Washington University School of Medicine

What is Psychosis?

Psychosis is a state that occurs when someone experiences a break with reality. Those experiencing psychosis have difficulties recognizing what is real and what is not real. For example, they may become very suspicious of people or things happening around them. They may see or hear things that others don’t. They may believe things that could be considered odd or bizarre to others, or behave in unusual or disorganized ways. Experiences vary from person to person and these symptoms can be confusing, distressing or frightening to those affected.

Psychosis is more common than many people realize. As much as 3% of the population will have a mental illness with psychotic features at some point in their lives. Common psychotic disorders include schizophrenia, schizoaffective disorder or some forms of bipolar disorder involving psychosis.

Symptoms of psychotic disorders are usually first experienced in late adolescence or early adulthood. They can derail a young person’s social, academic, and vocational development and initiate a trajectory of accumulating disability. Youth who develop psychotic disorders frequently become unable to continue with their education or employment. Many of those affected become disabled and require repeated hospitalizations due to the disorder’s often unremitting and relapsing course.

Before the onset of psychosis, patients often experience attenuated psychotic-like experiences. Some signs of early psychosis include:

  • Recent change in thinking or speech
  • Bizarre behaviors
  • Unusual or irrational beliefs
  • Social withdrawal
  • Increased suspiciousness of others
  • Decreased personal hygiene
  • Hearing voices or misperceiving sounds
  • Visual hallucinations

Often depression and anxiety are also reported. Additionally, many of those experiencing psychosis may abuse drugs and alcohol to cope with symptoms.

Adolescence and young adulthood are particularly formative periods in life when several major changes occur. During this time, the brain undergoes a rearrangement of critical neural circuits. This is also when many potentially severe mental disorders first manifest clinically. Studies have shown that intervening early in the course of a psychotic disorder can improve long-term outcomes compared to intervening years after disorder onset.

More information about psychosis can be found here.