of a coach to facilitate goal achievement.
- Case management: Provides opportunities for individuals with psychosis to work with a case manager to address practical challenges and improve access to necessary support services.
People with psychosis should actively participate in their treatment planning and decision-making regarding their care. Treatment programs should be driven by their individual needs and goals, which will promote engagement throughout the recovery process.
Finding a mental health professional who is trained in psychosis treatment and with whom the individual feels comfortable is crucial. With early diagnosis and appropriate treatment, recovery from psychosis is possible. Some individuals who receive early treatment may never experience another psychotic break. For others, recovery entails living a fulfilling and productive life, even if psychotic symptoms occasionally resurface.
Seeking Help and Support
If you or someone you know is experiencing symptoms of psychosis, seeking professional help is essential. Early intervention and comprehensive treatment can significantly improve outcomes and quality of life. Remember, recovery is possible, and support is available.
