Please note that health information can only support the conversation with a psychotherapist or physician: It should never be a substitute for it!

What is psychosis?

Psychoses are mental illnesses which can manifest in different forms depending on the life context of the sufferer. However, there are symptom areas that are consistently changed in many sufferers. For instance, in psychosis, the thoughts, feelings and perception about one's own body and contact with other people can be changed. Sufferers often have difficulty distinguishing between reality and their own, subjective perception. This can lead to them hearing voices that other people do not hear, to them feeling that they are being followed or threatened (even by people who are close to them), to them receiving messages from a world that is not accessible to others, or to the feeling that they are physically changing.


For people on the outside, psychosis can best be understood as a state of being extremely thin-skinned. Internal and external processes can barely be distinguished from one another, proximity to loved ones can seem threatening.

The term "psychosis" is nowadays used as an umbrella term for different mental illnesses, of which the most marked signs of illness include hallucinations or delusions. This applies above all to schizophrenia, as well as other disorders of the schizophrenic spectrum, bipolar psychoses or psychoses in the context of severe depression.

How frequent are psychoses and who is affected?

1 to 2 out of 100 people suffer from a psychosis once in their lives. Currently, 51 million people worldwide are suffering from schizophrenia alone. Usually, the illness occurs for the first time between the ages of 12 and 29 years. Men and women are equally at risk. Nevertheless, there are risk factors that make a psychosis more likely.

What are the symptoms of a psychosis?

  • Positive symptoms (delusions, hallucinations)
  • Negative symptoms
  • Cognitive symptoms (disorganisation of thought processes, neurocognitive symptoms)
Positive symptom How you might perceive it
Hallucination "I can hear noises, conversations or voices even though I am in a quiet room. Other people say they can't hear anything. But I'm certain."
  "I see people or things in changed colours or shapes."
  "In some rooms it smells bad, like poisonous gases."
  "Some food tastes as though it is poisoned."
Delusion "I am a victim of unjustified stalking."
  "I know that there are people who have it in for me and won't leave me alone."
  "I have exceptional abilities that distinguish me from other people."
  "I have a close relationship with special powers or persons."
  "I am responsible for the happiness of all of the people on this planet."
 
Negative symptom How you might perceive it
Lack of drive "It's difficult to get out of bed in the morning. I usually just stay lying there."
  "I can't cope with some of my tasks."
  "Sometimes I have no motivation to even go out or get things done."
  "I frequently feel dispirited and lacking in drive."
Social withdrawal "I have rather lost interest in contact with other people."
Mood impairments "I have the feeling that I can't even be happy anymore, I can't communicate properly."
  "I speak much less than before and overall."
  "It feels like I am indifferent to everything. In part I feel numbed, like under a glass cover."
Cognitive symptom How you might perceive it
Thought disorder "Sometimes I can't think a thought through to the end."
  "I have too many thoughts in my head at the same time."
  "Sometimes I can't concentrate for long."
  "Sometimes I jump from one thought to the next."
  "My memory doesn't work like it used to."

How does a psychosis emerge?

We all go through stable and less stable phases in our lives. There are times when everything is fine and times when lots of things happen. These are also times of upheaval such as puberty, leaving school, commitment to a partner, the birth of a child or the loss of a loved one. When, during such times, current burdens also arise, for people with increased vulnerability (susceptibility), the likelihood of developing a psychosis can increase. Vulnerability means being thin-skinned, sensibility, but also sensitivity. People with a heightened vulnerability are more open to attack and can react with psychotic symptoms in stressful phases of life. An increased vulnerability emerges through various factors: traumatic effects which are difficult to process, early developmental disorders, previous family burdens, an injury or serious infection of the brain, or very early and heavy cannabis consumption. For vulnerable people to whom one or more factors apply, it is therefore particularly important to cultivate family and social strengths as well as to extend relaxation and coping strategies.

What are the first signs of a psychosis?

Many symptoms that arise in an acute psychosis can already have been present previously in a weaker form. Such early warning signs are difficult to detect. Only in retrospect do many people realise that unusual behaviours were present long before the onset of a psychosis. However, these were misunderstood and attributed, for example, to growing up, to drug abuse or to personal characteristics.

The following list should provide some help for recognising typical early warning signs of a psychosis:

Possible early signs How you might perceive it
Change of being Restlessness, nervousness, excitability, sensitivity, hypersensitivity, irritability, sleep disorders (excessive sleep or forgoing sleep), lack of appetite, self-neglect, wearing strange clothes, sudden lack of interest, initiative, energy
Change in feelings Depression, flattened feelings or mood swings, fears – in particular fears of being damaged/ threatened
Change in ability Low resilience (particularly in times of stress), concentration disturbances, increased distractibility, reduced performance
Change in social area Distrust, social withdrawal, isolation, problems with relationships, breaking off contacts
Change in interests Sudden unusual interests, e.g. for religious or supernatural things, magic etc.
Change in perception and experience Unusual perceptions (e.g. intensification or change of noises and colours; feeling that oneself or one's environment is changed; feeling of seeing, hearing, tasting or smelling things that other people don't perceive), peculiar ideas and unusual experience (e.g. self-references, one refers experiences or actions / statements of other people to oneself; feeling of being watched and of being influenced (feeling that other people have access to me or my feelings, control me or guide me))

What forms are there?

There are various types of psychoses, which differ from one another in terms of their causes, symptoms and in the duration of their symptoms:

  • Drug-induced psychosis

The use of drugs or stopping taking drugs and/ or alcohol can be linked to psychotic symptoms. Normally, the symptoms disappear as soon as the individual stops taking the drugs.

  • Organic psychosis

Sometimes, psychotic symptoms occur in the framework of illnesses in which the brain function is disturbed, for example with encephalitis (inflammation of the brain), AIDS, tumours or epilepsy. Normally, other physical symptoms are also present.

  • Brief psychotic disorder

Psychotic symptoms usually occur suddenly and often as a reaction to a great personal stress, for example triggered by the death of a close family member. The symptoms are frequently very severe, but the patients usually recover quickly.

  • Delusional disorder

The predominant problem in this type is marked delusions. Other symptoms are only temporary and are milder.

  • Schizophrenia

Describes a psychotic disorder in which behavioural changes and associated symptoms exist over at least six months. The symptoms and the duration of the illness differ greatly from person to person. Many people live a happy and fulfilled life despite schizophrenia.

  • Brief schizophreniform disorder

The same criteria apply as for schizophrenia, but changes in behaviour and the accompanying symptoms exist for less than six months.

 

How do psychoses progress?

The progression of psychoses depends on many factors and therefore differs greatly: Through longitudinal studies with patients suffering from schizophrenic disorders, the following has been established:

  • In 10 to 15 out of 100 sufferers, psychoses occur once.
  • In 30 out of 100 sufferers, several psychotic episodes occur, without further psychotic symptoms between the episodes.
  • In about 30 out of 100 sufferers, several acute psychotic episodes occur, with psychotic symptoms between the episodes.
  • In around 10 to 20 out of 100 suffers, long-lasting psychotic symptoms occur directly after the first episode.

How do you find out if you are suffering from a psychosis?

If you contact a treatment centre for psychoses, you can expect the following steps to be taken:

First of all, there will be a conversation, preferably together with your family members, in which you will be given sufficient time to describe your burdens, your life circumstances and your current state of health.
Then the psychiatrist or psychotherapist will ask you detailed questions about various areas of life and signs of illness. This will help them to better understand your situation and to get to know you and your family better. Often, several conversations are necessary, which depending on your wishes, can then take place with you alone or with your family.
If your symptoms are more diffuse and cannot be directly assessed, you will be offered regular out-patient appointments for monitoring purposes. If signs of another mental health problem are present, you will be referred on to the responsible institution. If you currently find yourself in a severe crisis, you will get immediate support.

If clear signs of the onset of a psychosis are shown, a more far-reaching diagnosis takes place. This includes a standardised psychological and physical examination, a blood test, an ECG, a so-called EEG to clarify whether you have a seizure disorder and a so-called CCT or MRT, i.e. an image recording of your brain. If you also have cognitive problems, so-called neuropsychological testing will also be conducted. All of these examinations are routine and are not painful.

During the time of the examinations you will continue to have contact with a therapist, who will support you with these steps.
Finally, we will discuss the results with you in detail and the resulting steps for a further therapy. It is essential that you feel that you are in good hands in the therapy, but also that your own decisions play a role in all therapy steps. Moreover, it is important that your family members are well informed in order to help alleviate their own worries.

How is a psychosis treated?

First of all, it is important that the patient is able to calm down and the sensory overload is reduced. This is helped by a personal therapeutic relationship which can offer orientation guidance and self-assurance. To limit the sensory overload, medication is also helpful. But above all, the "chemistry" between therapist and patient has to be right. This is the basis of the medication and not vice versa. For the therapy of psychoses, a multitude of possibilities are available. As each psychosis, each person and each family is different, it is important that the therapy is oriented towards the needs of the sufferer and his family.

Medication therapy is carried out above all with so-called antipsychotic drugs. Based on whatever the central problems are, however, the treatment can also be supplemented with other medications. Medication therapy should be applied in combination with psychotherapy, social and/or other therapies. Numerous therapy procedures are successfully implemented in psychoses:

•    Psychoeducation

•    Cognitive behavioural therapy (CBT)

•    Psychodynamic psychotherapy (PP)

•    Addiction therapy

•    Family therapy

•    Occupational therapy, art therapy, dance therapy

•    Sociotherapy

•    Social competence training (SCT)

•    Metacognitive training (MCT), CogPack

Through a combination of different therapies, an "overflow barrier" against stress is formed. Generally speaking, it is important that the therapy is begun as early as possible. This applies for the first psychosis as well as in the case of a renewed psychotic episode, i.e. a relapse.

What can friends and family do?

If a person is suffering from a psychosis, he perceives himself and his environment in a changed manner. Conversely, he is also different to his environment. For the close family members, partner or friends, it is a time of uncertainty and burden – long before diagnoses or indeed help measures come into play. Nevertheless, maintaining trust in one another and keeping the family able to function is a great challenge.

To support psychological crises, family members require composure and attentiveness at the same time, have to perform a balancing act between affection and limitation for the sufferer and feedback about what it triggers in the family member himself. They need to support one another, but also require professional information and support.

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1 to 2 out of 100 people

suffer from a psychosis in the course of their lives

I noticed with […] that he […] had become more distant towards the whole family […], more disinterested. To a degree also more aggressive […] more thin-skinned, sensitive.

Mother of a person with experience of psychosis

In my worst phase I thought I could hear what other people were thinking about me. […] In my nicest phases I was convinced that I could, and would, change the world.

Person with experience of psychosis

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I definitely get the most strength from my girlfriend. […] That is my support. The best.

Person with experience of psychosis

1 to 2 out of 100 people

suffer from a psychosis in the course of their lives