Psychosis: What is it and when should it be treated?

In this informative article, highly respected consultant psychiatrist Dr Maria Martinez Herves shares her expert insight on psychosis, a mental health problem which impairs a person’s ability to perceive reality. The leading specialist also explains the importance of prompt treatment and the various therapeutic approaches available.

What is meant by psychosis?

Psychosis affects the mind severely and separates it from reality. Initial psychotic episodes often appear between adolescence and early adulthood (until the mid-twenties), and often onset in a very gradual way, with the young person presenting initially with changes in behaviour. This can manifest in the person becoming socially withdrawn, or experiencing difficulty in focusing or thinking, an altered sleep pattern, self-neglect or suspiciousness.

Most evident symptoms of psychosis often develop in later stages, such as auditory, visual or somatosensory hallucinations, or delusions, including paranoia. Psychosis is associated with poor general functioning.

What are the leading causes?

Psychosis can be a symptom of other conditions, such as schizophrenia, bipolar disorder and depression. It can also be a consequence of substance intoxication, medications or physical illnesses. Therefore it is important to rule out organic causes of this presentation when the specialist considers this is indicated. The diagnosis of psychosis is clinical, and other investigations will just be complementary.

When and how should psychosis be treated?

It is important that psychosis is treated as soon as possible, as the long duration of untreated psychosis (DUP) is associated with more serious prognosis. There is a wide range of therapeutic approaches including:

• medication
• individual therapy
• CBT family work
• psychoeducation
• occupational therapy
• social prescribing

What happens if psychosis is left unnoticed or untreated?

The prognosis of psychosis will vary depending on its cause. There is a combination of factors at play, including individual vulnerability as well as social and life circumstances. Additionally, some patients have important ACEs (adverse childhood experiences), trauma, substance misuse or acquired physical health problems, amongst others.

When psychosis has an abrupt onset, for example when produced by drugs, it often self resolves. If the acute onset is due to an underlying physical health problem, the prognosis will depend in many cases on the treatment, management and prognosis of that physical health condition. Psychosis can have a fluctuating presentation, however it worsens the cognitive and functional outcomes of the patient if left untreated.

If you are concerned about psychosis and wish to schedule a consultation with Dr Martinez Herves, you can do so by visiting her Top Doctors profile.