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| Boilerpipe Text | Psychosis
Other names
Psychotic break (
colloquial
), psychotic episode
Specialty
Neurology
,
psychiatry
,
emergency medicine
,
clinical psychology
Symptoms
Delusions
,
hallucinations
, incoherent speech and behavior
[
1
]
Complications
Self-harm
,
suicide
[
2
]
Causes
Mental illness
(
schizophrenia
,
bipolar disorder
),
trauma
,
sleep deprivation
, some medical conditions, certain
medications
, drugs (including
alcohol
,
caffeine
and
cannabis
)
[
1
]
Treatment
Antipsychotics
,
counselling
,
social support
[
2
]
Prognosis
Depends on cause
[
2
]
Frequency
3% of people at some point in their lives (U.S.)
[
1
]
In
psychopathology
,
psychosis
is the inability to distinguish what is or is not
real
.
[
3
]
Examples of psychotic symptoms are
delusions
,
hallucinations
, and disorganized or
incoherent thoughts
or speech.
[
3
]
Psychosis is a description of a person's state or symptoms, rather than a particular
mental illness
, and it is not related to
psychopathy
(a
personality
construct
[
4
]
[
5
]
characterized by impaired
empathy
and
remorse
, along with
bold
,
disinhibited
, and
egocentric
traits).
[
6
]
Common causes of
chronic
(i.e. ongoing or repeating) psychosis include
schizophrenia
or
schizoaffective disorder
,
bipolar disorder
, and
brain damage
(usually as a result of
alcoholism
).
[
7
]
[
8
]
Acute (temporary) psychosis can also be caused by
severe distress
,
sleep deprivation
,
sensory deprivation
,
[
9
]
some
medications
, and
drug use
(including
alcohol
,
cannabis
,
hallucinogens
, and
stimulants
).
[
10
]
Acute psychosis is termed primary if it results from a psychiatric condition and secondary if it is caused by another medical condition or drugs.
[
10
]
The diagnosis of a mental-health condition requires excluding other potential causes.
[
11
]
Tests can be done to check whether psychosis is caused by
central nervous system
diseases, toxins, or other health problems.
[
12
]
Treatment may include
antipsychotic medication
,
psychotherapy
, and
social support
.
[
1
]
[
2
]
Early treatment appears to improve outcomes.
[
1
]
Medications appear to have a moderate effect.
[
13
]
Outcomes depend on the underlying cause.
[
2
]
Psychosis is not well-understood at the
neurological
level, but
dopamine
(along with other
neurotransmitters
) is known to play an important role.
[
14
]
[
15
]
[
16
]
In the United States about 3% of people develop psychosis at some point in their lives.
[
1
]
Psychosis has been described as early as the 4th century BCE by
Hippocrates
and possibly as early as 1500 BCE in the
Ebers Papyrus
.
[
17
]
[
18
]
A
hallucination
is defined as a sensory perception in the absence of external stimuli.
[
19
]
Hallucinations are different from
illusions
and perceptual distortions, which are the misperception of external stimuli.
[
20
]
[
21
]
Hallucinations may occur in any of the senses and take on almost any form. They may consist of simple sensations (such as lights, colors, sounds, tastes, or smells) or more detailed experiences (such as seeing and interacting with animals and people,
hearing voices
, and having complex tactile sensations). Hallucinations are generally characterized as being vivid and uncontrollable.
[
19
]
[
22
]
Auditory hallucinations
, particularly experiences of hearing voices, are the most common and often prominent feature of psychosis.
[
citation needed
]
Up to 15% of the general population may experience auditory hallucinations (though not all are due to psychosis).
[
23
]
The prevalence of auditory hallucinations in patients with
schizophrenia
is generally put around 70%.
[
24
]
Reported prevalence in
bipolar disorder
ranges between 11% and 68%.
[
25
]
During the early 20th century, auditory hallucinations were second to
visual hallucinations
in frequency, but they are now the most common manifestation of schizophrenia, although rates vary between cultures and regions. Auditory hallucinations are most commonly intelligible voices. When voices are present, the average number has been estimated at three. Content, like frequency, differs significantly, especially across cultures and demographics. People who experience auditory hallucinations can frequently identify the loudness, location of origin, and may settle on identities for voices. Western cultures are associated with auditory experiences concerning religious content, frequently related to sin. Hallucinations may command a person to do something potentially dangerous when combined with delusions.
[
26
]
So-called "minor hallucinations", such as extracampine hallucinations, or false perceptions of people or movement occurring outside of one's visual field, frequently occur in neurocognitive disorders, such as Parkinson's disease.
[
27
]
Visual hallucinations occur in roughly a third of people with schizophrenia, although certain studies show rates higher than 60%, suggesting that the prevalence of visual hallucinations may be higher in certain samples than traditionally thought.
[
28
]
The reported prevalence in bipolar disorder is around 15%.
[
29
]
Content commonly involves animate objects, although perceptual abnormalities such as changes in lighting, shading, streaks, or lines may be seen. Visual abnormalities may conflict with
proprioceptive
information, and visions may include experiences such as the ground tilting.
Lilliputian hallucinations
are less common in schizophrenia, and are more common in various types of
encephalopathy
, such as
peduncular hallucinosis
.
[
26
]
[
30
]
A visceral hallucination, also called a cenesthetic hallucination, is characterized by visceral sensations in the absence of stimuli. Cenesthetic hallucinations may include sensations of burning, or re-arrangement of internal organs.
[
26
]
A
delusion
is a fixed, false,
idiosyncratic
belief, which does not change even when presented with incontrovertible evidence to the contrary.
[
31
]
[
32
]
[
33
]
Delusions are context- and culture-dependent: a belief that inhibits critical functioning and is widely considered delusional in one population may be common (and even adaptive) in another, or in the same population at a later time.
[
33
]
[
34
]
Since
normative
views may contradict available evidence, a belief need not contravene cultural standards in order to be considered delusional. However, the
DSM-5
considers a belief delusional only if it is not widely accepted within a cultural or subcultural context.
[
35
]
Prevalence of delusions in schizophrenia is generally considered around 80-90%, according to
Columbia University
.
[
36
]
A 2022 systematic review found a prevalence of around 70% in bipolar disorder.
[
37
]
The DSM-5 characterizes certain delusions as "bizarre" if they are clearly implausible, or are incompatible with the surrounding cultural context.
[
32
]
The concept of bizarre delusions has many criticisms, the most prominent being that judging their presence is not highly reliable even among trained individuals.
[
26
]
A delusion may involve diverse thematic content. The most common type is a
persecutory delusion
, in which a person believes that an entity seeks to harm them.
[
32
]
[
33
]
Others include
delusions of reference
(the belief that some element of one's experience represents a deliberate and specific act by or message from some other entity),
delusions of grandeur
(the belief that one possesses special power or influence beyond one's actual limits),
thought broadcasting
(the belief that one's thoughts are audible) and
thought insertion
(the belief that one's thoughts are not one's own).
[
33
]
A delusion may also involve
misidentification
of objects, persons, or environs that the afflicted should reasonably be able to recognize; such examples include
Cotard's syndrome
(the belief that oneself is partly or wholly
dead
) and
clinical lycanthropy
(the belief that oneself is or has transformed into an animal).
[
citation needed
]
The subject matter of delusions seems to reflect the current culture in a particular time and location. For example, in the early 1900s in the United States,
syphilis
was a common theme in delusions. During the Second World War, it was Germany. In the
Cold War
era, communists became a frequent focus. Now, in recent years, technology is a common subject matter of delusions.
[
38
]
Some psychologists, such as those who practice the
Open Dialogue
method, believe that the content of psychosis represents an underlying thought process, that may in part, be responsible for psychosis,
[
39
]
though the accepted medical position is that psychosis is due to a brain disorder.
[
40
]
Historically,
Karl Jaspers
classified psychotic delusions into
primary
and
secondary
types. Primary delusions are defined as arising suddenly and not being comprehensible in terms of normal mental processes, whereas secondary delusions are typically understood as being influenced by the person's background or current situation (e.g., ethnicity, religious, superstitious, or political beliefs).
[
41
]
Disorganized speech/thought and disorganized behavior
[
edit
]
Disorganization is categorized into either disorganized speech (disorganized speech stemming from disorganized thought), and grossly disorganized motor behavior. Disorganized speech or thought, also formally called
thought disorder
, is disorganization of thinking that is
inferred
from speech. Characteristics of disorganized speech include rapidly switching topics which is called
derailment
or loose
association
, switching to topics that are unrelated which is called
tangential thinking
, incomprehensible speech which is called incoherence and referred to as a
word salad
. Disorganized motor behavior includes repetitive, odd, or sometimes purposeless movement. Disorganized motor behavior rarely includes
catatonia
, and although it was a prominent symptom historically, it is rarely seen today. Whether this may be due to the use of historical treatments or the lack thereof is unknown.
[
26
]
[
22
]
Catatonia describes a profoundly agitated state in which the experience of reality is generally considered impaired. There are two primary manifestations of catatonic behavior. The classic presentation is a person who does not move or interact with the world in any way while awake. This type of catatonia presents with
waxy flexibility
. Waxy flexibility is when someone physically moves part of a catatonic person's body and the person stays in the position even if it is bizarre and otherwise nonfunctional (such as moving a person's arm straight up in the air and the arm staying there).
[
42
]
The other type of catatonia is more of an outward presentation of the profoundly agitated state described above. It involves excessive and purposeless motor behaviour, as well as an extreme mental preoccupation that prevents an intact experience of reality. An example is someone walking very fast in circles to the exclusion of anything else with a level of mental preoccupation (meaning not focused on anything relevant to the situation) that was not typical of the person prior to the symptom onset. In both types of catatonia, there is generally no reaction to anything that happens outside of them. It is important to distinguish catatonic agitation from severe bipolar mania, although someone could have both.
[
citation needed
]
Negative symptoms include
reduced emotional expression
,
decreased motivation
(
avolition
), and
reduced spontaneous speech
(poverty of speech,
alogia
). Individuals with this condition lack interest and spontaneity, and have the
inability to feel pleasure
(
anhedonia
).
[
43
]
Altered Behavioral Inhibition System functioning could possibly cause reduced sustained attention in psychosis and overall contribute to more negative reactions.
[
44
]
Psychosis in adolescents
[
edit
]
Psychosis is relatively rare in adolescents but not uncommon.
[
45
]
Young people who have psychosis may have trouble connecting with the world around them and may experience hallucinations or delusions.
[
46
]
Adolescents with psychosis may also have cognitive deficits that may make it harder for the youth to socialize and work.
[
46
]
Potential impairments include a reduced speed of mental processing, the lack of ability to focus without getting distracted (limited
attention span
), and deficits in
verbal memory
.
[
46
]
If an adolescent is experiencing psychosis, they most likely have comorbidity, meaning that they could have multiple mental illnesses.
[
47
]
Because of this, it may be difficult to determine whether it is psychosis or
autism
,
social
or
generalized anxiety disorder
, or
obsessive-compulsive disorder
.
[
47
]
The symptoms of psychosis may be caused by serious
psychiatric disorders
such as
schizophrenia
, a number of medical illnesses, and
trauma
. Psychosis may also be temporary or transient, and be caused by medications or
substance use disorder
(
substance-induced psychosis
).
[
citation needed
]
Brief hallucinations are not uncommon in those without any psychiatric disease, including healthy children. Causes or triggers include:
[
48
]
Falling asleep and waking:
hypnagogic
and
hypnopompic
hallucinations
[
49
]
Bereavement
, in which hallucinations of a deceased loved one are common
[
48
]
[
50
]
Severe
sleep deprivation
[
51
]
[
52
]
Extreme stress (see below)
[
53
]
Abnormal brainwaves
[
54
]
[
55
]
Abnormal brain networks
[
56
]
[
57
]
[
58
]
Traumatic brain injury
[
59
]
[
60
]
[
61
]
Traumatic life events have been linked with an elevated risk of developing psychotic symptoms.
[
62
]
Childhood trauma
has specifically been shown to be a predictor of adolescent and adult psychosis.
[
63
]
Individuals with psychotic symptoms are three times more likely to have experienced childhood trauma (e.g.,
physical
or
sexual abuse
, physical or emotional
neglect
) than those in the general population.
[
63
]
Increased individual vulnerability toward psychosis may interact with traumatic experiences promoting an onset of future psychotic symptoms, particularly during sensitive developmental periods.
[
63
]
Importantly, the relationship between traumatic life events and psychotic symptoms appears to be dose-dependent in which multiple traumatic life events accumulate, compounding symptom expression and severity.
[
62
]
[
63
]
However, acute, stressful events can also trigger brief psychotic episodes.
[
64
]
Trauma prevention and early intervention may be an important target for decreasing the incidence of psychotic disorders and ameliorating its effects.
[
62
]
A healthy person could become psychotic when inside an empty room with no light and sound. After about 15 minutes, psychosis can occur, this is a phenomenon known as
sensory deprivation
.
[
9
]
Neuroticism
, a personality trait associated with vulnerability to stressors, is an independent predictor of the development of psychosis.
[
65
]
Psychiatric disorders
[
edit
]
Traditionally psychotic disorders have been believed to have one of two roots: organic (physiological) or functional (mental). Organic disorders being those caused by physical conditions directly affecting the brain with psychosis as a secondary feature, and functional disorders being primary psychological or psychiatric disorders (disorders of the functioning of the mind) in the absence of physiological causes. Subtle physical abnormalities have been found in illnesses traditionally considered functional, such as
schizophrenia
. The
DSM-IV-TR
avoids the functional/organic distinction, and instead lists traditional psychotic illnesses, psychosis due to general medical conditions, and substance-induced psychosis.
[
citation needed
]
Primary psychiatric causes of psychosis include the following:
[
66
]
[
67
]
[
48
]
Primary psychotic disorders
Schizophrenia
Schizoaffective disorder
Schizophreniform disorder
Brief psychotic disorder
Delusional disorder
Mood disorders
Psychotic depression
, also known as
major depressive disorder
with psychotic features
Bipolar disorder
Bipolar I disorder
in
manic
and
mixed episodes
, as well as depressive episodes
Bipolar II disorder
in depressive episodes
Psychotic symptoms may also be seen in:
[
48
]
Certain
personality disorders
: such as
schizotypal personality disorder
,
paranoid personality disorder
, and
borderline personality disorder
Post-traumatic stress disorder
Obsessive–compulsive disorder
Dissociative identity disorder
Paraphrenia
Subtypes of psychosis include:
Postpartum psychosis
,
[
68
]
occurring shortly after
giving birth
, primarily associated with maternal
bipolar disorder
Monothematic delusions
Myxedematous psychosis
Stimulant psychosis
Tardive psychosis
Shared psychosis
Cycloid psychosis is typically an acute, self-limiting form of psychosis with psychotic and mood symptoms that progress from normal to full-blown, usually between a few hours to days, and not related to drug intake or
brain injury
.
[
69
]
While proposed as a distinct entity, clinically separate from schizophrenia and affective disorders, cycloid psychosis is not formally acknowledged by current ICD or DSM criteria.
[
69
]
Its unclear place in psychiatric nosology has likely contributed to the limited scientific investigation and literature on the topic.
[
70
]
Postpartum psychosis
[
edit
]
Postpartum psychosis
is a rare yet serious and debilitating form of psychosis.
[
71
]
Symptoms range from fluctuating moods and insomnia to mood-incongruent delusions related to the individual or the infant.
[
71
]
Women experiencing postpartum psychosis are at increased risk for suicide or infanticide. Many women who experience first-time psychosis from postpartum often have bipolar disorder, meaning they could experience an increase of psychotic episodes even after postpartum.
[
71
]
A very large number of medical conditions can cause psychosis, sometimes called
secondary psychosis
.
[
48
]
Examples include:
Disorders causing
delirium
(
toxic psychosis
), in which consciousness is disturbed
Neurodevelopmental disorders
and
chromosomal abnormalities
, including
velocardiofacial syndrome
Neurodegenerative disorders
, such as
Alzheimer's disease
,
dementia with Lewy bodies
, and
Parkinson's disease
[
72
]
Focal neurological disease, such as
stroke
,
brain tumors
,
[
73
]
multiple sclerosis
,
[
3
]
and some forms of
epilepsy
Malignancy
(typically via masses in the brain,
paraneoplastic syndromes
)
[
3
]
Infectious and postinfectious syndromes, including infections causing
delirium
,
viral encephalitis
,
HIV/AIDS
,
[
74
]
malaria
,
[
75
]
syphilis
[
74
]
Endocrine disease
, such as
hypothyroidism
,
hyperthyroidism
,
Cushing's syndrome
,
hypoparathyroidism
and
hyperparathyroidism
;
[
76
]
sex hormones also affect psychotic symptoms and sometimes giving birth can provoke psychosis, termed
postpartum psychosis
[
77
]
Inborn errors of metabolism, such as
Wilson's disease
,
porphyria
, and
homocysteinemia
[
78
]
Nutritional deficiency
, such as
vitamin B
12
deficiency
[
10
]
Other acquired
metabolic disorders
, including
electrolyte
disturbances such as
hypocalcemia
,
hypernatremia
,
hyponatremia
,
hypokalemia
,
hypomagnesemia
,
hypermagnesemia
,
hypercalcemia
, and
hypophosphatemia
, but also
hypoglycemia
,
hypoxia
, and failure of the
liver
or
kidneys
[
76
]
[
10
]
Autoimmune and related disorders
, such as
systemic lupus erythematosus
(lupus, SLE),
sarcoidosis
,
Hashimoto's encephalopathy
,
anti-NMDA-receptor encephalitis
, and
non-celiac gluten sensitivity
[
79
]
[
80
]
Poisoning
by a range of plants, fungi, metals, organic compounds, and a few animal toxins
[
48
]
Sleep disorders
, such as in
narcolepsy
(in which
REM sleep
intrudes into wakefulness)
[
48
]
Parasitic diseases
, such as
neurocysticercosis
Various
psychoactive substances
(both legal and illegal) have been implicated in causing, exacerbating, or precipitating psychotic states or disorders in users, with varying levels of evidence.
[
81
]
This may be upon intoxication for a more prolonged period after use, or upon
withdrawal
.
[
48
]
Individuals who experience substance-induced psychosis tend to have a greater awareness of their psychosis and tend to have higher levels of
suicidal thinking
compared to those who have a primary psychotic illness.
[
82
]
Drugs commonly alleged to induce psychotic symptoms include
alcohol
,
cannabis
,
cocaine
,
amphetamines
,
cathinones
,
psychedelic drugs
(such as
LSD
and
psilocybin
),
κ-opioid receptor
agonists
(such as
enadoline
and
salvinorin A
) and
NMDA receptor antagonists
(such as
phencyclidine
and
ketamine
).
[
48
]
[
83
]
Caffeine
may worsen symptoms in those with schizophrenia and cause psychosis at very high doses in people without the condition.
[
84
]
[
85
]
Cannabis and other illicit recreational drugs are often associated with psychosis in adolescents and cannabis use before 15 years old may increase the risk of psychosis in adulthood.
[
46
]
Approximately 3% of people with
alcoholism
experience psychosis during acute intoxication or withdrawal. Alcohol related psychosis may manifest itself through a
kindling mechanism
. The mechanism of alcohol-related psychosis is due to the
long-term effects of alcohol consumption
resulting in distortions to neuronal membranes,
gene expression
, as well as
thiamine
deficiency. It is possible that hazardous alcohol use via a kindling mechanism can cause the development of a chronic substance-induced psychotic disorder, i.e. schizophrenia. The effects of an alcohol-related psychosis include an increased risk of depression and suicide as well as causing psychosocial impairments.
[
86
]
Delirium tremens
, a symptom of chronic alcoholism that can appear in the acute withdrawal phase, shares many symptoms with alcohol-related psychosis suggesting a common mechanism.
[
87
]
According to current studies, cannabis use is associated with increased risk of psychotic disorders, and the more often cannabis is used the more likely a person is to develop a psychotic illness.
[
88
]
Furthermore, people with a history of cannabis use develop psychotic symptoms earlier than those who have never used cannabis.
[
88
]
Some debate exists regarding the causal relationship between cannabis use and psychosis with some studies suggesting that cannabis use hastens the onset of psychosis primarily in those with pre-existing vulnerability.
[
88
]
[
89
]
[
90
]
Indeed, cannabis use plays an important role in the development of psychosis in vulnerable individuals, and cannabis use in adolescence should be discouraged.
[
91
]
Some studies indicate that the effects of two active compounds in cannabis,
tetrahydrocannabinol
(THC) and
cannabidiol
(CBD), have opposite effects with respect to psychosis. While THC can induce psychotic symptoms in healthy individuals, limited evidence suggests that CBD may have antipsychotic effects.
[
92
]
Methamphetamine
induces a psychosis in 26%–46% of heavy users. Some of these people develop a long-lasting psychosis that can persist for longer than six months. Those who have had a short-lived psychosis from methamphetamine can have a relapse of the methamphetamine psychosis years later after a stressful event such as severe insomnia or a period of hazardous alcohol use despite not relapsing back to methamphetamine.
[
93
]
Individuals who have a long history of methamphetamine use and who have experienced psychosis in the past from methamphetamine use are highly likely to re-experience methamphetamine psychosis if drug use is recommenced.
[
citation needed
]
Methamphetamine-induced psychosis is likely gated by genetic vulnerability, which can produce long-term changes in brain neurochemistry following repetitive use.
[
94
]
Methamphetamine users with more
ADHD
-related behaviours in childhood experience methamphetamine-related psychosis more frequently.
[
95
]
A 2024 meta-analysis found an incidence of psychedelic-induced psychosis at 0.002% in population studies, 0.2% in uncontrolled clinical trials, and 0.6% in randomised controlled trials.
[
96
]
This meta-analysis found that in uncontrolled clinical trials involving only patients with schizophrenia, 3.8% developed prolonged psychotic reactions. A 2024 study found that
psychedelic
use was not generally associated with a change in the number of psychotic symptoms.
[
97
]
This study found that psychedelic use interacted with a family history of bipolar disorder, such that in those with a family history of bipolar disorder, psychedelic use was associated with an increase in the number of psychotic symptoms, while in those with a personal history of psychosis but no family history of psychotic disorders, psychedelic use was associated with a decrease in the number of psychotic symptoms. A 2023 study found an interaction between lifetime psychedelic use and family history of psychosis or bipolar disorder on psychotic symptoms over the past two weeks. Psychotic symptoms were highest among those with both a family history of psychosis or bipolar disorder and life-time psychedelic use, while they were lowest among those with life-time psychedelic use but no family history of these disorders.
[
98
]
Administration, or sometimes withdrawal, of a large number of medications may provoke psychotic symptoms.
[
48
]
Drugs that can induce psychosis experimentally or in a significant proportion of people include:
Stimulants, such as
amphetamine
and other
sympathomimetics
Dopamine
agonists
Ketamine
Corticosteroids
(often with mood changes in addition)
Some anticonvulsants such as
vigabatrin
[
99
]
[
100
]
[
101
]
The first brain image of an individual with psychosis was completed as far back as 1935 using a technique called
pneumoencephalography
[
102
]
(a painful and now obsolete procedure where
cerebrospinal fluid
is drained from around the brain and replaced with air to allow the structure of the brain to show up more clearly on an
X-ray
picture).
[
citation needed
]
Both
first episode psychosis
, and high risk status is associated with reductions in
grey matter
volume (GMV). First episode psychotic and high risk populations are associated with similar but distinct abnormalities in GMV. Reductions in the right
middle temporal gyrus
, right
superior temporal gyrus
(STG), right
parahippocampus
, right
hippocampus
, right
middle frontal gyrus
, and left
anterior cingulate cortex
(ACC) are observed in high risk populations. Reductions in first episode psychosis span a region from the right STG to the right insula, left insula, and
cerebellum
, and are more severe in the right ACC, right STG, insula and cerebellum.
[
103
]
[
104
]
Another meta analysis reported bilateral reductions in insula, operculum, STG, medial frontal cortex, and ACC, but also reported increased GMV in the right
lingual gyrus
and left
precentral gyrus
.
[
105
]
The
Kraepelinian dichotomy
is made questionable
[
clarification needed
]
by grey matter abnormalities in bipolar and schizophrenia; schizophrenia is distinguishable from bipolar in that regions of grey matter reduction are generally larger in magnitude, although adjusting for gender differences reduces the difference to the left
dorsomedial prefrontal cortex
(dmPFC), and right
dorsolateral prefrontal cortex
(dlPFC).
[
106
]
During attentional tasks, first episode psychosis is associated with hypoactivation in the right middle frontal gyrus, a region generally described as encompassing the dlPFC. Altered Behavioral Inhibition System functioning could possibly cause reduced sustained attention in psychosis and overall contribute to more negative reactions.
[
107
]
In congruence with studies on grey matter volume, hypoactivity in the right insula, and right inferior parietal lobe is also reported.
[
108
]
During cognitive tasks, hypoactivities in the right insula, dorsal anterior cingulate cortex, and the left
precuneus
, as well as reduced deactivations in the right
basal ganglia
, right
thalamus
, right
inferior frontal gyrus
and left
precentral gyrus
are observed. These results are highly consistent and replicable possibly except the abnormalities of the right inferior frontal gyrus.
[
109
]
Decreased grey matter volume in conjunction with bilateral hypoactivity is observed in anterior insula, dorsal medial frontal cortex, and dorsal anterior cingulate cortex. Decreased grey matter volume and bilateral hyperactivity is reported in posterior insula, ventral medial frontal cortex, and ventral anterior cingulate cortex.
[
110
]
Studies during acute experiences of hallucinations demonstrate increased activity in primary or secondary sensory cortices. As auditory hallucinations are most common in psychosis, most robust evidence exists for increased activity in the left
middle temporal gyrus
, left
superior temporal gyrus
, and left
inferior frontal gyrus
(i.e.
Broca's area
). Activity in the
ventral striatum
,
hippocampus
,
[
111
]
and ACC are related to the lucidity of hallucinations, and indicate that activation or involvement of emotional circuitry are key to the impact of abnormal activity in sensory cortices. Together, these findings indicate abnormal processing of internally generated sensory experiences, coupled with abnormal emotional processing, results in hallucinations. One proposed model involves a failure of feedforward networks from sensory cortices to the inferior frontal cortex, which normally cancel out sensory cortex activity during internally generated speech. The resulting disruption in expected and perceived speech is thought to produce lucid hallucinatory experiences.
[
112
]
The two-factor model of delusions posits that dysfunction in both belief formation systems and belief evaluation systems are necessary for delusions. Dysfunction in evaluations systems localized to the right lateral prefrontal cortex, regardless of delusion content, is supported by neuroimaging studies and is congruent with its role in conflict monitoring in healthy persons. Abnormal activation and reduced volume is seen in people with delusions, as well as in disorders associated with delusions such as
frontotemporal dementia
, psychosis and
Lewy body dementia
. Furthermore, lesions to this region are associated with "jumping to conclusions", damage to this region is associated with post-stroke delusions, and hypometabolism this region associated with caudate strokes presenting with delusions.
[
citation needed
]
The
aberrant salience model
suggests that delusions are a result of people assigning excessive importance to irrelevant stimuli. In support of this hypothesis, regions normally associated with the
salience network
demonstrate reduced grey matter in people with delusions, and the neurotransmitter
dopamine
, which is widely implicated in salience processing, is also widely implicated in psychotic disorders.
[
citation needed
]
Specific regions have been associated with specific types of delusions. The volume of the hippocampus and parahippocampus is related to paranoid delusions in
Alzheimer's disease
, and has been reported to be abnormal post mortem in one person with delusions.
Capgras delusions
have been associated with occipito-temporal damage, and may be related to failure to elicit normal emotions or memories in response to faces.
[
113
]
Psychosis is associated with the
ventral striatum
(VS), which is the part of the brain that is involved with the desire to naturally satisfy the body's needs.
[
114
]
When high reports of
negative symptoms
were recorded, there were significant irregularities in the left VS. Anhedonia, defined as the inability to feel joy or pleasure,
[
115
]
is a commonly reported symptom in psychosis; experiences with the condition are present in most people with schizophrenia.
[
116
]
Previous research has indicated that a deficiency in the
neural representation
in regards to goals and the motivation to achieve them, has demonstrated that when a reward is not present, a strong reaction is noted in the ventral striatum; reinforcement learning is intact when contingencies about stimulus-reward are implicit, but not when they require explicit neural processing; reward prediction errors are what the actual reward is versus what the reward was predicted to be.
[
117
]
In most cases positive prediction errors are considered an abnormal occurrence. A positive prediction error response occurs when there is an increased activation in a brain region, typically the
striatum
, in response to unexpected rewards. A negative prediction error response occurs when there is a decreased activation in a region when predicted rewards do not occur. The
anterior cingulate cortex
(ACC) response, taken as an indicator of effort allocation, does not increase with reward or reward probability increase, and is associated with negative symptoms; deficits in dorsolateral prefrontal cortex (dlPFC) activity and failure to improve performance on cognitive tasks when offered monetary incentives are present; and dopamine mediated functions are abnormal.
[
citation needed
]
Psychosis has been traditionally linked to the overactivity of the
neurotransmitter
dopamine
, in particular to its effect in the
mesolimbic pathway
, spanning from the
ventral tegmental area
to the ventral
striatum
. Additionally, recent evidence suggests a crucial involvement of the pathway spanning from the
substantia nigra
to the dorsal
striatum
.
[
118
]
The two major sources of evidence given to support this theory are that
dopamine receptor D
2
blocking drugs (i.e.,
antipsychotics
) tend to reduce the intensity of psychotic symptoms, and that drugs that accentuate dopamine release, or inhibit its reuptake (such as
amphetamines
and
cocaine
) can trigger psychosis in some people (see
stimulant psychosis
).
[
119
]
However, there is substantial evidence that dopaminergic overactivity does not fully explain psychosis, and that neurodegerative pathophysiology plays a significant role. This is evidenced by the fact that psychosis commonly occurs in neurodegenerative diseases of the dopaminergic nervous system, such as Parkinson's disease, which involved reduced, rather than increased, dopaminergic activity.
[
120
]
The
endocannabinoid system
is also implicated in psychosis. This is evidenced by the propensity of
CB
1
receptor
agonists such as
THC
to induce psychotic symptoms,
[
121
]
and the efficacy of
CB
1
receptor
antagonists such as
CBD
in ameliorating psychosis.
[
122
]
NMDA receptor dysfunction has been proposed as a mechanism in psychosis.
[
123
]
This theory is reinforced by the fact that
dissociative
NMDA receptor antagonists
such as
ketamine
,
PCP
and
dextromethorphan
(at large overdoses) induce a psychotic state. The symptoms of dissociative
intoxication
are also considered to mirror the symptoms of schizophrenia, including
negative symptoms
.
[
124
]
NMDA receptor antagonism, in addition to producing symptoms reminiscent of psychosis, mimics the neurophysiological aspects, such as reduction in the amplitude of
P50
,
P300
, and
MMN
evoked potentials
.
[
125
]
Hierarchical Bayesian neurocomputational models of sensory feedback, in agreement with neuroimaging literature, link NMDA receptor hypofunction to delusional or hallucinatory symptoms via proposing a failure of NMDA mediated top down predictions to adequately cancel out enhanced bottom up AMPA mediated predictions errors.
[
126
]
Excessive prediction errors in response to stimuli that would normally not produce such a response is thought to root from conferring excessive salience to otherwise mundane events.
[
127
]
Dysfunction higher up in the hierarchy, where representation is more abstract, could result in delusions.
[
128
]
The common finding of reduced
GAD67
expression in psychotic disorders may explain enhanced AMPA mediated signaling, caused by reduced GABAergic inhibition.
[
129
]
[
130
]
The connection between dopamine and psychosis is generally believed to be complex. While dopamine receptor D
2
suppresses
adenylate cyclase
activity, the
D
1
receptor increases it. If D
2
-blocking drugs are administered, the blocked dopamine spills over to the D
1
receptors. The increased adenylate cyclase activity affects
genetic expression
in the nerve cell, which takes time. Hence antipsychotic drugs take a week or two to reduce the symptoms of psychosis. Moreover, newer and equally effective antipsychotic drugs actually block slightly less dopamine in the brain than older drugs whilst also blocking 5-HT
2A
receptors, suggesting the 'dopamine hypothesis' may be oversimplified.
[
131
]
Soyka and colleagues found no evidence of dopaminergic dysfunction in people with alcohol-induced psychosis
[
132
]
and Zoldan et al. reported moderately successful use of
ondansetron
, a 5-HT
3
receptor antagonist, in the treatment of
levodopa
psychosis in
Parkinson's disease
patients.
[
133
]
A review found an association between a first-episode of psychosis and prediabetes.
[
134
]
Prolonged or high dose use of
psychostimulants
can alter normal functioning, making it similar to the manic phase of bipolar disorder.
[
135
]
NMDA antagonists replicate some of the so-called "negative" symptoms like
thought disorder
in subanesthetic doses (doses insufficient to induce
anesthesia
), and
catatonia
in high doses. Psychostimulants, especially in one already prone to psychotic thinking, can cause some "positive" symptoms, such as delusional beliefs, particularly those persecutory in nature.
[
citation needed
]
Cross-cultural studies into schizophrenia have found that individual experiences of psychosis and 'hearing voices' vary across cultures.
[
136
]
[
137
]
In countries such as the
United States
where there exists a predominantly biomedical understanding of the body, the mind and in turn, mental health, subjects were found to report their hallucinations as having 'violent content' and self-describing as 'crazy'.
[
136
]
This experience is at odds with the experiences of subjects in
Accra, Ghana
, who describe the voices they hear as having 'spiritual meaning' and are often reported as positive in nature; or subjects in
Chennai, India
, who describe their hallucinations as kin, family members or close friends, and offering guidance.
[
136
]
These differences are attributed to 'social kindling' or how one's social context shapes the way they interpret and experience sensations such as hallucinations. This concept aligns with preexisting cognitive theory such as reality modelling and is supported by recent research that demonstrates that individuals with psychosis can be taught to attend to their hallucinations differently, which in turn alters the hallucinations themselves.
[
138
]
Such research creates pathways for social or community-based treatment, such as reality monitoring, for individuals with schizophrenia and other psychotic disorders, providing alternatives to, or supplementing traditional pharmacologic management.
[
citation needed
]
Cross-cultural studies explore the way in which psychosis varies in different cultures, countries and religions. The cultural differences are based on the individual or shared illness narratives surrounding cultural meanings of illness experience.
[
139
]
In countries such as
India
,
Cambodia
and
Muslim
majority countries, they each share alternative epistemologies. These are known as knowledge systems that focus on the connections between mind, body, culture, nature and society.
[
140
]
Cultural perceptions of mental disorders such as psychosis or schizophrenia are believed to be caused by
jinn
(spirits) in Muslim majority countries.
[
141
]
Furthermore, those in
Arab
-Muslim societies perceive those who act differently than the social norm as "crazy" or as abnormal behaviour.
[
141
]
This differs from the experiences of individuals in India and how they attain their perspectives on mental health issues through a variety of spiritual and healing traditions.
[
142
]
In Cambodia, hallucinations are linked with spirit visitation, a term they call "cultural kindling".
[
143
]
These examples of differences are attributed to culture and the way it shapes conceptions of mental disorders.
[
141
]
These cultural differences can be useful in bridging the gap of cultural understanding and psychiatric signs and symptoms.
[
139
]
To make a diagnosis of a mental illness in someone with psychosis
other potential causes must be excluded
.
[
144
]
An initial assessment includes a comprehensive history and physical examination by a health care provider. Tests may be done to exclude substance use, medication, toxins, surgical complications, or other medical illnesses.
Delirium
should be ruled out, which can be distinguished by visual hallucinations, acute onset and fluctuating level of consciousness, indicating other underlying factors, including medical illnesses.
[
145
]
Excluding medical illnesses associated with psychosis is performed by using blood tests to measure:
Thyroid-stimulating hormone
to exclude
hypo-
or
hyperthyroidism
Vitamin B
12
serum and urinary
MMA
to role out
pernicious anemia
or
vitamin B
12
deficiency
Basic electrolytes
and
serum calcium
to rule out a metabolic disturbance
Full blood count
including
ESR
to rule out a systemic infection or chronic disease
Serology
to exclude
syphilis
or
HIV
infection.
Other investigations include:
EEG
to exclude
epilepsy
MRI
or
CT scan
of the head to exclude brain lesions
Because psychosis may be precipitated or exacerbated by common classes of medications, medication-induced psychosis should be
ruled out
, particularly for first-episode psychosis. Both substance- and medication-induced psychosis can be
excluded
to a high level of certainty, using toxicology screening.
[
citation needed
]
Because some
dietary supplements
may also induce psychosis or mania, but cannot be ruled out with laboratory tests, a psychotic individual's family, partner, or friends should be asked whether the patient is currently taking any dietary supplements.
[
146
]
Common mistakes made when diagnosing people who are psychotic include:
[
144
]
Not properly excluding
delirium
Not appreciating medical abnormalities (e.g.,
vital signs
)
Not obtaining a medical history and family history
Indiscriminate screening without an organizing framework
Missing a toxic psychosis by not screening for substances
and
medications
Not asking their families or others about dietary supplements
Premature diagnostic closure
Not revisiting or questioning the initial diagnostic impression of primary psychiatric disorder
Only after relevant and known causes of psychosis are excluded, a mental health clinician may make a psychiatric
differential diagnosis
using a person's family history, incorporating information from the person with psychosis, and information from family, friends or romantic partners.
[
citation needed
]
Types of psychosis in psychiatric disorders may be established by formal rating scales. The
Brief Psychiatric Rating Scale
(BPRS)
[
147
]
assesses the level of 18 symptom constructs of psychosis such as
hostility
,
suspicion
,
hallucination
, and
grandiosity
. It is based on the clinician's interview with the patient and observations of the patient's behavior over the previous 2–3 days. The patient's family can also answer questions on the behavior report. During the initial assessment and the follow-up, both positive and negative symptoms of psychosis can be assessed using the 30 item
Positive and Negative Syndrome Scale
(PANSS).
[
148
]
The
DSM-5
characterizes disorders as psychotic or on the schizophrenia spectrum if they involve hallucinations, delusions, disorganized thinking, grossly disorganized motor behavior, or negative symptoms.
[
22
]
The DSM-5 does not include psychosis as a definition in the glossary, although it defines "psychotic features", as well as "psychoticism" with respect to personality disorder. The
ICD-10
has no specific definition of psychosis.
[
149
]
The Psychosis Screening Questionnaire (PSQ) is the most common tool in detecting psychotic symptoms and it includes five root questions that assess the presence of PLE (mania, thought insertion, paranoia, strange experiences and perceptual disturbances)
[
150
]
The different tools used to assess symptom severity include the Revised Behavior and Symptom Identification Scale (BASIS-R), a 24-item self-report instrument with six scales: psychosis, depression/functioning, interpersonal problems, alcohol/drug use, self-harm, and emotional lability. The Symptom Checklist-90-Revised (SCL-90-R), a 90-item self assessment tool that measures psychoticism and paranoid ideation in addition to seven other symptom scales. Finally, the Brief Symptom Inventory (BSI), a 53-item self-administered scale developed from the SCL-90-R. The BSI has good psychometric properties and is an acceptable brief alternative to the SCL-90-R.
[
151
]
These seem to be the most accurate tools at the moment,
[
when?
]
but a research in 2007 that focused on quantifying self-reports of auditory verbal hallucinations (AVH) in persons with psychosis, suggest that The Hamilton Program for Schizophrenia Voices Questionnaire (HPSVQ) is also potentially a reliable and useful measure for specifically quantifying AVHs in relation to psychosis.
[
152
]
Factor analysis
of symptoms generally regarded as psychosis frequently yields a five factor solution, albeit five factors that are distinct from the five domains defined by the DSM-5 to encompass
psychotic
or schizophrenia spectrum disorders. The five factors are frequently labeled as hallucinations, delusions, disorganization, excitement, and emotional distress.
[
149
]
The DSM-5 emphasizes a
psychotic spectrum
, wherein the low end is characterized by schizoid personality disorder, and the high end is characterized by schizophrenia.
[
3
]
Gouzoulis-Mayfrank et al. said that the pleasant or emotionally positive experiences that are common in psychosis, particularly in the early stages, are more easily overlooked in clinical practice than the negative experiences.
[
153
]
Nev Jones and Mona Shattel wrote that there is less curiosity towards the complications, or towards the richness of the good things as well as the bad things.
[
153
]
The evidence for the effectiveness of early interventions to
prevent
psychosis appeared inconclusive.
[
154
]
But psychosis caused by drugs can be prevented.
[
155
]
Whilst early intervention in those with a psychotic episode might improve short-term outcomes, little benefit was seen from these measures after five years.
[
156
]
However, there is evidence that
cognitive behavioral therapy
(CBT) may reduce the risk of becoming psychotic in those at high risk,
[
157
]
and in 2014 the U.K.
National Institute for Health and Care Excellence
(NICE) recommended preventive CBT for people at risk of psychosis.
[
158
]
[
159
]
The treatment of psychosis depends on the specific diagnosis (such as schizophrenia, bipolar disorder or substance intoxication). The first-line treatment for many psychotic disorders is antipsychotic medication,
[
160
]
which can reduce the positive symptoms of psychosis in about 7 to 14 days. For youth or adolescents, treatment options include medications, psychological interventions, and social interventions.
[
46
]
The choice of which
antipsychotic
to use is based on benefits, risks, and costs.
[
156
]
It is debatable whether, as a class,
typical
or
atypical antipsychotics
are better.
[
161
]
[
162
]
Tentative evidence supports that
amisulpride
,
olanzapine
,
risperidone
and
clozapine
may be more effective for positive symptoms but result in more side effects.
[
163
]
Typical antipsychotics have equal drop-out and symptom relapse rates to atypicals when used at low to moderate dosages.
[
164
]
There is a good response in 40–50%, a partial response in 30–40%, and treatment resistance (failure of symptoms to respond satisfactorily after six weeks to two or three different antipsychotics) in 20% of people.
[
165
]
Clozapine is an effective treatment for those who respond poorly to other drugs ("treatment-resistant" or "refractory" schizophrenia),
[
166
]
but it has the potentially serious side effect of
agranulocytosis
(lowered
white blood cell
count) in less than 4% of people.
[
156
]
[
167
]
[
168
]
Most people on antipsychotics get side effects. People on typical antipsychotics tend to have a higher rate of
extrapyramidal side effects
while some atypicals are associated with considerable weight gain, diabetes and risk of
metabolic syndrome
; this is most pronounced with olanzapine, while risperidone and
quetiapine
are also associated with weight gain.
[
163
]
Risperidone has a similar rate of extrapyramidal symptoms to haloperidol.
[
163
]
Psychological treatments such as
acceptance and commitment therapy
(ACT) are possibly useful in the treatment of psychosis, helping people to focus more on what they can do in terms of valued life directions despite challenging symptomology.
[
169
]
Metacognitive training
(MCT) is associated with reduced
delusions
,
hallucinations
and
negative symptoms
as well as improved
self-esteem
and functioning in individuals with schizophrenia spectrum disorders.
[
170
]
There are many psychosocial interventions that seek to treat the symptoms of psychosis:
need adapted treatment
,
Open Dialogue
, psychoanalysis/psychodynamic psychotherapy,
major role therapy
,
soteria
, psychosocial outpatient and inpatient treatment,
milieu therapy
, and
cognitive behavioral therapy
(CBT). In relation to the success of CBT for psychosis, a randomized controlled trial for a web-based Cognitive Behavioral Therapy for Psychosis (CBT-P) skills program named Coping With Voices (CWV) suggest that the program has promise for increasing access to CBT-P It also associated benefits in the management of distressing psychotic symptoms and improved social functioning. When CBT and the other psychosocial interventions
[
171
]
these are used without antipsychotic medications, they may be somewhat effective for some people, especially for CBT, need-adapted treatment, and soteria.
[
172
]
Early intervention in psychosis
is based on the observation that identifying and treating someone in the early stages of a psychosis can improve his or her longer-term outcome.
[
173
]
This approach advocates the use of an intensive multi-disciplinary approach during what is known as the
critical period
, where intervention is the most effective, and prevents the long-term morbidity associated with chronic psychotic illness.
[
citation needed
]
The word
psychosis
was introduced to the psychiatric literature in 1841 by
Karl Friedrich Canstatt
in his work
Handbuch der Medizinischen Klinik
. He used it as a shorthand for 'psychic neurosis'. At that time neurosis meant any disease of the
nervous system
, and Canstatt was thus referring to what was considered a psychological manifestation of brain disease.
[
174
]
Ernst von Feuchtersleben
is also widely credited as introducing the term in 1845,
[
175
]
as an alternative to
insanity
and
mania
.
[
citation needed
]
The term stems from
Modern Latin
psychosis
, "a giving soul or life to, animating, quickening" and that from
Ancient Greek
ψυχή (
psyche
), "soul" and the suffix -ωσις (-
osis
), in this case "abnormal condition".
[
176
]
[
177
]
In its adjective form "psychotic", references to psychosis can be found in both clinical and non-clinical discussions. However, in a
non
-clinical context, "psychotic" is a nonspecific colloquialism used to mean "insane".
[
citation needed
]
The word was also used to distinguish a condition considered a disorder of the mind, as opposed to
neurosis
, which was considered a disorder of the nervous system.
[
178
]
The psychoses thus became the modern equivalent of the old notion of
madness
, and hence there was much debate on whether there was only one (
unitary
) or many forms of the new disease.
[
179
]
One type of broad usage would later be narrowed down by
Koch
in 1891 to the 'psychopathic inferiorities'—later renamed abnormal personalities by
Schneider
.
[
174
]
The division of the major psychoses into manic depressive illness (now called
bipolar disorder
) and dementia praecox (now called
schizophrenia
) was made by
Emil Kraepelin
, who attempted to create a synthesis of the various mental disorders identified by 19th-century
psychiatrists
, by grouping diseases together based on classification of common symptoms. Kraepelin used the term 'manic depressive insanity' to describe the whole spectrum of
mood disorders
, in a far wider sense than it is usually used today.
[
citation needed
]
In Kraepelin's classification this would include 'unipolar'
clinical depression
, as well as bipolar disorder and other mood disorders such as
cyclothymia
. These are characterised by problems with mood control and the psychotic episodes appear associated with disturbances in mood, and patients often have periods of normal functioning between psychotic episodes even without medication.
Schizophrenia
is characterized by psychotic episodes that appear unrelated to disturbances in mood, and most non-medicated patients show signs of disturbance between psychotic episodes.
[
citation needed
]
Written record of supernatural causes and resultant treatments can be traced back to the
New Testament
.
Mark 5
:8–13 describes a man displaying what would today be described as psychotic symptoms.
Christ
cured this "
demonic
madness" by casting out the demons and hurling them into a herd of swine. Exorcism is still utilized in some religious circles as a treatment for psychosis presumed to be demonic possession.
[
180
]
A research study of out-patients in psychiatric clinics found that 30% of religious patients attributed the cause of their psychotic symptoms to evil spirits. Many of these patients underwent exorcistic healing rituals that, though largely regarded as positive experiences by the patients, had no effect on symptomology. Results did however show a significant worsening of psychotic symptoms associated with exclusion of medical treatment for coercive forms of exorcism.
[
181
]
Bust of Hippocrates
The medical teachings of the fourth-century philosopher and physician
Hippocrates of Cos
proposed a natural, rather than supernatural, cause of human illness. In Hippocrates' work, the
Hippocratic corpus
, a holistic explanation for health and disease was developed to include madness and other "diseases of the mind". Hippocrates writes:
Men ought to know that from the brain, and from the brain only, arise our pleasures, joys, laughter, and jests, as well as our sorrows, pains, griefs and tears. Through it, in particular, we think, see, hear, and distinguish the ugly from the beautiful, the bad from the good, the pleasant from the unpleasant.... It is the same thing which makes us mad or delirious, inspires us with dread and fear, whether by night or by day, brings sleeplessness, inopportune mistakes, aimless anxieties, absentmindedness, and acts that are contrary to habit.
[
182
]
Hippocrates espoused a theory of
humoralism
wherein disease is resultant of a shifting balance in bodily fluids including
blood
,
phlegm
,
black bile
, and
yellow bile
.
[
183
]
According to humoralism, each fluid or "
humour
" has temperamental or behavioral correlates. In the case of psychosis, symptoms are thought to be caused by an excess of both blood and yellow bile. Thus, the proposed surgical intervention for psychotic or manic behavior was
bloodletting
.
[
184
]
18th-century physician, educator, and widely considered "founder of American psychiatry",
Benjamin Rush
, also prescribed bloodletting as a first-line treatment for psychosis. Although not a proponent of humoralism, Rush believed that active purging and bloodletting were efficacious corrections for disruptions in the circulatory system, a complication he believed was the primary cause of "insanity".
[
185
]
Although Rush's treatment modalities are now considered antiquated and brutish, his contributions to psychiatry, namely the biological underpinnings of psychiatric phenomenon including psychosis, have been invaluable to the field. In honor of such contributions, Benjamin Rush's image is in the official seal of the
American Psychiatric Association
.
[
citation needed
]
Early 20th-century treatments for severe and persisting psychosis were characterized by an emphasis on shocking the nervous system. Such therapies include
insulin shock therapy
,
cardiazol
shock therapy, and
electroconvulsive therapy
.
[
186
]
Despite considerable risk, shock therapy was considered highly efficacious in the treatment of psychosis including
schizophrenia
. The acceptance of high-risk treatments led to more invasive medical interventions including
psychosurgery
.
[
187
]
Gottlieb Burckhardt (1836–1907)
In 1888, Swiss psychiatrist
Gottlieb Burckhardt
performed the first medically sanctioned psychosurgery in which the
cerebral cortex
was excised. Although some patients showed improvement of symptoms and became more subdued, one patient died and several developed
aphasia
or seizure disorders. Burckhardt would go on to publish his clinical outcomes in a scholarly paper. This procedure was met with criticism from the medical community and his academic and surgical endeavors were largely ignored.
[
188
]
In the late 1930s,
Egas Moniz
conceived the
leucotomy
(AKA
prefrontal lobotomy
) in which the fibers connecting the
frontal lobes
to the rest of the brain were severed. Moniz's primary inspiration stemmed from a demonstration by neuroscientists John Fulton and Carlyle's 1935 experiment in which two chimpanzees were given leucotomies and pre- and post-surgical behavior was compared. Prior to the leucotomy, the chimps engaged in typical behavior including throwing feces and fighting. After the procedure, both chimps were pacified and less violent. During the Q&A, Moniz asked if such a procedure could be extended to human subjects, a question that Fulton admitted was quite startling.
[
189
]
Moniz would go on to extend the controversial practice to humans with various psychotic disorders, an endeavor for which he received a
Nobel Prize
in 1949.
[
190
]
Between the late 1930s and early 1970s, the leucotomy was a widely accepted practice, often performed in non-
sterile
environments such as small
outpatient
clinics and patient homes.
[
189
]
Psychosurgery remained standard practice until the discovery of antipsychotic pharmacology in the 1950s.
[
191
]
The first clinical trial of
antipsychotics
(also commonly known as neuroleptics) for the treatment of psychosis took place in 1952.
Chlorpromazine
(brand name: Thorazine) passed clinical trials and became the first antipsychotic medication approved for the treatment of both acute and chronic psychosis. Although the mechanism of action was not discovered until 1963, the administration of chlorpromazine marked the advent of the
dopamine antagonist
, or first generation antipsychotic.
[
192
]
While clinical trials showed a high response rate for both acute psychosis and disorders with psychotic features, the
side effects
were particularly harsh, which included high rates of often irreversible Parkinsonian symptoms such as
tardive dyskinesia
. With the advent of
atypical antipsychotics
(also known as second generation antipsychotics) came a dopamine antagonist with a comparable response rate but a far different, though still extensive, side-effect profile that included a lower risk of Parkinsonian symptoms but a higher risk of cardiovascular disease.
[
193
]
Atypical antipsychotics remain the first-line treatment for psychosis associated with various psychiatric and
neurological disorders
including schizophrenia,
bipolar disorder
,
major depressive disorder
,
anxiety disorders
,
dementia
, and some
autism spectrum
disorders.
[
194
]
Dopamine is now one of the primary neurotransmitters implicated in psychotic symptomology. Blocking dopamine receptors (namely, the dopamine D2 receptors) and decreasing dopaminergic activity continues to be an effective but highly unrefined effect of antipsychotics, which are commonly used to treat psychosis. Recent pharmacological research suggests that the decrease in dopaminergic activity does not eradicate psychotic
delusions
or
hallucinations
, but rather attenuates the reward mechanisms involved in the development of delusional thinking; that is, connecting or finding meaningful relationships between unrelated stimuli or ideas.
[
119
]
The author of this research paper acknowledges the importance of future investigation:
The model presented here is based on incomplete knowledge related to dopamine, schizophrenia, and antipsychotics—and as such will need to evolve as more is known about these.
— Shitij Kapur, From dopamine to salience to psychosis—linking biology, pharmacology and phenomenology of psychosis
Freud
's former student Wilhelm Reich explored independent insights into the physical effects of neurotic and traumatic upbringing, and published his holistic psychoanalytic treatment with a schizophrenic. With his incorporation of breathwork and insight with the patient, a young woman, she achieved sufficient self-management skills to end the therapy.
[
195
]
Lacan
extended Freud's ideas to create a psychoanalytic model of psychosis based upon the concept of "
foreclosure
", the rejection of the symbolic concept of the father.
[
citation needed
]
Psychiatrist
David Healy
has criticised pharmaceutical companies for promoting simplified biological theories of mental illness that seem to imply the primacy of pharmaceutical treatments while ignoring social and developmental factors that are known important influences in the etiology of psychosis.
[
196
]
Society and culture
[
edit
]
Symptoms of psychosis can also include visions or quasi-visual experiences, felt presences, alterations of time, alterations of space, or alterations of spatiotemporal qualities of objects and things.
[
153
]
While there are many overwhelmingly negative experiences of psychosis, some experiences of psychosis can be overwhelmingly positive and can be experienced as uplifting or as healing or as difficult but meaningful.
[
153
]
Jones and Shattell said that mutual dialogue in clinical practice would in theory allow the meaning and complexity of psychotic experiences to emerge.
[
153
]
The classification of psychosis as a
social disability
is a common occurrence.
Psychosis is considered to be among the top ten causes of social disability among adults in developed countries.
[
197
]
The traditional, negative narrative around disability has been shown to adversely influence employment and education for people experiencing psychosis.
[
198
]
Social disability by way of social disconnection is a significant public health concern and is associated with a broad range of negative outcomes, including premature mortality. Social disconnection refers to the ongoing absence of family or social relationships with marginal participation in social activities.
[
199
]
Research on psychosis found that reduced participation in social networks, not only negatively effects the individual on a physical and mental level, it has been shown that failure to be included in social networks influences the individual's ability to participate in the wider community through employment and education opportunities.
[
200
]
[
201
]
[
202
]
Equal opportunity to participate in meaningful relationships with friends, family and romantic partners, as well as engaging in social constructs such as employment, can provide significant physical and mental value to people's lives.
[
200
]
And how breaking the disability mind-set around people experiencing psychosis is imperative for their overall, long-term health and well-being as well as the contributions they are able to make to their immediate social connections and the wider community.
[
201
]
Further research in the form of randomized controlled trials is needed to determine the effectiveness of treatment approaches for helping
adolescents
with psychosis.
[
46
]
Through 10 randomized clinical trials, studies showed that Early Intervention Services (EIS) for patients with early-phase schizophrenia spectrum disorders have generated promising outcomes.
[
203
]
EIS are specifically intended to fulfill the needs of patients with early-phase psychosis.
[
203
]
In addition, one meta-analysis that consisted of four randomized clinical trials has examined and discovered the efficacy of EIS to Therapy as Usual (TAU) for early-phase psychosis, revealing that EIS techniques are superior to TAU.
[
203
]
A study suggests that combining cognitive behavioral therapy (CBT) with SlowMo, an application that helps notice their "unhelpful quick-thinking", might be more effective for treating paranoia in people with psychosis than CBT. alone.
[
204
]
[
205
]
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.
National Institute of Mental Health | |||||||||
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## Contents
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- [(Top)](https://en.wikipedia.org/wiki/Psychosis)
- [1 Signs and symptoms](https://en.wikipedia.org/wiki/Psychosis#Signs_and_symptoms)
Toggle Signs and symptoms subsection
- [1\.1 Hallucinations](https://en.wikipedia.org/wiki/Psychosis#Hallucinations)
- [1\.2 Delusions](https://en.wikipedia.org/wiki/Psychosis#Delusions)
- [1\.3 Disorganized speech/thought and disorganized behavior](https://en.wikipedia.org/wiki/Psychosis#Disorganized_speech/thought_and_disorganized_behavior)
- [1\.4 Negative symptoms](https://en.wikipedia.org/wiki/Psychosis#Negative_symptoms)
- [1\.5 Psychosis in adolescents](https://en.wikipedia.org/wiki/Psychosis#Psychosis_in_adolescents)
- [2 Causes](https://en.wikipedia.org/wiki/Psychosis#Causes)
Toggle Causes subsection
- [2\.1 Normal states](https://en.wikipedia.org/wiki/Psychosis#Normal_states)
- [2\.2 Trauma and stress](https://en.wikipedia.org/wiki/Psychosis#Trauma_and_stress)
- [2\.3 Psychiatric disorders](https://en.wikipedia.org/wiki/Psychosis#Psychiatric_disorders)
- [2\.3.1 Subtypes](https://en.wikipedia.org/wiki/Psychosis#Subtypes)
- [2\.3.2 Cycloid psychosis](https://en.wikipedia.org/wiki/Psychosis#Cycloid_psychosis)
- [2\.3.3 Postpartum psychosis](https://en.wikipedia.org/wiki/Psychosis#Postpartum_psychosis)
- [2\.4 Medical conditions](https://en.wikipedia.org/wiki/Psychosis#Medical_conditions)
- [2\.5 Psychoactive drugs](https://en.wikipedia.org/wiki/Psychosis#Psychoactive_drugs)
- [2\.5.1 Alcohol](https://en.wikipedia.org/wiki/Psychosis#Alcohol)
- [2\.5.2 Cannabis](https://en.wikipedia.org/wiki/Psychosis#Cannabis)
- [2\.5.3 Methamphetamine](https://en.wikipedia.org/wiki/Psychosis#Methamphetamine)
- [2\.5.4 Psychedelics](https://en.wikipedia.org/wiki/Psychosis#Psychedelics)
- [2\.6 Medication](https://en.wikipedia.org/wiki/Psychosis#Medication)
- [3 Pathophysiology](https://en.wikipedia.org/wiki/Psychosis#Pathophysiology)
Toggle Pathophysiology subsection
- [3\.1 Neuroimaging](https://en.wikipedia.org/wiki/Psychosis#Neuroimaging)
- [3\.2 Hallucinations](https://en.wikipedia.org/wiki/Psychosis#Hallucinations_2)
- [3\.3 Delusions](https://en.wikipedia.org/wiki/Psychosis#Delusions_2)
- [3\.4 Negative symptoms](https://en.wikipedia.org/wiki/Psychosis#Negative_symptoms_2)
- [3\.5 Neurobiology](https://en.wikipedia.org/wiki/Psychosis#Neurobiology)
- [3\.6 Culture](https://en.wikipedia.org/wiki/Psychosis#Culture)
- [4 Diagnosis](https://en.wikipedia.org/wiki/Psychosis#Diagnosis)
- [5 Prevention](https://en.wikipedia.org/wiki/Psychosis#Prevention)
- [6 Treatment](https://en.wikipedia.org/wiki/Psychosis#Treatment)
Toggle Treatment subsection
- [6\.1 Medication](https://en.wikipedia.org/wiki/Psychosis#Medication_2)
- [6\.2 Psychotherapy](https://en.wikipedia.org/wiki/Psychosis#Psychotherapy)
- [6\.3 Early intervention](https://en.wikipedia.org/wiki/Psychosis#Early_intervention)
- [7 History](https://en.wikipedia.org/wiki/Psychosis#History)
Toggle History subsection
- [7\.1 Etymology](https://en.wikipedia.org/wiki/Psychosis#Etymology)
- [7\.2 Classification](https://en.wikipedia.org/wiki/Psychosis#Classification)
- [7\.3 Treatment](https://en.wikipedia.org/wiki/Psychosis#Treatment_2)
- [8 Society and culture](https://en.wikipedia.org/wiki/Psychosis#Society_and_culture)
Toggle Society and culture subsection
- [8\.1 Disability](https://en.wikipedia.org/wiki/Psychosis#Disability)
- [9 Research](https://en.wikipedia.org/wiki/Psychosis#Research)
- [10 References](https://en.wikipedia.org/wiki/Psychosis#References)
- [11 Bibliography](https://en.wikipedia.org/wiki/Psychosis#Bibliography)
- [12 Further reading](https://en.wikipedia.org/wiki/Psychosis#Further_reading)
- [13 External links](https://en.wikipedia.org/wiki/Psychosis#External_links)
Toggle the table of contents
# Psychosis
82 languages
- [Afrikaans](https://af.wikipedia.org/wiki/Psigose "Psigose – Afrikaans")
- [العربية](https://ar.wikipedia.org/wiki/%D8%B0%D9%87%D8%A7%D9%86 "ذهان – Arabic")
- [مصرى](https://arz.wikipedia.org/wiki/%D8%B3%D9%8A%D9%83%D9%88%D8%B2 "سيكوز – Egyptian Arabic")
- [Asturianu](https://ast.wikipedia.org/wiki/Sicosis "Sicosis – Asturian")
- [Azərbaycanca](https://az.wikipedia.org/wiki/Psixoz "Psixoz – Azerbaijani")
- [تۆرکجه](https://azb.wikipedia.org/wiki/%D8%B3%D8%A7%DB%8C%DA%A9%D9%88%D8%B3%DB%8C%D8%B3 "سایکوسیس – South Azerbaijani")
- [Basa Bali](https://ban.wikipedia.org/wiki/Psikosis "Psikosis – Balinese")
- [Беларуская (тарашкевіца)](https://be-tarask.wikipedia.org/wiki/%D0%9F%D1%81%D1%8B%D1%85%D0%BE%D0%B7 "Псыхоз – Belarusian (Taraškievica orthography)")
- [Беларуская](https://be.wikipedia.org/wiki/%D0%9F%D1%81%D1%96%D1%85%D0%BE%D0%B7 "Псіхоз – Belarusian")
- [Български](https://bg.wikipedia.org/wiki/%D0%9F%D1%81%D0%B8%D1%85%D0%BE%D0%B7%D0%B0 "Психоза – Bulgarian")
- [বাংলা](https://bn.wikipedia.org/wiki/%E0%A6%AE%E0%A6%A8%E0%A7%8B%E0%A6%AC%E0%A7%8D%E0%A6%AF%E0%A6%BE%E0%A6%A7%E0%A6%BF "মনোব্যাধি – Bangla")
- [Brezhoneg](https://br.wikipedia.org/wiki/Psikosis "Psikosis – Breton")
- [Català](https://ca.wikipedia.org/wiki/Psicosi "Psicosi – Catalan")
- [کوردی](https://ckb.wikipedia.org/wiki/%D8%B3%D8%A7%DB%8C%DA%A9%DB%86%D8%B3%D8%B2 "سایکۆسز – Central Kurdish")
- [Čeština](https://cs.wikipedia.org/wiki/Psych%C3%B3za "Psychóza – Czech")
- [Dansk](https://da.wikipedia.org/wiki/Psykose "Psykose – Danish")
- [Deutsch](https://de.wikipedia.org/wiki/Psychose "Psychose – German")
- [Ελληνικά](https://el.wikipedia.org/wiki/%CE%A8%CF%8D%CF%87%CF%89%CF%83%CE%B7 "Ψύχωση – Greek")
- [Esperanto](https://eo.wikipedia.org/wiki/Psikozo "Psikozo – Esperanto")
- [Español](https://es.wikipedia.org/wiki/Psicosis "Psicosis – Spanish")
- [Eesti](https://et.wikipedia.org/wiki/Ps%C3%BChhoos "Psühhoos – Estonian")
- [Euskara](https://eu.wikipedia.org/wiki/Psikosi "Psikosi – Basque")
- [فارسی](https://fa.wikipedia.org/wiki/%D8%B1%D9%88%D8%A7%D9%86%E2%80%8C%D9%BE%D8%B1%DB%8C%D8%B4%DB%8C "روانپریشی – Persian")
- [Suomi](https://fi.wikipedia.org/wiki/Psykoosi "Psykoosi – Finnish")
- [Français](https://fr.wikipedia.org/wiki/Psychose "Psychose – French")
- [Gaeilge](https://ga.wikipedia.org/wiki/S%C3%ADoc%C3%B3is "Síocóis – Irish")
- [Galego](https://gl.wikipedia.org/wiki/Psicose "Psicose – Galician")
- [Ghanaian Pidgin](https://gpe.wikipedia.org/wiki/Psychosis "Psychosis – Ghanaian Pidgin")
- [עברית](https://he.wikipedia.org/wiki/%D7%A4%D7%A1%D7%99%D7%9B%D7%95%D7%96%D7%94 "פסיכוזה – Hebrew")
- [हिन्दी](https://hi.wikipedia.org/wiki/%E0%A4%AE%E0%A4%A8%E0%A4%B8%E0%A5%8D%E0%A4%A4%E0%A4%BE%E0%A4%AA "मनस्ताप – Hindi")
- [Hrvatski](https://hr.wikipedia.org/wiki/Psihoza "Psihoza – Croatian")
- [Kreyòl ayisyen](https://ht.wikipedia.org/wiki/Sikoz "Sikoz – Haitian Creole")
- [Magyar](https://hu.wikipedia.org/wiki/Pszich%C3%B3zis "Pszichózis – Hungarian")
- [Հայերեն](https://hy.wikipedia.org/wiki/%D5%93%D5%BD%D5%AB%D5%AD%D5%B8%D5%A6 "Փսիխոզ – Armenian")
- [Bahasa Indonesia](https://id.wikipedia.org/wiki/Psikosis "Psikosis – Indonesian")
- [Ido](https://io.wikipedia.org/wiki/Psikoso "Psikoso – Ido")
- [Íslenska](https://is.wikipedia.org/wiki/Ge%C3%B0rof "Geðrof – Icelandic")
- [Italiano](https://it.wikipedia.org/wiki/Psicosi "Psicosi – Italian")
- [日本語](https://ja.wikipedia.org/wiki/%E7%B2%BE%E7%A5%9E%E7%97%85 "精神病 – Japanese")
- [ქართული](https://ka.wikipedia.org/wiki/%E1%83%A4%E1%83%A1%E1%83%98%E1%83%A5%E1%83%9D%E1%83%96%E1%83%98 "ფსიქოზი – Georgian")
- [Kabɩyɛ](https://kbp.wikipedia.org/wiki/Kpa%C5%8B "Kpaŋ – Kabiye")
- [Қазақша](https://kk.wikipedia.org/wiki/%D0%9F%D1%81%D0%B8%D1%85%D0%BE%D0%B7 "Психоз – Kazakh")
- [한국어](https://ko.wikipedia.org/wiki/%EC%A0%95%EC%8B%A0%EC%A6%9D "정신증 – Korean")
- [Перем коми](https://koi.wikipedia.org/wiki/Psikoz "Psikoz – Komi-Permyak")
- [Kurdî](https://ku.wikipedia.org/wiki/Ps%C3%AEkoz "Psîkoz – Kurdish")
- [Lietuvių](https://lt.wikipedia.org/wiki/Psichoz%C4%97 "Psichozė – Lithuanian")
- [Latviešu](https://lv.wikipedia.org/wiki/Psihoze "Psihoze – Latvian")
- [Madhurâ](https://mad.wikipedia.org/wiki/Psikosis "Psikosis – Madurese")
- [Македонски](https://mk.wikipedia.org/wiki/%D0%9F%D1%81%D0%B8%D1%85%D0%BE%D0%B7%D0%B0 "Психоза – Macedonian")
- [മലയാളം](https://ml.wikipedia.org/wiki/%E0%B4%9A%E0%B4%BF%E0%B4%A4%E0%B5%8D%E0%B4%A4%E0%B4%B5%E0%B4%BF%E0%B4%AD%E0%B5%8D%E0%B4%B0%E0%B4%BE%E0%B4%A8%E0%B5%8D%E0%B4%A4%E0%B4%BF "ചിത്തവിഭ്രാന്തി – Malayalam")
- [Bahasa Melayu](https://ms.wikipedia.org/wiki/Psikosis "Psikosis – Malay")
- [Mirandés](https://mwl.wikipedia.org/wiki/Psicose "Psicose – Mirandese")
- [नेपाली](https://ne.wikipedia.org/wiki/%E0%A4%AA%E0%A4%BE%E0%A4%97%E0%A4%B2%E0%A4%AA%E0%A4%A8 "पागलपन – Nepali")
- [नेपाल भाषा](https://new.wikipedia.org/wiki/%E0%A4%AE%E0%A4%A8%E0%A4%B8%E0%A5%8D%E0%A4%A4%E0%A4%BE%E0%A4%AA "मनस्ताप – Newari")
- [Nederlands](https://nl.wikipedia.org/wiki/Psychose "Psychose – Dutch")
- [Norsk nynorsk](https://nn.wikipedia.org/wiki/Psykose "Psykose – Norwegian Nynorsk")
- [Norsk bokmål](https://no.wikipedia.org/wiki/Psykose "Psykose – Norwegian Bokmål")
- [ଓଡ଼ିଆ](https://or.wikipedia.org/wiki/%E0%AC%B8%E0%AC%BE%E0%AC%87%E0%AC%95%E0%AD%8B%E0%AC%B8%E0%AC%BF%E0%AC%B8 "ସାଇକୋସିସ – Odia")
- [Papiamentu](https://pap.wikipedia.org/wiki/Psicosis "Psicosis – Papiamento")
- [Polski](https://pl.wikipedia.org/wiki/Psychoza "Psychoza – Polish")
- [Português](https://pt.wikipedia.org/wiki/Psicose "Psicose – Portuguese")
- [Română](https://ro.wikipedia.org/wiki/Psihoz%C4%83 "Psihoză – Romanian")
- [Русский](https://ru.wikipedia.org/wiki/%D0%9F%D1%81%D0%B8%D1%85%D0%BE%D0%B7 "Психоз – Russian")
- [Srpskohrvatski / српскохрватски](https://sh.wikipedia.org/wiki/Psihoza "Psihoza – Serbo-Croatian")
- [සිංහල](https://si.wikipedia.org/wiki/%E0%B7%83%E0%B6%BA%E0%B7%92%E0%B6%9A%E0%B7%9D%E0%B7%83%E0%B7%92%E0%B6%BA%E0%B7%8F%E0%B7%80 "සයිකෝසියාව – Sinhala")
- [Simple English](https://simple.wikipedia.org/wiki/Psychosis "Psychosis – Simple English")
- [Slovenčina](https://sk.wikipedia.org/wiki/Psych%C3%B3za "Psychóza – Slovak")
- [Shqip](https://sq.wikipedia.org/wiki/Psikoza "Psikoza – Albanian")
- [Српски / srpski](https://sr.wikipedia.org/wiki/%D0%9F%D1%81%D0%B8%D1%85%D0%BE%D0%B7%D0%B0 "Психоза – Serbian")
- [Svenska](https://sv.wikipedia.org/wiki/Psykos "Psykos – Swedish")
- [తెలుగు](https://te.wikipedia.org/wiki/%E0%B0%B8%E0%B1%88%E0%B0%95%E0%B1%8B%E0%B0%B8%E0%B0%BF%E0%B0%B8%E0%B1%8D "సైకోసిస్ – Telugu")
- [ไทย](https://th.wikipedia.org/wiki/%E0%B9%82%E0%B8%A3%E0%B8%84%E0%B8%88%E0%B8%B4%E0%B8%95 "โรคจิต – Thai")
- [Tagalog](https://tl.wikipedia.org/wiki/Sikosis "Sikosis – Tagalog")
- [Türkçe](https://tr.wikipedia.org/wiki/Psikoz "Psikoz – Turkish")
- [Українська](https://uk.wikipedia.org/wiki/%D0%9F%D1%81%D0%B8%D1%85%D0%BE%D0%B7 "Психоз – Ukrainian")
- [اردو](https://ur.wikipedia.org/wiki/%D8%B0%DA%BE%D8%A7%D9%86 "ذھان – Urdu")
- [Oʻzbekcha / ўзбекча](https://uz.wikipedia.org/wiki/Psixoz "Psixoz – Uzbek")
- [Tiếng Việt](https://vi.wikipedia.org/wiki/Lo%E1%BA%A1n_th%E1%BA%A7n "Loạn thần – Vietnamese")
- [吴语](https://wuu.wikipedia.org/wiki/%E7%B2%BE%E7%A5%9E%E9%94%99%E4%B9%B1 "精神错乱 – Wu")
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From Wikipedia, the free encyclopedia
Abnormal condition of the mind
For other uses, see [Psychosis (disambiguation)](https://en.wikipedia.org/wiki/Psychosis_\(disambiguation\) "Psychosis (disambiguation)").
Not to be confused with [Psychopathy](https://en.wikipedia.org/wiki/Psychopathy "Psychopathy"), [Sycosis](https://en.wikipedia.org/wiki/Sycosis "Sycosis"), or [Psykotic](https://en.wikipedia.org/wiki/Psykotic "Psykotic").
| | |
|---|---|
|  | This article **needs more [reliable medical references](https://en.wikipedia.org/wiki/Wikipedia:Identifying_reliable_sources_\(medicine\) "Wikipedia:Identifying reliable sources (medicine)") for [verification](https://en.wikipedia.org/wiki/Wikipedia:Verifiability "Wikipedia:Verifiability") or relies too heavily on [primary sources](https://en.wikipedia.org/wiki/Wikipedia:Primary_sources "Wikipedia:Primary sources")**. Please review the contents of the article and [add the appropriate references](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit) if you can. Unsourced or poorly sourced material may be challenged and [removed](https://en.wikipedia.org/wiki/Wikipedia:Verifiability#Burden_of_evidence "Wikipedia:Verifiability"). *Find sources:* ["Psychosis"](https://www.google.com/search?as_eq=wikipedia&q=%22Psychosis%22) – [news](https://www.google.com/search?tbm=nws&q=%22Psychosis%22+-wikipedia&tbs=ar:1) **·** [newspapers](https://www.google.com/search?&q=%22Psychosis%22&tbs=bkt:s&tbm=bks) **·** [books](https://www.google.com/search?tbs=bks:1&q=%22Psychosis%22+-wikipedia) **·** [scholar](https://scholar.google.com/scholar?q=%22Psychosis%22) **·** [JSTOR](https://www.jstor.org/action/doBasicSearch?Query=%22Psychosis%22&acc=on&wc=on) *(February 2021)* |
Medical condition
| Psychosis | |
|---|---|
| Other names | Psychotic break (*colloquial*), psychotic episode |
| [Specialty](https://en.wikipedia.org/wiki/Medical_specialty "Medical specialty") | [Neurology](https://en.wikipedia.org/wiki/Neurology "Neurology"), [psychiatry](https://en.wikipedia.org/wiki/Psychiatry "Psychiatry"), [emergency medicine](https://en.wikipedia.org/wiki/Emergency_medicine "Emergency medicine"), [clinical psychology](https://en.wikipedia.org/wiki/Clinical_psychology "Clinical psychology") |
| [Symptoms](https://en.wikipedia.org/wiki/Signs_and_symptoms "Signs and symptoms") | [Delusions](https://en.wikipedia.org/wiki/Delusion "Delusion"), [hallucinations](https://en.wikipedia.org/wiki/Hallucination "Hallucination"), incoherent speech and behavior[\[1\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-NIH2018QA-1) |
| [Complications](https://en.wikipedia.org/wiki/Complication_\(medicine\) "Complication (medicine)") | [Self-harm](https://en.wikipedia.org/wiki/Self-harm "Self-harm"), [suicide](https://en.wikipedia.org/wiki/Suicide "Suicide")[\[2\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-NHS2016-2) |
| [Causes](https://en.wikipedia.org/wiki/Cause_\(medicine\) "Cause (medicine)") | [Mental illness](https://en.wikipedia.org/wiki/Mental_illness "Mental illness") ([schizophrenia](https://en.wikipedia.org/wiki/Schizophrenia "Schizophrenia"), [bipolar disorder](https://en.wikipedia.org/wiki/Bipolar_disorder "Bipolar disorder")), [trauma](https://en.wikipedia.org/wiki/Psychological_trauma "Psychological trauma"), [sleep deprivation](https://en.wikipedia.org/wiki/Sleep_deprivation "Sleep deprivation"), some medical conditions, certain [medications](https://en.wikipedia.org/wiki/Medication "Medication"), drugs (including [alcohol](https://en.wikipedia.org/wiki/Alcohol_\(drug\) "Alcohol (drug)"), [caffeine](https://en.wikipedia.org/wiki/Caffeine "Caffeine") and [cannabis](https://en.wikipedia.org/wiki/Cannabis_\(drug\) "Cannabis (drug)"))[\[1\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-NIH2018QA-1) |
| Treatment | [Antipsychotics](https://en.wikipedia.org/wiki/Antipsychotic "Antipsychotic"), [counselling](https://en.wikipedia.org/wiki/Counselling "Counselling"), [social support](https://en.wikipedia.org/wiki/Social_support "Social support")[\[2\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-NHS2016-2) |
| [Prognosis](https://en.wikipedia.org/wiki/Prognosis "Prognosis") | Depends on cause[\[2\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-NHS2016-2) |
| Frequency | 3% of people at some point in their lives (U.S.)[\[1\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-NIH2018QA-1) |
In [psychopathology](https://en.wikipedia.org/wiki/Psychopathology "Psychopathology"), **psychosis** is the inability to distinguish what is or is not [real](https://en.wikipedia.org/wiki/Reality "Reality").[\[3\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Continuum-3) Examples of psychotic symptoms are [delusions](https://en.wikipedia.org/wiki/Delusion "Delusion"), [hallucinations](https://en.wikipedia.org/wiki/Hallucination "Hallucination"), and disorganized or [incoherent thoughts](https://en.wikipedia.org/wiki/Thought_disorder "Thought disorder") or speech.[\[3\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Continuum-3) Psychosis is a description of a person's state or symptoms, rather than a particular [mental illness](https://en.wikipedia.org/wiki/Mental_disorder "Mental disorder"), and it is not related to [psychopathy](https://en.wikipedia.org/wiki/Psychopathy "Psychopathy") (a [personality](https://en.wikipedia.org/wiki/Personality "Personality") [construct](https://en.wikipedia.org/wiki/Construct_\(psychology\) "Construct (psychology)")[\[4\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-4)[\[5\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-5) characterized by impaired [empathy](https://en.wikipedia.org/wiki/Empathy "Empathy") and [remorse](https://en.wikipedia.org/wiki/Remorse "Remorse"), along with [bold](https://en.wikipedia.org/wiki/Boldness "Boldness"), [disinhibited](https://en.wikipedia.org/wiki/Disinhibited "Disinhibited"), and [egocentric](https://en.wikipedia.org/wiki/Egocentrism "Egocentrism") traits).[\[6\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-6)
Common causes of [chronic](https://en.wikipedia.org/wiki/Chronic_condition "Chronic condition") (i.e. ongoing or repeating) psychosis include [schizophrenia](https://en.wikipedia.org/wiki/Schizophrenia "Schizophrenia") or [schizoaffective disorder](https://en.wikipedia.org/wiki/Schizoaffective_disorder "Schizoaffective disorder"), [bipolar disorder](https://en.wikipedia.org/wiki/Bipolar_disorder "Bipolar disorder"), and [brain damage](https://en.wikipedia.org/wiki/Wernicke%E2%80%93Korsakoff_syndrome "Wernicke–Korsakoff syndrome") (usually as a result of [alcoholism](https://en.wikipedia.org/wiki/Alcoholism "Alcoholism")).[\[7\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-7)[\[8\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-8) Acute (temporary) psychosis can also be caused by [severe distress](https://en.wikipedia.org/wiki/Psychological_trauma "Psychological trauma"), [sleep deprivation](https://en.wikipedia.org/wiki/Sleep_deprivation "Sleep deprivation"), [sensory deprivation](https://en.wikipedia.org/wiki/Sensory_deprivation "Sensory deprivation"),[\[9\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Oxford_Textbook_of_Psychiatry-9) some [medications](https://en.wikipedia.org/wiki/Medication "Medication"), and [drug use](https://en.wikipedia.org/wiki/Drug "Drug") (including [alcohol](https://en.wikipedia.org/wiki/Alcohol_\(drug\) "Alcohol (drug)"), [cannabis](https://en.wikipedia.org/wiki/Cannabis_\(drug\) "Cannabis (drug)"), [hallucinogens](https://en.wikipedia.org/wiki/Hallucinogen "Hallucinogen"), and [stimulants](https://en.wikipedia.org/wiki/Stimulant "Stimulant")).[\[10\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Griswold-10) Acute psychosis is termed primary if it results from a psychiatric condition and secondary if it is caused by another medical condition or drugs.[\[10\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Griswold-10) The diagnosis of a mental-health condition requires excluding other potential causes.[\[11\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-11) Tests can be done to check whether psychosis is caused by [central nervous system](https://en.wikipedia.org/wiki/Central_nervous_system "Central nervous system") diseases, toxins, or other health problems.[\[12\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-12)
Treatment may include [antipsychotic medication](https://en.wikipedia.org/wiki/Antipsychotic_medication "Antipsychotic medication"), [psychotherapy](https://en.wikipedia.org/wiki/Psychotherapy "Psychotherapy"), and [social support](https://en.wikipedia.org/wiki/Social_support "Social support").[\[1\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-NIH2018QA-1)[\[2\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-NHS2016-2) Early treatment appears to improve outcomes.[\[1\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-NIH2018QA-1) Medications appear to have a moderate effect.[\[13\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-13) Outcomes depend on the underlying cause.[\[2\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-NHS2016-2)
Psychosis is not well-understood at the [neurological](https://en.wikipedia.org/wiki/Neurological "Neurological") level, but [dopamine](https://en.wikipedia.org/wiki/Dopamine "Dopamine") (along with other [neurotransmitters](https://en.wikipedia.org/wiki/Neurotransmitter "Neurotransmitter")) is known to play an important role.[\[14\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-14)[\[15\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-15)[\[16\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-16) In the United States about 3% of people develop psychosis at some point in their lives.[\[1\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-NIH2018QA-1) Psychosis has been described as early as the 4th century BCE by [Hippocrates](https://en.wikipedia.org/wiki/Hippocrates "Hippocrates") and possibly as early as 1500 BCE in the [Ebers Papyrus](https://en.wikipedia.org/wiki/Ebers_Papyrus "Ebers Papyrus").[\[17\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-17)[\[18\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-18)
## Signs and symptoms
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=1 "Edit section: Signs and symptoms")\]
### Hallucinations
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=2 "Edit section: Hallucinations")\]
A [hallucination](https://en.wikipedia.org/wiki/Hallucination "Hallucination") is defined as a sensory perception in the absence of external stimuli.[\[19\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:9-19) Hallucinations are different from [illusions](https://en.wikipedia.org/wiki/Illusion "Illusion") and perceptual distortions, which are the misperception of external stimuli.[\[20\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-20)[\[21\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-21) Hallucinations may occur in any of the senses and take on almost any form. They may consist of simple sensations (such as lights, colors, sounds, tastes, or smells) or more detailed experiences (such as seeing and interacting with animals and people, [hearing voices](https://en.wikipedia.org/wiki/Auditory_verbal_hallucinations "Auditory verbal hallucinations"), and having complex tactile sensations). Hallucinations are generally characterized as being vivid and uncontrollable.[\[19\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:9-19)[\[22\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-DSM-22) [Auditory hallucinations](https://en.wikipedia.org/wiki/Auditory_hallucination "Auditory hallucination"), particularly experiences of hearing voices, are the most common and often prominent feature of psychosis.\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
Up to 15% of the general population may experience auditory hallucinations (though not all are due to psychosis).[\[23\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-23) The prevalence of auditory hallucinations in patients with [schizophrenia](https://en.wikipedia.org/wiki/Schizophrenia "Schizophrenia") is generally put around 70%.[\[24\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-24) Reported prevalence in [bipolar disorder](https://en.wikipedia.org/wiki/Bipolar_disorder "Bipolar disorder") ranges between 11% and 68%.[\[25\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Toh-25) During the early 20th century, auditory hallucinations were second to [visual hallucinations](https://en.wikipedia.org/wiki/Visual_hallucinations_in_psychosis "Visual hallucinations in psychosis") in frequency, but they are now the most common manifestation of schizophrenia, although rates vary between cultures and regions. Auditory hallucinations are most commonly intelligible voices. When voices are present, the average number has been estimated at three. Content, like frequency, differs significantly, especially across cultures and demographics. People who experience auditory hallucinations can frequently identify the loudness, location of origin, and may settle on identities for voices. Western cultures are associated with auditory experiences concerning religious content, frequently related to sin. Hallucinations may command a person to do something potentially dangerous when combined with delusions.[\[26\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Sadock_Psychosis-26)
So-called "minor hallucinations", such as extracampine hallucinations, or false perceptions of people or movement occurring outside of one's visual field, frequently occur in neurocognitive disorders, such as Parkinson's disease.[\[27\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-27)
Visual hallucinations occur in roughly a third of people with schizophrenia, although certain studies show rates higher than 60%, suggesting that the prevalence of visual hallucinations may be higher in certain samples than traditionally thought.[\[28\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-28) The reported prevalence in bipolar disorder is around 15%.[\[29\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-29) Content commonly involves animate objects, although perceptual abnormalities such as changes in lighting, shading, streaks, or lines may be seen. Visual abnormalities may conflict with [proprioceptive](https://en.wikipedia.org/wiki/Proprioceptive "Proprioceptive") information, and visions may include experiences such as the ground tilting. [Lilliputian hallucinations](https://en.wikipedia.org/wiki/Lilliputian_hallucinations "Lilliputian hallucinations") are less common in schizophrenia, and are more common in various types of [encephalopathy](https://en.wikipedia.org/wiki/Encephalopathy "Encephalopathy"), such as [peduncular hallucinosis](https://en.wikipedia.org/wiki/Peduncular_hallucinosis "Peduncular hallucinosis").[\[26\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Sadock_Psychosis-26)[\[30\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Blom2021-30)
A visceral hallucination, also called a cenesthetic hallucination, is characterized by visceral sensations in the absence of stimuli. Cenesthetic hallucinations may include sensations of burning, or re-arrangement of internal organs.[\[26\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Sadock_Psychosis-26)
### Delusions
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=3 "Edit section: Delusions")\]
A [delusion](https://en.wikipedia.org/wiki/Delusion "Delusion") is a fixed, false, [idiosyncratic](https://en.wikipedia.org/wiki/Idiosyncrasy "Idiosyncrasy") belief, which does not change even when presented with incontrovertible evidence to the contrary.[\[31\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-31)[\[32\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:13-32)[\[33\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:14-33) Delusions are context- and culture-dependent: a belief that inhibits critical functioning and is widely considered delusional in one population may be common (and even adaptive) in another, or in the same population at a later time.[\[33\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:14-33)[\[34\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-34) Since [normative](https://en.wikipedia.org/wiki/Norm_\(philosophy\) "Norm (philosophy)") views may contradict available evidence, a belief need not contravene cultural standards in order to be considered delusional. However, the [DSM-5](https://en.wikipedia.org/wiki/DSM-5 "DSM-5") considers a belief delusional only if it is not widely accepted within a cultural or subcultural context.[\[35\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-35)
Prevalence of delusions in schizophrenia is generally considered around 80-90%, according to [Columbia University](https://en.wikipedia.org/wiki/Columbia_University "Columbia University").[\[36\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-36) A 2022 systematic review found a prevalence of around 70% in bipolar disorder.[\[37\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-37)
The DSM-5 characterizes certain delusions as "bizarre" if they are clearly implausible, or are incompatible with the surrounding cultural context.[\[32\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:13-32) The concept of bizarre delusions has many criticisms, the most prominent being that judging their presence is not highly reliable even among trained individuals.[\[26\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Sadock_Psychosis-26)
A delusion may involve diverse thematic content. The most common type is a [persecutory delusion](https://en.wikipedia.org/wiki/Persecutory_delusion "Persecutory delusion"), in which a person believes that an entity seeks to harm them.[\[32\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:13-32)[\[33\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:14-33) Others include [delusions of reference](https://en.wikipedia.org/wiki/Delusions_of_reference "Delusions of reference") (the belief that some element of one's experience represents a deliberate and specific act by or message from some other entity), [delusions of grandeur](https://en.wikipedia.org/wiki/Delusions_of_grandeur "Delusions of grandeur") (the belief that one possesses special power or influence beyond one's actual limits), [thought broadcasting](https://en.wikipedia.org/wiki/Thought_broadcasting "Thought broadcasting") (the belief that one's thoughts are audible) and [thought insertion](https://en.wikipedia.org/wiki/Thought_insertion "Thought insertion") (the belief that one's thoughts are not one's own).[\[33\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:14-33) A delusion may also involve [misidentification](https://en.wikipedia.org/wiki/Delusional_misidentification_syndrome "Delusional misidentification syndrome") of objects, persons, or environs that the afflicted should reasonably be able to recognize; such examples include [Cotard's syndrome](https://en.wikipedia.org/wiki/Cotard%27s_syndrome "Cotard's syndrome") (the belief that oneself is partly or wholly [dead](https://en.wikipedia.org/wiki/Dead "Dead")) and [clinical lycanthropy](https://en.wikipedia.org/wiki/Clinical_lycanthropy "Clinical lycanthropy") (the belief that oneself is or has transformed into an animal).\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
The subject matter of delusions seems to reflect the current culture in a particular time and location. For example, in the early 1900s in the United States, [syphilis](https://en.wikipedia.org/wiki/Syphilis "Syphilis") was a common theme in delusions. During the Second World War, it was Germany. In the [Cold War](https://en.wikipedia.org/wiki/Cold_War "Cold War") era, communists became a frequent focus. Now, in recent years, technology is a common subject matter of delusions.[\[38\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Cannon_Kramer_pp._323%E2%80%93327-38) Some psychologists, such as those who practice the [Open Dialogue](https://en.wikipedia.org/wiki/Open_Dialogue "Open Dialogue") method, believe that the content of psychosis represents an underlying thought process, that may in part, be responsible for psychosis,[\[39\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Seikkula,_Birgitta_Alakare,_Jukka_A_2001_pp._247%E2%80%93265-39) though the accepted medical position is that psychosis is due to a brain disorder.[\[40\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-40)
Historically, [Karl Jaspers](https://en.wikipedia.org/wiki/Karl_Jaspers "Karl Jaspers") classified psychotic delusions into *primary* and *secondary* types. Primary delusions are defined as arising suddenly and not being comprehensible in terms of normal mental processes, whereas secondary delusions are typically understood as being influenced by the person's background or current situation (e.g., ethnicity, religious, superstitious, or political beliefs).[\[41\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Jaspers-41)
### Disorganized speech/thought and disorganized behavior
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=4 "Edit section: Disorganized speech/thought and disorganized behavior")\]
Disorganization is categorized into either disorganized speech (disorganized speech stemming from disorganized thought), and grossly disorganized motor behavior. Disorganized speech or thought, also formally called [thought disorder](https://en.wikipedia.org/wiki/Thought_disorder "Thought disorder"), is disorganization of thinking that is *inferred* from speech. Characteristics of disorganized speech include rapidly switching topics which is called [derailment](https://en.wikipedia.org/wiki/Derailment_\(thought_disorder\) "Derailment (thought disorder)") or loose [association](https://en.wikipedia.org/wiki/Association_\(psychology\) "Association (psychology)"), switching to topics that are unrelated which is called [tangential thinking](https://en.wikipedia.org/wiki/Tangential_speech "Tangential speech"), incomprehensible speech which is called incoherence and referred to as a [word salad](https://en.wikipedia.org/wiki/Word_salad "Word salad"). Disorganized motor behavior includes repetitive, odd, or sometimes purposeless movement. Disorganized motor behavior rarely includes [catatonia](https://en.wikipedia.org/wiki/Catatonia "Catatonia"), and although it was a prominent symptom historically, it is rarely seen today. Whether this may be due to the use of historical treatments or the lack thereof is unknown.[\[26\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Sadock_Psychosis-26)[\[22\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-DSM-22)
Catatonia describes a profoundly agitated state in which the experience of reality is generally considered impaired. There are two primary manifestations of catatonic behavior. The classic presentation is a person who does not move or interact with the world in any way while awake. This type of catatonia presents with [waxy flexibility](https://en.wikipedia.org/wiki/Waxy_flexibility "Waxy flexibility"). Waxy flexibility is when someone physically moves part of a catatonic person's body and the person stays in the position even if it is bizarre and otherwise nonfunctional (such as moving a person's arm straight up in the air and the arm staying there).[\[42\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-42)
The other type of catatonia is more of an outward presentation of the profoundly agitated state described above. It involves excessive and purposeless motor behaviour, as well as an extreme mental preoccupation that prevents an intact experience of reality. An example is someone walking very fast in circles to the exclusion of anything else with a level of mental preoccupation (meaning not focused on anything relevant to the situation) that was not typical of the person prior to the symptom onset. In both types of catatonia, there is generally no reaction to anything that happens outside of them. It is important to distinguish catatonic agitation from severe bipolar mania, although someone could have both.\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
### Negative symptoms
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=5 "Edit section: Negative symptoms")\]
See also: [Clouding of consciousness](https://en.wikipedia.org/wiki/Clouding_of_consciousness "Clouding of consciousness") and [Depression (mood)](https://en.wikipedia.org/wiki/Depression_\(mood\) "Depression (mood)")
Negative symptoms include [reduced emotional expression](https://en.wikipedia.org/wiki/Reduced_affect_display "Reduced affect display"), [decreased motivation](https://en.wikipedia.org/wiki/Avolition "Avolition") ([avolition](https://en.wikipedia.org/wiki/Avolition "Avolition")), and [reduced spontaneous speech](https://en.wikipedia.org/wiki/Alogia "Alogia") (poverty of speech, [alogia](https://en.wikipedia.org/wiki/Alogia "Alogia")). Individuals with this condition lack interest and spontaneity, and have the [inability to feel pleasure](https://en.wikipedia.org/wiki/Anhedonia "Anhedonia") ([anhedonia](https://en.wikipedia.org/wiki/Anhedonia "Anhedonia")).[\[43\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-43) Altered Behavioral Inhibition System functioning could possibly cause reduced sustained attention in psychosis and overall contribute to more negative reactions.[\[44\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-44)
### Psychosis in adolescents
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=6 "Edit section: Psychosis in adolescents")\]
Psychosis is relatively rare in adolescents but not uncommon.[\[45\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-45) Young people who have psychosis may have trouble connecting with the world around them and may experience hallucinations or delusions.[\[46\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:3-46) Adolescents with psychosis may also have cognitive deficits that may make it harder for the youth to socialize and work.[\[46\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:3-46) Potential impairments include a reduced speed of mental processing, the lack of ability to focus without getting distracted (limited [attention span](https://en.wikipedia.org/wiki/Attention_span "Attention span")), and deficits in [verbal memory](https://en.wikipedia.org/wiki/Verbal_memory "Verbal memory").[\[46\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:3-46) If an adolescent is experiencing psychosis, they most likely have comorbidity, meaning that they could have multiple mental illnesses.[\[47\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:11-47) Because of this, it may be difficult to determine whether it is psychosis or [autism](https://en.wikipedia.org/wiki/Autism "Autism"), [social](https://en.wikipedia.org/wiki/Social_anxiety_disorder "Social anxiety disorder") or [generalized anxiety disorder](https://en.wikipedia.org/wiki/Generalized_anxiety_disorder "Generalized anxiety disorder"), or [obsessive-compulsive disorder](https://en.wikipedia.org/wiki/Obsessive%E2%80%93compulsive_disorder "Obsessive–compulsive disorder").[\[47\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:11-47)
## Causes
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=7 "Edit section: Causes")\]
The symptoms of psychosis may be caused by serious [psychiatric disorders](https://en.wikipedia.org/wiki/Psychiatric_disorders "Psychiatric disorders") such as [schizophrenia](https://en.wikipedia.org/wiki/Schizophrenia "Schizophrenia"), a number of medical illnesses, and [trauma](https://en.wikipedia.org/wiki/Psychological_trauma "Psychological trauma"). Psychosis may also be temporary or transient, and be caused by medications or [substance use disorder](https://en.wikipedia.org/wiki/Substance_use_disorder "Substance use disorder") ([substance-induced psychosis](https://en.wikipedia.org/wiki/Substance-induced_psychosis "Substance-induced psychosis")).\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
### Normal states
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=8 "Edit section: Normal states")\]
Brief hallucinations are not uncommon in those without any psychiatric disease, including healthy children. Causes or triggers include:[\[48\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Cardinal_2011_diagnosis_psychosis-48)
- Falling asleep and waking: [hypnagogic](https://en.wikipedia.org/wiki/Hypnagogic "Hypnagogic") and [hypnopompic](https://en.wikipedia.org/wiki/Hypnopompic "Hypnopompic") hallucinations[\[49\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-49)
- [Bereavement](https://en.wikipedia.org/wiki/Bereavement "Bereavement"), in which hallucinations of a deceased loved one are common[\[48\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Cardinal_2011_diagnosis_psychosis-48)[\[50\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-50)
- Severe [sleep deprivation](https://en.wikipedia.org/wiki/Sleep_deprivation "Sleep deprivation")[\[51\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-51)[\[52\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-52)
- Extreme stress (see below)[\[53\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-53)
- Abnormal brainwaves[\[54\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-54)[\[55\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-55)
- Abnormal brain networks[\[56\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-56)[\[57\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-57)[\[58\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-58)
- [Traumatic brain injury](https://en.wikipedia.org/wiki/Traumatic_brain_injury "Traumatic brain injury")[\[59\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-59)[\[60\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-60)[\[61\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-61)
### Trauma and stress
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=9 "Edit section: Trauma and stress")\]
Traumatic life events have been linked with an elevated risk of developing psychotic symptoms.[\[62\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:1-62) [Childhood trauma](https://en.wikipedia.org/wiki/Childhood_trauma "Childhood trauma") has specifically been shown to be a predictor of adolescent and adult psychosis.[\[63\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:2-63) Individuals with psychotic symptoms are three times more likely to have experienced childhood trauma (e.g., [physical](https://en.wikipedia.org/wiki/Physical_abuse "Physical abuse") or [sexual abuse](https://en.wikipedia.org/wiki/Sexual_abuse#Children "Sexual abuse"), physical or emotional [neglect](https://en.wikipedia.org/wiki/Neglect#Child_neglect "Neglect")) than those in the general population.[\[63\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:2-63) Increased individual vulnerability toward psychosis may interact with traumatic experiences promoting an onset of future psychotic symptoms, particularly during sensitive developmental periods.[\[63\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:2-63) Importantly, the relationship between traumatic life events and psychotic symptoms appears to be dose-dependent in which multiple traumatic life events accumulate, compounding symptom expression and severity.[\[62\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:1-62)[\[63\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:2-63) However, acute, stressful events can also trigger brief psychotic episodes.[\[64\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-64) Trauma prevention and early intervention may be an important target for decreasing the incidence of psychotic disorders and ameliorating its effects.[\[62\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:1-62) A healthy person could become psychotic when inside an empty room with no light and sound. After about 15 minutes, psychosis can occur, this is a phenomenon known as [sensory deprivation](https://en.wikipedia.org/wiki/Sensory_deprivation "Sensory deprivation").[\[9\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Oxford_Textbook_of_Psychiatry-9)
[Neuroticism](https://en.wikipedia.org/wiki/Neuroticism "Neuroticism"), a personality trait associated with vulnerability to stressors, is an independent predictor of the development of psychosis.[\[65\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-NeuroticismMA-65)
### Psychiatric disorders
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=10 "Edit section: Psychiatric disorders")\]
Traditionally psychotic disorders have been believed to have one of two roots: organic (physiological) or functional (mental). Organic disorders being those caused by physical conditions directly affecting the brain with psychosis as a secondary feature, and functional disorders being primary psychological or psychiatric disorders (disorders of the functioning of the mind) in the absence of physiological causes. Subtle physical abnormalities have been found in illnesses traditionally considered functional, such as [schizophrenia](https://en.wikipedia.org/wiki/Schizophrenia "Schizophrenia"). The [DSM-IV-TR](https://en.wikipedia.org/wiki/DSM-IV-TR "DSM-IV-TR") avoids the functional/organic distinction, and instead lists traditional psychotic illnesses, psychosis due to general medical conditions, and substance-induced psychosis.\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
Primary psychiatric causes of psychosis include the following:[\[66\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-ICD-10-66)[\[67\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-67)[\[48\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Cardinal_2011_diagnosis_psychosis-48)
- **Primary psychotic disorders**
- [Schizophrenia](https://en.wikipedia.org/wiki/Schizophrenia "Schizophrenia")
- [Schizoaffective disorder](https://en.wikipedia.org/wiki/Schizoaffective_disorder "Schizoaffective disorder")
- [Schizophreniform disorder](https://en.wikipedia.org/wiki/Schizophreniform_disorder "Schizophreniform disorder")
- [Brief psychotic disorder](https://en.wikipedia.org/wiki/Brief_psychotic_disorder "Brief psychotic disorder")
- [Delusional disorder](https://en.wikipedia.org/wiki/Delusional_disorder "Delusional disorder")
- [Mood disorders](https://en.wikipedia.org/wiki/Mood_disorders "Mood disorders")
- [Psychotic depression](https://en.wikipedia.org/wiki/Psychotic_depression "Psychotic depression"), also known as [major depressive disorder](https://en.wikipedia.org/wiki/Major_depressive_disorder "Major depressive disorder") with psychotic features
- [Bipolar disorder](https://en.wikipedia.org/wiki/Bipolar_disorder "Bipolar disorder")
- [Bipolar I disorder](https://en.wikipedia.org/wiki/Bipolar_I_disorder "Bipolar I disorder") in [manic](https://en.wikipedia.org/wiki/Mania "Mania") and [mixed episodes](https://en.wikipedia.org/wiki/Mixed_episode "Mixed episode"), as well as depressive episodes
- [Bipolar II disorder](https://en.wikipedia.org/wiki/Bipolar_II "Bipolar II") in depressive episodes
Psychotic symptoms may also be seen in:[\[48\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Cardinal_2011_diagnosis_psychosis-48)
- Certain [personality disorders](https://en.wikipedia.org/wiki/Personality_disorders "Personality disorders"): such as [schizotypal personality disorder](https://en.wikipedia.org/wiki/Schizotypal_personality_disorder "Schizotypal personality disorder"), [paranoid personality disorder](https://en.wikipedia.org/wiki/Paranoid_personality_disorder "Paranoid personality disorder"), and [borderline personality disorder](https://en.wikipedia.org/wiki/Borderline_personality_disorder "Borderline personality disorder")
- [Post-traumatic stress disorder](https://en.wikipedia.org/wiki/Post-traumatic_stress_disorder "Post-traumatic stress disorder")
- [Obsessive–compulsive disorder](https://en.wikipedia.org/wiki/Obsessive%E2%80%93compulsive_disorder "Obsessive–compulsive disorder")
- [Dissociative identity disorder](https://en.wikipedia.org/wiki/Dissociative_identity_disorder "Dissociative identity disorder")
- [Paraphrenia](https://en.wikipedia.org/wiki/Paraphrenia "Paraphrenia")
#### Subtypes
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=11 "Edit section: Subtypes")\]
Subtypes of psychosis include:
- [Postpartum psychosis](https://en.wikipedia.org/wiki/Postpartum_psychosis "Postpartum psychosis"),[\[68\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-68) occurring shortly after [giving birth](https://en.wikipedia.org/wiki/Giving_birth "Giving birth"), primarily associated with maternal [bipolar disorder](https://en.wikipedia.org/wiki/Bipolar_disorder "Bipolar disorder")
- [Monothematic delusions](https://en.wikipedia.org/wiki/Monothematic_delusion "Monothematic delusion")
- [Myxedematous psychosis](https://en.wikipedia.org/wiki/Myxedematous_psychosis "Myxedematous psychosis")
- [Stimulant psychosis](https://en.wikipedia.org/wiki/Stimulant_psychosis "Stimulant psychosis")
- [Tardive psychosis](https://en.wikipedia.org/wiki/Tardive_psychosis "Tardive psychosis")
- [Shared psychosis](https://en.wikipedia.org/wiki/Shared_psychosis "Shared psychosis")
#### Cycloid psychosis
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=12 "Edit section: Cycloid psychosis")\]
Cycloid psychosis is typically an acute, self-limiting form of psychosis with psychotic and mood symptoms that progress from normal to full-blown, usually between a few hours to days, and not related to drug intake or [brain injury](https://en.wikipedia.org/wiki/Brain_injury "Brain injury").[\[69\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:0-69) While proposed as a distinct entity, clinically separate from schizophrenia and affective disorders, cycloid psychosis is not formally acknowledged by current ICD or DSM criteria.[\[69\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:0-69) Its unclear place in psychiatric nosology has likely contributed to the limited scientific investigation and literature on the topic.[\[70\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-70)
#### Postpartum psychosis
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=13 "Edit section: Postpartum psychosis")\]
[Postpartum psychosis](https://en.wikipedia.org/wiki/Postpartum_psychosis "Postpartum psychosis") is a rare yet serious and debilitating form of psychosis.[\[71\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:10-71) Symptoms range from fluctuating moods and insomnia to mood-incongruent delusions related to the individual or the infant.[\[71\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:10-71) Women experiencing postpartum psychosis are at increased risk for suicide or infanticide. Many women who experience first-time psychosis from postpartum often have bipolar disorder, meaning they could experience an increase of psychotic episodes even after postpartum.[\[71\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:10-71)
### Medical conditions
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=14 "Edit section: Medical conditions")\]
A very large number of medical conditions can cause psychosis, sometimes called *secondary psychosis*.[\[48\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Cardinal_2011_diagnosis_psychosis-48) Examples include:
- Disorders causing *[delirium](https://en.wikipedia.org/wiki/Delirium "Delirium")* (*toxic psychosis*), in which consciousness is disturbed
- [Neurodevelopmental disorders](https://en.wikipedia.org/wiki/Neurodevelopmental_disorder "Neurodevelopmental disorder") and [chromosomal abnormalities](https://en.wikipedia.org/wiki/Chromosome_abnormality "Chromosome abnormality"), including [velocardiofacial syndrome](https://en.wikipedia.org/wiki/Velocardiofacial_syndrome "Velocardiofacial syndrome")
- [Neurodegenerative disorders](https://en.wikipedia.org/wiki/Neurodegenerative_disease "Neurodegenerative disease"), such as [Alzheimer's disease](https://en.wikipedia.org/wiki/Alzheimer%27s_disease "Alzheimer's disease"), [dementia with Lewy bodies](https://en.wikipedia.org/wiki/Dementia_with_Lewy_bodies "Dementia with Lewy bodies"), and [Parkinson's disease](https://en.wikipedia.org/wiki/Parkinson%27s_disease "Parkinson's disease")[\[72\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-72)
- Focal neurological disease, such as [stroke](https://en.wikipedia.org/wiki/Stroke "Stroke"), [brain tumors](https://en.wikipedia.org/wiki/Brain_tumor "Brain tumor"),[\[73\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Brain_tumor-73) [multiple sclerosis](https://en.wikipedia.org/wiki/Multiple_sclerosis "Multiple sclerosis"),[\[3\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Continuum-3) and some forms of [epilepsy](https://en.wikipedia.org/wiki/Epilepsy "Epilepsy")
- [Malignancy](https://en.wikipedia.org/wiki/Malignancy "Malignancy") (typically via masses in the brain, [paraneoplastic syndromes](https://en.wikipedia.org/wiki/Paraneoplastic_syndrome "Paraneoplastic syndrome"))[\[3\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Continuum-3)
- Infectious and postinfectious syndromes, including infections causing [delirium](https://en.wikipedia.org/wiki/Delirium "Delirium"), [viral encephalitis](https://en.wikipedia.org/wiki/Viral_encephalitis "Viral encephalitis"), [HIV/AIDS](https://en.wikipedia.org/wiki/HIV/AIDS "HIV/AIDS"),[\[74\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Munjal_681%E2%80%93712-74) [malaria](https://en.wikipedia.org/wiki/Malaria "Malaria"),[\[75\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-75) [syphilis](https://en.wikipedia.org/wiki/Syphilis "Syphilis")[\[74\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Munjal_681%E2%80%93712-74)
- [Endocrine disease](https://en.wikipedia.org/wiki/Endocrine_disease "Endocrine disease"), such as [hypothyroidism](https://en.wikipedia.org/wiki/Hypothyroidism "Hypothyroidism"), [hyperthyroidism](https://en.wikipedia.org/wiki/Hyperthyroidism "Hyperthyroidism"), [Cushing's syndrome](https://en.wikipedia.org/wiki/Cushing%27s_syndrome "Cushing's syndrome"), [hypoparathyroidism](https://en.wikipedia.org/wiki/Hypoparathyroidism "Hypoparathyroidism") and [hyperparathyroidism](https://en.wikipedia.org/wiki/Hyperparathyroidism "Hyperparathyroidism");[\[76\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:6-76) sex hormones also affect psychotic symptoms and sometimes giving birth can provoke psychosis, termed [postpartum psychosis](https://en.wikipedia.org/wiki/Postpartum_psychosis "Postpartum psychosis")[\[77\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:7-77)
- Inborn errors of metabolism, such as [Wilson's disease](https://en.wikipedia.org/wiki/Wilson%27s_disease "Wilson's disease"), [porphyria](https://en.wikipedia.org/wiki/Porphyria "Porphyria"), and [homocysteinemia](https://en.wikipedia.org/wiki/Homocysteinemia "Homocysteinemia")[\[78\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-78)
- [Nutritional deficiency](https://en.wikipedia.org/wiki/Nutritional_deficiency "Nutritional deficiency"), such as [vitamin B12 deficiency](https://en.wikipedia.org/wiki/Vitamin_B12_deficiency "Vitamin B12 deficiency")[\[10\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Griswold-10)
- Other acquired [metabolic disorders](https://en.wikipedia.org/wiki/Metabolic_disorder "Metabolic disorder"), including [electrolyte](https://en.wikipedia.org/wiki/Electrolyte "Electrolyte") disturbances such as [hypocalcemia](https://en.wikipedia.org/wiki/Hypocalcemia "Hypocalcemia"), [hypernatremia](https://en.wikipedia.org/wiki/Hypernatremia "Hypernatremia"), [hyponatremia](https://en.wikipedia.org/wiki/Hyponatremia "Hyponatremia"), [hypokalemia](https://en.wikipedia.org/wiki/Hypokalemia "Hypokalemia"), [hypomagnesemia](https://en.wikipedia.org/wiki/Hypomagnesemia "Hypomagnesemia"), [hypermagnesemia](https://en.wikipedia.org/wiki/Hypermagnesemia "Hypermagnesemia"), [hypercalcemia](https://en.wikipedia.org/wiki/Hypercalcemia "Hypercalcemia"), and [hypophosphatemia](https://en.wikipedia.org/wiki/Hypophosphatemia "Hypophosphatemia"), but also [hypoglycemia](https://en.wikipedia.org/wiki/Hypoglycemia "Hypoglycemia"), [hypoxia](https://en.wikipedia.org/wiki/Hypoxia_\(medical\) "Hypoxia (medical)"), and failure of the [liver](https://en.wikipedia.org/wiki/Liver "Liver") or [kidneys](https://en.wikipedia.org/wiki/Kidney "Kidney")[\[76\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:6-76)[\[10\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Griswold-10)
- [Autoimmune and related disorders](https://en.wikipedia.org/wiki/Autoimmune_disease "Autoimmune disease") , such as [systemic lupus erythematosus](https://en.wikipedia.org/wiki/Systemic_lupus_erythematosus "Systemic lupus erythematosus") (lupus, SLE), [sarcoidosis](https://en.wikipedia.org/wiki/Sarcoidosis "Sarcoidosis"), [Hashimoto's encephalopathy](https://en.wikipedia.org/wiki/Hashimoto%27s_encephalopathy "Hashimoto's encephalopathy"), [anti-NMDA-receptor encephalitis](https://en.wikipedia.org/wiki/Anti-NMDA-receptor_encephalitis "Anti-NMDA-receptor encephalitis"), and [non-celiac gluten sensitivity](https://en.wikipedia.org/wiki/Non-celiac_gluten_sensitivity "Non-celiac gluten sensitivity")[\[79\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-LosurdoPrincipi2018-79)[\[80\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-80)
- [Poisoning](https://en.wikipedia.org/wiki/Poisoning "Poisoning") by a range of plants, fungi, metals, organic compounds, and a few animal toxins[\[48\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Cardinal_2011_diagnosis_psychosis-48)
- [Sleep disorders](https://en.wikipedia.org/wiki/Sleep_disorder "Sleep disorder"), such as in [narcolepsy](https://en.wikipedia.org/wiki/Narcolepsy "Narcolepsy") (in which [REM sleep](https://en.wikipedia.org/wiki/REM_sleep "REM sleep") intrudes into wakefulness)[\[48\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Cardinal_2011_diagnosis_psychosis-48)
- [Parasitic diseases](https://en.wikipedia.org/wiki/Parasitic_disease "Parasitic disease"), such as [neurocysticercosis](https://en.wikipedia.org/wiki/Neurocysticercosis "Neurocysticercosis")
### Psychoactive drugs
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=15 "Edit section: Psychoactive drugs")\]
Main article: [Substance-induced psychosis](https://en.wikipedia.org/wiki/Substance-induced_psychosis "Substance-induced psychosis")
Various [psychoactive substances](https://en.wikipedia.org/wiki/Psychoactive_substances "Psychoactive substances") (both legal and illegal) have been implicated in causing, exacerbating, or precipitating psychotic states or disorders in users, with varying levels of evidence.[\[81\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-81) This may be upon intoxication for a more prolonged period after use, or upon [withdrawal](https://en.wikipedia.org/wiki/Drug_withdrawal "Drug withdrawal").[\[48\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Cardinal_2011_diagnosis_psychosis-48) Individuals who experience substance-induced psychosis tend to have a greater awareness of their psychosis and tend to have higher levels of [suicidal thinking](https://en.wikipedia.org/wiki/Suicidal_thinking "Suicidal thinking") compared to those who have a primary psychotic illness.[\[82\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-pmid21728034-82) Drugs commonly alleged to induce psychotic symptoms include [alcohol](https://en.wikipedia.org/wiki/Alcohol_\(drug\) "Alcohol (drug)"), [cannabis](https://en.wikipedia.org/wiki/Cannabis_\(drug\) "Cannabis (drug)"), [cocaine](https://en.wikipedia.org/wiki/Cocaine "Cocaine"), [amphetamines](https://en.wikipedia.org/wiki/Amphetamine "Amphetamine"), [cathinones](https://en.wikipedia.org/wiki/Cathinone "Cathinone"), [psychedelic drugs](https://en.wikipedia.org/wiki/Psychedelic_drug "Psychedelic drug") (such as [LSD](https://en.wikipedia.org/wiki/LSD "LSD") and [psilocybin](https://en.wikipedia.org/wiki/Psilocybin "Psilocybin")), [κ-opioid receptor](https://en.wikipedia.org/wiki/%CE%9A-opioid_receptor "Κ-opioid receptor") [agonists](https://en.wikipedia.org/wiki/Agonist "Agonist") (such as [enadoline](https://en.wikipedia.org/wiki/Enadoline "Enadoline") and [salvinorin A](https://en.wikipedia.org/wiki/Salvinorin_A "Salvinorin A")) and [NMDA receptor antagonists](https://en.wikipedia.org/wiki/NMDA_receptor_antagonist "NMDA receptor antagonist") (such as [phencyclidine](https://en.wikipedia.org/wiki/Phencyclidine "Phencyclidine") and [ketamine](https://en.wikipedia.org/wiki/Ketamine "Ketamine")).[\[48\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Cardinal_2011_diagnosis_psychosis-48)[\[83\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-83) [Caffeine](https://en.wikipedia.org/wiki/Caffeine "Caffeine") may worsen symptoms in those with schizophrenia and cause psychosis at very high doses in people without the condition.[\[84\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-84)[\[85\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-85) Cannabis and other illicit recreational drugs are often associated with psychosis in adolescents and cannabis use before 15 years old may increase the risk of psychosis in adulthood.[\[46\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:3-46)
#### Alcohol
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=16 "Edit section: Alcohol")\]
Further information: [Long-term effects of alcohol consumption § Mental health effects](https://en.wikipedia.org/wiki/Long-term_effects_of_alcohol_consumption#Mental_health_effects "Long-term effects of alcohol consumption")
Approximately 3% of people with [alcoholism](https://en.wikipedia.org/wiki/Alcoholism "Alcoholism") experience psychosis during acute intoxication or withdrawal. Alcohol related psychosis may manifest itself through a [kindling mechanism](https://en.wikipedia.org/wiki/Kindling_\(sedative-hypnotic_withdrawal\) "Kindling (sedative-hypnotic withdrawal)"). The mechanism of alcohol-related psychosis is due to the [long-term effects of alcohol consumption](https://en.wikipedia.org/wiki/Long-term_effects_of_alcohol_consumption "Long-term effects of alcohol consumption") resulting in distortions to neuronal membranes, [gene expression](https://en.wikipedia.org/wiki/Gene_expression "Gene expression"), as well as [thiamine](https://en.wikipedia.org/wiki/Thiamine "Thiamine") deficiency. It is possible that hazardous alcohol use via a kindling mechanism can cause the development of a chronic substance-induced psychotic disorder, i.e. schizophrenia. The effects of an alcohol-related psychosis include an increased risk of depression and suicide as well as causing psychosocial impairments.[\[86\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-86) [Delirium tremens](https://en.wikipedia.org/wiki/Delirium_tremens "Delirium tremens"), a symptom of chronic alcoholism that can appear in the acute withdrawal phase, shares many symptoms with alcohol-related psychosis suggesting a common mechanism.[\[87\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-87)
#### Cannabis
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=17 "Edit section: Cannabis")\]
Further information: [Causes of schizophrenia § Cannabis](https://en.wikipedia.org/wiki/Causes_of_schizophrenia#Cannabis "Causes of schizophrenia"), and [Long-term effects of cannabis § Chronic psychosis and schizophrenia spectrum disorders](https://en.wikipedia.org/wiki/Long-term_effects_of_cannabis#Chronic_psychosis_and_schizophrenia_spectrum_disorders "Long-term effects of cannabis")
According to current studies, cannabis use is associated with increased risk of psychotic disorders, and the more often cannabis is used the more likely a person is to develop a psychotic illness.[\[88\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:8-88) Furthermore, people with a history of cannabis use develop psychotic symptoms earlier than those who have never used cannabis.[\[88\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:8-88) Some debate exists regarding the causal relationship between cannabis use and psychosis with some studies suggesting that cannabis use hastens the onset of psychosis primarily in those with pre-existing vulnerability.[\[88\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:8-88)[\[89\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-89)[\[90\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-90) Indeed, cannabis use plays an important role in the development of psychosis in vulnerable individuals, and cannabis use in adolescence should be discouraged.[\[91\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-91) Some studies indicate that the effects of two active compounds in cannabis, [tetrahydrocannabinol](https://en.wikipedia.org/wiki/Tetrahydrocannabinol "Tetrahydrocannabinol") (THC) and [cannabidiol](https://en.wikipedia.org/wiki/Cannabidiol "Cannabidiol") (CBD), have opposite effects with respect to psychosis. While THC can induce psychotic symptoms in healthy individuals, limited evidence suggests that CBD may have antipsychotic effects.[\[92\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-92)
#### Methamphetamine
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=18 "Edit section: Methamphetamine")\]
Main article: [Stimulant psychosis](https://en.wikipedia.org/wiki/Stimulant_psychosis "Stimulant psychosis")
[Methamphetamine](https://en.wikipedia.org/wiki/Methamphetamine "Methamphetamine") induces a psychosis in 26%–46% of heavy users. Some of these people develop a long-lasting psychosis that can persist for longer than six months. Those who have had a short-lived psychosis from methamphetamine can have a relapse of the methamphetamine psychosis years later after a stressful event such as severe insomnia or a period of hazardous alcohol use despite not relapsing back to methamphetamine.[\[93\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-93) Individuals who have a long history of methamphetamine use and who have experienced psychosis in the past from methamphetamine use are highly likely to re-experience methamphetamine psychosis if drug use is recommenced. \[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\] Methamphetamine-induced psychosis is likely gated by genetic vulnerability, which can produce long-term changes in brain neurochemistry following repetitive use.[\[94\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-94) Methamphetamine users with more [ADHD](https://en.wikipedia.org/wiki/ADHD "ADHD")\-related behaviours in childhood experience methamphetamine-related psychosis more frequently.[\[95\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-95)
#### Psychedelics
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=19 "Edit section: Psychedelics")\]
A 2024 meta-analysis found an incidence of psychedelic-induced psychosis at 0.002% in population studies, 0.2% in uncontrolled clinical trials, and 0.6% in randomised controlled trials.[\[96\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-96) This meta-analysis found that in uncontrolled clinical trials involving only patients with schizophrenia, 3.8% developed prolonged psychotic reactions. A 2024 study found that [psychedelic](https://en.wikipedia.org/wiki/Psychedelic "Psychedelic") use was not generally associated with a change in the number of psychotic symptoms.[\[97\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-97) This study found that psychedelic use interacted with a family history of bipolar disorder, such that in those with a family history of bipolar disorder, psychedelic use was associated with an increase in the number of psychotic symptoms, while in those with a personal history of psychosis but no family history of psychotic disorders, psychedelic use was associated with a decrease in the number of psychotic symptoms. A 2023 study found an interaction between lifetime psychedelic use and family history of psychosis or bipolar disorder on psychotic symptoms over the past two weeks. Psychotic symptoms were highest among those with both a family history of psychosis or bipolar disorder and life-time psychedelic use, while they were lowest among those with life-time psychedelic use but no family history of these disorders.[\[98\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-98)
### Medication
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=20 "Edit section: Medication")\]
Administration, or sometimes withdrawal, of a large number of medications may provoke psychotic symptoms.[\[48\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Cardinal_2011_diagnosis_psychosis-48) Drugs that can induce psychosis experimentally or in a significant proportion of people include:
- Stimulants, such as [amphetamine](https://en.wikipedia.org/wiki/Amphetamine "Amphetamine") and other [sympathomimetics](https://en.wikipedia.org/wiki/Sympathomimetics "Sympathomimetics")
- [Dopamine](https://en.wikipedia.org/wiki/Dopamine "Dopamine") agonists
- [Ketamine](https://en.wikipedia.org/wiki/Ketamine "Ketamine")
- [Corticosteroids](https://en.wikipedia.org/wiki/Corticosteroid "Corticosteroid") (often with mood changes in addition)
- Some anticonvulsants such as [vigabatrin](https://en.wikipedia.org/wiki/Vigabatrin "Vigabatrin")[\[99\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-99)[\[100\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-100)[\[101\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-101)
## Pathophysiology
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=21 "Edit section: Pathophysiology")\]
### Neuroimaging
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=22 "Edit section: Neuroimaging")\]
The first brain image of an individual with psychosis was completed as far back as 1935 using a technique called [pneumoencephalography](https://en.wikipedia.org/wiki/Pneumoencephalography "Pneumoencephalography")[\[102\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-102) (a painful and now obsolete procedure where [cerebrospinal fluid](https://en.wikipedia.org/wiki/Cerebrospinal_fluid "Cerebrospinal fluid") is drained from around the brain and replaced with air to allow the structure of the brain to show up more clearly on an [X-ray](https://en.wikipedia.org/wiki/X-ray "X-ray") picture).\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
Both [first episode psychosis](https://en.wikipedia.org/wiki/Antipsychotic#First_episode_psychosis "Antipsychotic"), and high risk status is associated with reductions in [grey matter](https://en.wikipedia.org/wiki/Grey_matter "Grey matter") volume (GMV). First episode psychotic and high risk populations are associated with similar but distinct abnormalities in GMV. Reductions in the right [middle temporal gyrus](https://en.wikipedia.org/wiki/Middle_temporal_gyrus "Middle temporal gyrus"), right [superior temporal gyrus](https://en.wikipedia.org/wiki/Superior_temporal_gyrus "Superior temporal gyrus") (STG), right [parahippocampus](https://en.wikipedia.org/wiki/Parahippocampus "Parahippocampus"), right [hippocampus](https://en.wikipedia.org/wiki/Hippocampus "Hippocampus"), right [middle frontal gyrus](https://en.wikipedia.org/wiki/Middle_frontal_gyrus "Middle frontal gyrus"), and left [anterior cingulate cortex](https://en.wikipedia.org/wiki/Anterior_cingulate_cortex "Anterior cingulate cortex") (ACC) are observed in high risk populations. Reductions in first episode psychosis span a region from the right STG to the right insula, left insula, and [cerebellum](https://en.wikipedia.org/wiki/Cerebellum "Cerebellum"), and are more severe in the right ACC, right STG, insula and cerebellum.[\[103\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-103)[\[104\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-104)
Another meta analysis reported bilateral reductions in insula, operculum, STG, medial frontal cortex, and ACC, but also reported increased GMV in the right [lingual gyrus](https://en.wikipedia.org/wiki/Lingual_gyrus "Lingual gyrus") and left [precentral gyrus](https://en.wikipedia.org/wiki/Precentral_gyrus "Precentral gyrus").[\[105\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Radua-105) The [Kraepelinian dichotomy](https://en.wikipedia.org/wiki/Kraepelinian_dichotomy "Kraepelinian dichotomy") is made questionable\[*[clarification needed](https://en.wikipedia.org/wiki/Wikipedia:Please_clarify "Wikipedia:Please clarify")*\] by grey matter abnormalities in bipolar and schizophrenia; schizophrenia is distinguishable from bipolar in that regions of grey matter reduction are generally larger in magnitude, although adjusting for gender differences reduces the difference to the left [dorsomedial prefrontal cortex](https://en.wikipedia.org/wiki/Dorsomedial_prefrontal_cortex "Dorsomedial prefrontal cortex") (dmPFC), and right [dorsolateral prefrontal cortex](https://en.wikipedia.org/wiki/Dorsolateral_prefrontal_cortex "Dorsolateral prefrontal cortex") (dlPFC).[\[106\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-106)
During attentional tasks, first episode psychosis is associated with hypoactivation in the right middle frontal gyrus, a region generally described as encompassing the dlPFC. Altered Behavioral Inhibition System functioning could possibly cause reduced sustained attention in psychosis and overall contribute to more negative reactions.[\[107\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-107) In congruence with studies on grey matter volume, hypoactivity in the right insula, and right inferior parietal lobe is also reported.[\[108\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-108) During cognitive tasks, hypoactivities in the right insula, dorsal anterior cingulate cortex, and the left [precuneus](https://en.wikipedia.org/wiki/Precuneus "Precuneus"), as well as reduced deactivations in the right [basal ganglia](https://en.wikipedia.org/wiki/Basal_ganglia "Basal ganglia"), right [thalamus](https://en.wikipedia.org/wiki/Thalamus "Thalamus"), right [inferior frontal gyrus](https://en.wikipedia.org/wiki/Inferior_frontal_gyrus "Inferior frontal gyrus") and left [precentral gyrus](https://en.wikipedia.org/wiki/Precentral_gyrus "Precentral gyrus") are observed. These results are highly consistent and replicable possibly except the abnormalities of the right inferior frontal gyrus.[\[109\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-109) Decreased grey matter volume in conjunction with bilateral hypoactivity is observed in anterior insula, dorsal medial frontal cortex, and dorsal anterior cingulate cortex. Decreased grey matter volume and bilateral hyperactivity is reported in posterior insula, ventral medial frontal cortex, and ventral anterior cingulate cortex.[\[110\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-110)
### Hallucinations
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=23 "Edit section: Hallucinations")\]
Studies during acute experiences of hallucinations demonstrate increased activity in primary or secondary sensory cortices. As auditory hallucinations are most common in psychosis, most robust evidence exists for increased activity in the left [middle temporal gyrus](https://en.wikipedia.org/wiki/Middle_temporal_gyrus "Middle temporal gyrus"), left [superior temporal gyrus](https://en.wikipedia.org/wiki/Superior_temporal_gyrus "Superior temporal gyrus"), and left [inferior frontal gyrus](https://en.wikipedia.org/wiki/Inferior_frontal_gyrus "Inferior frontal gyrus") (i.e. [Broca's area](https://en.wikipedia.org/wiki/Broca%27s_area "Broca's area")). Activity in the [ventral striatum](https://en.wikipedia.org/wiki/Ventral_striatum "Ventral striatum"), [hippocampus](https://en.wikipedia.org/wiki/Hippocampus "Hippocampus"),[\[111\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-111) and ACC are related to the lucidity of hallucinations, and indicate that activation or involvement of emotional circuitry are key to the impact of abnormal activity in sensory cortices. Together, these findings indicate abnormal processing of internally generated sensory experiences, coupled with abnormal emotional processing, results in hallucinations. One proposed model involves a failure of feedforward networks from sensory cortices to the inferior frontal cortex, which normally cancel out sensory cortex activity during internally generated speech. The resulting disruption in expected and perceived speech is thought to produce lucid hallucinatory experiences.[\[112\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-112)
### Delusions
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=24 "Edit section: Delusions")\]
The two-factor model of delusions posits that dysfunction in both belief formation systems and belief evaluation systems are necessary for delusions. Dysfunction in evaluations systems localized to the right lateral prefrontal cortex, regardless of delusion content, is supported by neuroimaging studies and is congruent with its role in conflict monitoring in healthy persons. Abnormal activation and reduced volume is seen in people with delusions, as well as in disorders associated with delusions such as [frontotemporal dementia](https://en.wikipedia.org/wiki/Frontotemporal_dementia "Frontotemporal dementia"), psychosis and [Lewy body dementia](https://en.wikipedia.org/wiki/Lewy_body_dementia "Lewy body dementia"). Furthermore, lesions to this region are associated with "jumping to conclusions", damage to this region is associated with post-stroke delusions, and hypometabolism this region associated with caudate strokes presenting with delusions.\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
The [aberrant salience model](https://en.wikipedia.org/wiki/Aberrant_salience "Aberrant salience") suggests that delusions are a result of people assigning excessive importance to irrelevant stimuli. In support of this hypothesis, regions normally associated with the [salience network](https://en.wikipedia.org/wiki/Salience_network "Salience network") demonstrate reduced grey matter in people with delusions, and the neurotransmitter [dopamine](https://en.wikipedia.org/wiki/Dopamine "Dopamine"), which is widely implicated in salience processing, is also widely implicated in psychotic disorders.\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
Specific regions have been associated with specific types of delusions. The volume of the hippocampus and parahippocampus is related to paranoid delusions in [Alzheimer's disease](https://en.wikipedia.org/wiki/Alzheimer%27s_disease "Alzheimer's disease"), and has been reported to be abnormal post mortem in one person with delusions. [Capgras delusions](https://en.wikipedia.org/wiki/Capgras_delusion "Capgras delusion") have been associated with occipito-temporal damage, and may be related to failure to elicit normal emotions or memories in response to faces.[\[113\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-113)
### Negative symptoms
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=25 "Edit section: Negative symptoms")\]
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|  | This section **may be too technical for most readers to understand**. Please [help improve it](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit) to [make it understandable to non-experts](https://en.wikipedia.org/wiki/Wikipedia:Make_technical_articles_understandable "Wikipedia:Make technical articles understandable"), without removing the technical details. *(November 2019)* *([Learn how and when to remove this message](https://en.wikipedia.org/wiki/Help:Maintenance_template_removal "Help:Maintenance template removal"))* |
Psychosis is associated with the [ventral striatum](https://en.wikipedia.org/wiki/Ventral_striatum "Ventral striatum") (VS), which is the part of the brain that is involved with the desire to naturally satisfy the body's needs.[\[114\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:02-114) When high reports of [negative symptoms](https://en.wikipedia.org/wiki/Symptom#Negative_symptoms "Symptom") were recorded, there were significant irregularities in the left VS. Anhedonia, defined as the inability to feel joy or pleasure,[\[115\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-115) is a commonly reported symptom in psychosis; experiences with the condition are present in most people with schizophrenia.[\[116\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:12-116) Previous research has indicated that a deficiency in the [neural representation](https://en.wikipedia.org/wiki/Neural_representation "Neural representation") in regards to goals and the motivation to achieve them, has demonstrated that when a reward is not present, a strong reaction is noted in the ventral striatum; reinforcement learning is intact when contingencies about stimulus-reward are implicit, but not when they require explicit neural processing; reward prediction errors are what the actual reward is versus what the reward was predicted to be.[\[117\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:22-117) In most cases positive prediction errors are considered an abnormal occurrence. A positive prediction error response occurs when there is an increased activation in a brain region, typically the [striatum](https://en.wikipedia.org/wiki/Striatum "Striatum"), in response to unexpected rewards. A negative prediction error response occurs when there is a decreased activation in a region when predicted rewards do not occur. The [anterior cingulate cortex](https://en.wikipedia.org/wiki/Anterior_cingulate_cortex "Anterior cingulate cortex") (ACC) response, taken as an indicator of effort allocation, does not increase with reward or reward probability increase, and is associated with negative symptoms; deficits in dorsolateral prefrontal cortex (dlPFC) activity and failure to improve performance on cognitive tasks when offered monetary incentives are present; and dopamine mediated functions are abnormal.\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
### Neurobiology
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=26 "Edit section: Neurobiology")\]
Further information: [Dopamine hypothesis of schizophrenia](https://en.wikipedia.org/wiki/Dopamine_hypothesis_of_schizophrenia "Dopamine hypothesis of schizophrenia")
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|  | This section **may be too technical for most readers to understand**. Please [help improve it](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit) to [make it understandable to non-experts](https://en.wikipedia.org/wiki/Wikipedia:Make_technical_articles_understandable "Wikipedia:Make technical articles understandable"), without removing the technical details. *(November 2019)* *([Learn how and when to remove this message](https://en.wikipedia.org/wiki/Help:Maintenance_template_removal "Help:Maintenance template removal"))* |
Psychosis has been traditionally linked to the overactivity of the [neurotransmitter](https://en.wikipedia.org/wiki/Neurotransmitter "Neurotransmitter") [dopamine](https://en.wikipedia.org/wiki/Dopamine "Dopamine"), in particular to its effect in the [mesolimbic pathway](https://en.wikipedia.org/wiki/Mesolimbic_pathway "Mesolimbic pathway"), spanning from the [ventral tegmental area](https://en.wikipedia.org/wiki/Ventral_tegmental_area "Ventral tegmental area") to the ventral [striatum](https://en.wikipedia.org/wiki/Striatum "Striatum"). Additionally, recent evidence suggests a crucial involvement of the pathway spanning from the [substantia nigra](https://en.wikipedia.org/wiki/Substantia_nigra "Substantia nigra") to the dorsal [striatum](https://en.wikipedia.org/wiki/Striatum "Striatum").[\[118\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-118) The two major sources of evidence given to support this theory are that [dopamine receptor D2](https://en.wikipedia.org/wiki/Dopamine_receptor_D2 "Dopamine receptor D2") blocking drugs (i.e., [antipsychotics](https://en.wikipedia.org/wiki/Antipsychotic "Antipsychotic")) tend to reduce the intensity of psychotic symptoms, and that drugs that accentuate dopamine release, or inhibit its reuptake (such as [amphetamines](https://en.wikipedia.org/wiki/Amphetamine "Amphetamine") and [cocaine](https://en.wikipedia.org/wiki/Cocaine "Cocaine")) can trigger psychosis in some people (see [stimulant psychosis](https://en.wikipedia.org/wiki/Stimulant_psychosis "Stimulant psychosis")).[\[119\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Kapur-119) However, there is substantial evidence that dopaminergic overactivity does not fully explain psychosis, and that neurodegerative pathophysiology plays a significant role. This is evidenced by the fact that psychosis commonly occurs in neurodegenerative diseases of the dopaminergic nervous system, such as Parkinson's disease, which involved reduced, rather than increased, dopaminergic activity.[\[120\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-120)
The [endocannabinoid system](https://en.wikipedia.org/wiki/Endocannabinoid_system "Endocannabinoid system") is also implicated in psychosis. This is evidenced by the propensity of [CB1 receptor](https://en.wikipedia.org/wiki/Cannabinoid_receptor_1 "Cannabinoid receptor 1") agonists such as [THC](https://en.wikipedia.org/wiki/THC "THC") to induce psychotic symptoms,[\[121\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-121) and the efficacy of [CB1 receptor](https://en.wikipedia.org/wiki/Cannabinoid_receptor_1 "Cannabinoid receptor 1") antagonists such as [CBD](https://en.wikipedia.org/wiki/Cannabidiol "Cannabidiol") in ameliorating psychosis.[\[122\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-122)
NMDA receptor dysfunction has been proposed as a mechanism in psychosis.[\[123\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-123) This theory is reinforced by the fact that [dissociative](https://en.wikipedia.org/wiki/Dissociative "Dissociative") [NMDA receptor antagonists](https://en.wikipedia.org/wiki/NMDA_receptor_antagonist "NMDA receptor antagonist") such as [ketamine](https://en.wikipedia.org/wiki/Ketamine "Ketamine"), [PCP](https://en.wikipedia.org/wiki/Phencyclidine "Phencyclidine") and [dextromethorphan](https://en.wikipedia.org/wiki/Dextromethorphan "Dextromethorphan") (at large overdoses) induce a psychotic state. The symptoms of dissociative [intoxication](https://en.wikipedia.org/wiki/Substance_intoxication "Substance intoxication") are also considered to mirror the symptoms of schizophrenia, including [negative symptoms](https://en.wikipedia.org/wiki/Schizophrenia#Negative_symptoms "Schizophrenia").[\[124\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-124) NMDA receptor antagonism, in addition to producing symptoms reminiscent of psychosis, mimics the neurophysiological aspects, such as reduction in the amplitude of [P50](https://en.wikipedia.org/wiki/P50_\(neuroscience\) "P50 (neuroscience)"), [P300](https://en.wikipedia.org/wiki/P300_\(neuroscience\) "P300 (neuroscience)"), and [MMN](https://en.wikipedia.org/wiki/Mismatch_negativity "Mismatch negativity") [evoked potentials](https://en.wikipedia.org/wiki/Evoked_potential "Evoked potential").[\[125\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-125) Hierarchical Bayesian neurocomputational models of sensory feedback, in agreement with neuroimaging literature, link NMDA receptor hypofunction to delusional or hallucinatory symptoms via proposing a failure of NMDA mediated top down predictions to adequately cancel out enhanced bottom up AMPA mediated predictions errors.[\[126\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-126) Excessive prediction errors in response to stimuli that would normally not produce such a response is thought to root from conferring excessive salience to otherwise mundane events.[\[127\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-127) Dysfunction higher up in the hierarchy, where representation is more abstract, could result in delusions.[\[128\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-128) The common finding of reduced [GAD67](https://en.wikipedia.org/wiki/GAD67 "GAD67") expression in psychotic disorders may explain enhanced AMPA mediated signaling, caused by reduced GABAergic inhibition.[\[129\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-129)[\[130\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-130)
The connection between dopamine and psychosis is generally believed to be complex. While dopamine receptor D2 suppresses [adenylate cyclase](https://en.wikipedia.org/wiki/Adenylate_cyclase "Adenylate cyclase") activity, the [D1](https://en.wikipedia.org/wiki/Dopamine_receptor_D1 "Dopamine receptor D1") receptor increases it. If D2\-blocking drugs are administered, the blocked dopamine spills over to the D1 receptors. The increased adenylate cyclase activity affects [genetic expression](https://en.wikipedia.org/wiki/Genetic_expression "Genetic expression") in the nerve cell, which takes time. Hence antipsychotic drugs take a week or two to reduce the symptoms of psychosis. Moreover, newer and equally effective antipsychotic drugs actually block slightly less dopamine in the brain than older drugs whilst also blocking 5-HT2A receptors, suggesting the 'dopamine hypothesis' may be oversimplified.[\[131\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-131) Soyka and colleagues found no evidence of dopaminergic dysfunction in people with alcohol-induced psychosis[\[132\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-132) and Zoldan et al. reported moderately successful use of [ondansetron](https://en.wikipedia.org/wiki/Ondansetron "Ondansetron"), a 5-HT3 receptor antagonist, in the treatment of [levodopa](https://en.wikipedia.org/wiki/Levodopa "Levodopa") psychosis in [Parkinson's disease](https://en.wikipedia.org/wiki/Parkinson%27s_disease "Parkinson's disease") patients.[\[133\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Zoldan_et_al_1995-133)
A review found an association between a first-episode of psychosis and prediabetes.[\[134\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-134)
Prolonged or high dose use of [psychostimulants](https://en.wikipedia.org/wiki/Psychostimulants "Psychostimulants") can alter normal functioning, making it similar to the manic phase of bipolar disorder.[\[135\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-135) NMDA antagonists replicate some of the so-called "negative" symptoms like [thought disorder](https://en.wikipedia.org/wiki/Thought_disorder "Thought disorder") in subanesthetic doses (doses insufficient to induce [anesthesia](https://en.wikipedia.org/wiki/Anesthesia "Anesthesia")), and [catatonia](https://en.wikipedia.org/wiki/Catatonia "Catatonia") in high doses. Psychostimulants, especially in one already prone to psychotic thinking, can cause some "positive" symptoms, such as delusional beliefs, particularly those persecutory in nature.\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
### Culture
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=27 "Edit section: Culture")\]
Cross-cultural studies into schizophrenia have found that individual experiences of psychosis and 'hearing voices' vary across cultures.[\[136\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:5-136)[\[137\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-137) In countries such as the [United States](https://en.wikipedia.org/wiki/United_States "United States") where there exists a predominantly biomedical understanding of the body, the mind and in turn, mental health, subjects were found to report their hallucinations as having 'violent content' and self-describing as 'crazy'.[\[136\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:5-136) This experience is at odds with the experiences of subjects in [Accra, Ghana](https://en.wikipedia.org/wiki/Accra,_Ghana "Accra, Ghana"), who describe the voices they hear as having 'spiritual meaning' and are often reported as positive in nature; or subjects in [Chennai, India](https://en.wikipedia.org/wiki/Chennai,_India "Chennai, India"), who describe their hallucinations as kin, family members or close friends, and offering guidance.[\[136\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:5-136)
These differences are attributed to 'social kindling' or how one's social context shapes the way they interpret and experience sensations such as hallucinations. This concept aligns with preexisting cognitive theory such as reality modelling and is supported by recent research that demonstrates that individuals with psychosis can be taught to attend to their hallucinations differently, which in turn alters the hallucinations themselves.[\[138\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-138) Such research creates pathways for social or community-based treatment, such as reality monitoring, for individuals with schizophrenia and other psychotic disorders, providing alternatives to, or supplementing traditional pharmacologic management.\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
Cross-cultural studies explore the way in which psychosis varies in different cultures, countries and religions. The cultural differences are based on the individual or shared illness narratives surrounding cultural meanings of illness experience.[\[139\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Jenkins_J_2018-139) In countries such as [India](https://en.wikipedia.org/wiki/India "India"), [Cambodia](https://en.wikipedia.org/wiki/Cambodia "Cambodia") and [Muslim](https://en.wikipedia.org/wiki/Muslim "Muslim") majority countries, they each share alternative epistemologies. These are known as knowledge systems that focus on the connections between mind, body, culture, nature and society.[\[140\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-140) Cultural perceptions of mental disorders such as psychosis or schizophrenia are believed to be caused by [jinn](https://en.wikipedia.org/wiki/Jinn "Jinn") (spirits) in Muslim majority countries.[\[141\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-doi.org-141) Furthermore, those in [Arab](https://en.wikipedia.org/wiki/Arab "Arab")\-Muslim societies perceive those who act differently than the social norm as "crazy" or as abnormal behaviour.[\[141\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-doi.org-141) This differs from the experiences of individuals in India and how they attain their perspectives on mental health issues through a variety of spiritual and healing traditions.[\[142\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-142) In Cambodia, hallucinations are linked with spirit visitation, a term they call "cultural kindling".[\[143\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-143) These examples of differences are attributed to culture and the way it shapes conceptions of mental disorders.[\[141\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-doi.org-141) These cultural differences can be useful in bridging the gap of cultural understanding and psychiatric signs and symptoms.[\[139\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Jenkins_J_2018-139)
## Diagnosis
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=28 "Edit section: Diagnosis")\]
To make a diagnosis of a mental illness in someone with psychosis [other potential causes must be excluded](https://en.wikipedia.org/wiki/Diagnosis_of_exclusion "Diagnosis of exclusion").[\[144\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Ol2012-144) An initial assessment includes a comprehensive history and physical examination by a health care provider. Tests may be done to exclude substance use, medication, toxins, surgical complications, or other medical illnesses.
[Delirium](https://en.wikipedia.org/wiki/Delirium "Delirium") should be ruled out, which can be distinguished by visual hallucinations, acute onset and fluctuating level of consciousness, indicating other underlying factors, including medical illnesses.[\[145\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Med_News-145) Excluding medical illnesses associated with psychosis is performed by using blood tests to measure:
- [Thyroid-stimulating hormone](https://en.wikipedia.org/wiki/Thyroid-stimulating_hormone "Thyroid-stimulating hormone") to exclude [hypo-](https://en.wikipedia.org/wiki/Hypothyroidism "Hypothyroidism") or [hyperthyroidism](https://en.wikipedia.org/wiki/Hyperthyroidism "Hyperthyroidism")
- [Vitamin B12](https://en.wikipedia.org/wiki/Vitamin_B12 "Vitamin B12") serum and urinary [MMA](https://en.wikipedia.org/wiki/Methylmalonic_acid "Methylmalonic acid") to role out [pernicious anemia](https://en.wikipedia.org/wiki/Pernicious_anemia "Pernicious anemia") or [vitamin B12 deficiency](https://en.wikipedia.org/wiki/Vitamin_B12_deficiency "Vitamin B12 deficiency")
- [Basic electrolytes](https://en.wikipedia.org/wiki/Blood_tests#Blood_chemistry_tests "Blood tests") and [serum calcium](https://en.wikipedia.org/wiki/Serum_calcium "Serum calcium") to rule out a metabolic disturbance
- [Full blood count](https://en.wikipedia.org/wiki/Full_blood_count "Full blood count") including [ESR](https://en.wikipedia.org/wiki/Erythrocyte_sedimentation_rate "Erythrocyte sedimentation rate") to rule out a systemic infection or chronic disease
- [Serology](https://en.wikipedia.org/wiki/Serology "Serology") to exclude [syphilis](https://en.wikipedia.org/wiki/Syphilis "Syphilis") or [HIV](https://en.wikipedia.org/wiki/HIV "HIV") infection.
Other investigations include:
- [EEG](https://en.wikipedia.org/wiki/EEG "EEG") to exclude [epilepsy](https://en.wikipedia.org/wiki/Epilepsy "Epilepsy")
- [MRI](https://en.wikipedia.org/wiki/MRI "MRI") or [CT scan](https://en.wikipedia.org/wiki/CT_scan "CT scan") of the head to exclude brain lesions
Because psychosis may be precipitated or exacerbated by common classes of medications, medication-induced psychosis should be [ruled out](https://en.wikipedia.org/wiki/Diagnosis_of_exclusion "Diagnosis of exclusion"), particularly for first-episode psychosis. Both substance- and medication-induced psychosis can be [excluded](https://en.wikipedia.org/wiki/Diagnosis_of_exclusion "Diagnosis of exclusion") to a high level of certainty, using toxicology screening.\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
Because some [dietary supplements](https://en.wikipedia.org/wiki/Dietary_supplement "Dietary supplement") may also induce psychosis or mania, but cannot be ruled out with laboratory tests, a psychotic individual's family, partner, or friends should be asked whether the patient is currently taking any dietary supplements.[\[146\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-146)
Common mistakes made when diagnosing people who are psychotic include:[\[144\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Ol2012-144)
- Not properly excluding [delirium](https://en.wikipedia.org/wiki/Delirium "Delirium")
- Not appreciating medical abnormalities (e.g., [vital signs](https://en.wikipedia.org/wiki/Vital_signs "Vital signs"))
- Not obtaining a medical history and family history
- Indiscriminate screening without an organizing framework
- Missing a toxic psychosis by not screening for substances *and* medications
- Not asking their families or others about dietary supplements
- Premature diagnostic closure
- Not revisiting or questioning the initial diagnostic impression of primary psychiatric disorder
Only after relevant and known causes of psychosis are excluded, a mental health clinician may make a psychiatric [differential diagnosis](https://en.wikipedia.org/wiki/Differential_diagnosis "Differential diagnosis") using a person's family history, incorporating information from the person with psychosis, and information from family, friends or romantic partners.\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
Types of psychosis in psychiatric disorders may be established by formal rating scales. The [Brief Psychiatric Rating Scale](https://en.wikipedia.org/wiki/Brief_Psychiatric_Rating_Scale "Brief Psychiatric Rating Scale") (BPRS)[\[147\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-147) assesses the level of 18 symptom constructs of psychosis such as [hostility](https://en.wikipedia.org/wiki/Hostility "Hostility"), [suspicion](https://en.wikipedia.org/wiki/Suspicion_\(emotion\) "Suspicion (emotion)"), [hallucination](https://en.wikipedia.org/wiki/Hallucination "Hallucination"), and [grandiosity](https://en.wikipedia.org/wiki/Grandiosity "Grandiosity"). It is based on the clinician's interview with the patient and observations of the patient's behavior over the previous 2–3 days. The patient's family can also answer questions on the behavior report. During the initial assessment and the follow-up, both positive and negative symptoms of psychosis can be assessed using the 30 item [Positive and Negative Syndrome Scale](https://en.wikipedia.org/wiki/Positive_and_Negative_Syndrome_Scale "Positive and Negative Syndrome Scale") (PANSS).[\[148\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-148)
The [DSM-5](https://en.wikipedia.org/wiki/DSM-5 "DSM-5") characterizes disorders as psychotic or on the schizophrenia spectrum if they involve hallucinations, delusions, disorganized thinking, grossly disorganized motor behavior, or negative symptoms.[\[22\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-DSM-22) The DSM-5 does not include psychosis as a definition in the glossary, although it defines "psychotic features", as well as "psychoticism" with respect to personality disorder. The [ICD-10](https://en.wikipedia.org/wiki/ICD-10 "ICD-10") has no specific definition of psychosis.[\[149\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Gaebel-149)
The Psychosis Screening Questionnaire (PSQ) is the most common tool in detecting psychotic symptoms and it includes five root questions that assess the presence of PLE (mania, thought insertion, paranoia, strange experiences and perceptual disturbances)[\[150\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-150) The different tools used to assess symptom severity include the Revised Behavior and Symptom Identification Scale (BASIS-R), a 24-item self-report instrument with six scales: psychosis, depression/functioning, interpersonal problems, alcohol/drug use, self-harm, and emotional lability. The Symptom Checklist-90-Revised (SCL-90-R), a 90-item self assessment tool that measures psychoticism and paranoid ideation in addition to seven other symptom scales. Finally, the Brief Symptom Inventory (BSI), a 53-item self-administered scale developed from the SCL-90-R. The BSI has good psychometric properties and is an acceptable brief alternative to the SCL-90-R.[\[151\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-151) These seem to be the most accurate tools at the moment,\[*[when?](https://en.wikipedia.org/wiki/Wikipedia:Manual_of_Style/Dates_and_numbers#Chronological_items "Wikipedia:Manual of Style/Dates and numbers")*\] but a research in 2007 that focused on quantifying self-reports of auditory verbal hallucinations (AVH) in persons with psychosis, suggest that The Hamilton Program for Schizophrenia Voices Questionnaire (HPSVQ) is also potentially a reliable and useful measure for specifically quantifying AVHs in relation to psychosis.[\[152\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-152)
[Factor analysis](https://en.wikipedia.org/wiki/Factor_analysis "Factor analysis") of symptoms generally regarded as psychosis frequently yields a five factor solution, albeit five factors that are distinct from the five domains defined by the DSM-5 to encompass [psychotic](https://en.wikipedia.org/wiki/Psychotic "Psychotic") or schizophrenia spectrum disorders. The five factors are frequently labeled as hallucinations, delusions, disorganization, excitement, and emotional distress.[\[149\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Gaebel-149) The DSM-5 emphasizes a [psychotic spectrum](https://en.wikipedia.org/wiki/Psychotic_spectrum "Psychotic spectrum"), wherein the low end is characterized by schizoid personality disorder, and the high end is characterized by schizophrenia.[\[3\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Continuum-3)
Gouzoulis-Mayfrank et al. said that the pleasant or emotionally positive experiences that are common in psychosis, particularly in the early stages, are more easily overlooked in clinical practice than the negative experiences.[\[153\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-ReferenceA-153) Nev Jones and Mona Shattel wrote that there is less curiosity towards the complications, or towards the richness of the good things as well as the bad things.[\[153\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-ReferenceA-153)
## Prevention
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=29 "Edit section: Prevention")\]
The evidence for the effectiveness of early interventions to [prevent](https://en.wikipedia.org/wiki/Mental_disorder#Prevention "Mental disorder") psychosis appeared inconclusive.[\[154\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-154) But psychosis caused by drugs can be prevented.[\[155\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-155) Whilst early intervention in those with a psychotic episode might improve short-term outcomes, little benefit was seen from these measures after five years.[\[156\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Lancet09-156) However, there is evidence that [cognitive behavioral therapy](https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy "Cognitive behavioral therapy") (CBT) may reduce the risk of becoming psychotic in those at high risk,[\[157\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-157) and in 2014 the U.K. [National Institute for Health and Care Excellence](https://en.wikipedia.org/wiki/National_Institute_for_Health_and_Care_Excellence "National Institute for Health and Care Excellence") (NICE) recommended preventive CBT for people at risk of psychosis.[\[158\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-158)[\[159\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-159)
## Treatment
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=30 "Edit section: Treatment")\]
The treatment of psychosis depends on the specific diagnosis (such as schizophrenia, bipolar disorder or substance intoxication). The first-line treatment for many psychotic disorders is antipsychotic medication, [\[160\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-fn_72-160) which can reduce the positive symptoms of psychosis in about 7 to 14 days. For youth or adolescents, treatment options include medications, psychological interventions, and social interventions.[\[46\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:3-46)
### Medication
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=31 "Edit section: Medication")\]
The choice of which [antipsychotic](https://en.wikipedia.org/wiki/Antipsychotic "Antipsychotic") to use is based on benefits, risks, and costs.[\[156\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Lancet09-156) It is debatable whether, as a class, [typical](https://en.wikipedia.org/wiki/Typical_antipsychotic "Typical antipsychotic") or [atypical antipsychotics](https://en.wikipedia.org/wiki/Atypical_antipsychotic "Atypical antipsychotic") are better.[\[161\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-161)[\[162\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-162) Tentative evidence supports that [amisulpride](https://en.wikipedia.org/wiki/Amisulpride "Amisulpride"), [olanzapine](https://en.wikipedia.org/wiki/Olanzapine "Olanzapine"), [risperidone](https://en.wikipedia.org/wiki/Risperidone "Risperidone") and [clozapine](https://en.wikipedia.org/wiki/Clozapine "Clozapine") may be more effective for positive symptoms but result in more side effects.[\[163\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-barry_2012-163) Typical antipsychotics have equal drop-out and symptom relapse rates to atypicals when used at low to moderate dosages.[\[164\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-AFP07-164) There is a good response in 40–50%, a partial response in 30–40%, and treatment resistance (failure of symptoms to respond satisfactorily after six weeks to two or three different antipsychotics) in 20% of people.[\[165\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-AFP10-165) Clozapine is an effective treatment for those who respond poorly to other drugs ("treatment-resistant" or "refractory" schizophrenia),[\[166\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-166) but it has the potentially serious side effect of [agranulocytosis](https://en.wikipedia.org/wiki/Agranulocytosis "Agranulocytosis") (lowered [white blood cell](https://en.wikipedia.org/wiki/White_blood_cell "White blood cell") count) in less than 4% of people.[\[156\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Lancet09-156)[\[167\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-BMJ07-167)[\[168\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-168)
Most people on antipsychotics get side effects. People on typical antipsychotics tend to have a higher rate of [extrapyramidal side effects](https://en.wikipedia.org/wiki/Extrapyramidal_side_effects "Extrapyramidal side effects") while some atypicals are associated with considerable weight gain, diabetes and risk of [metabolic syndrome](https://en.wikipedia.org/wiki/Metabolic_syndrome "Metabolic syndrome"); this is most pronounced with olanzapine, while risperidone and [quetiapine](https://en.wikipedia.org/wiki/Quetiapine "Quetiapine") are also associated with weight gain.[\[163\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-barry_2012-163) Risperidone has a similar rate of extrapyramidal symptoms to haloperidol.[\[163\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-barry_2012-163)
### Psychotherapy
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=32 "Edit section: Psychotherapy")\]
Psychological treatments such as [acceptance and commitment therapy](https://en.wikipedia.org/wiki/Acceptance_and_commitment_therapy "Acceptance and commitment therapy") (ACT) are possibly useful in the treatment of psychosis, helping people to focus more on what they can do in terms of valued life directions despite challenging symptomology.[\[169\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-169) [Metacognitive training](https://en.wikipedia.org/wiki/Metacognitive_training "Metacognitive training") (MCT) is associated with reduced [delusions](https://en.wikipedia.org/wiki/Delusion "Delusion"), [hallucinations](https://en.wikipedia.org/wiki/Hallucination "Hallucination") and [negative symptoms](https://en.wikipedia.org/wiki/Negative_symptoms "Negative symptoms") as well as improved [self-esteem](https://en.wikipedia.org/wiki/Self-esteem "Self-esteem") and functioning in individuals with schizophrenia spectrum disorders.[\[170\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-170)
There are many psychosocial interventions that seek to treat the symptoms of psychosis: [need adapted treatment](https://en.wikipedia.org/w/index.php?title=Need_adapted_treatment&action=edit&redlink=1 "Need adapted treatment (page does not exist)"), [Open Dialogue](https://en.wikipedia.org/wiki/Open_Dialogue "Open Dialogue"), psychoanalysis/psychodynamic psychotherapy, [major role therapy](https://en.wikipedia.org/w/index.php?title=Major_role_therapy&action=edit&redlink=1 "Major role therapy (page does not exist)"), [soteria](https://en.wikipedia.org/wiki/Soteria_\(psychiatric_treatment\) "Soteria (psychiatric treatment)"), psychosocial outpatient and inpatient treatment, [milieu therapy](https://en.wikipedia.org/wiki/Milieu_therapy "Milieu therapy"), and [cognitive behavioral therapy](https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy "Cognitive behavioral therapy") (CBT). In relation to the success of CBT for psychosis, a randomized controlled trial for a web-based Cognitive Behavioral Therapy for Psychosis (CBT-P) skills program named Coping With Voices (CWV) suggest that the program has promise for increasing access to CBT-P It also associated benefits in the management of distressing psychotic symptoms and improved social functioning. When CBT and the other psychosocial interventions[\[171\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-171) these are used without antipsychotic medications, they may be somewhat effective for some people, especially for CBT, need-adapted treatment, and soteria.[\[172\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Schizophrenia_Research_2019_p.-172)
### Early intervention
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=33 "Edit section: Early intervention")\]
Main article: [Early intervention in psychosis](https://en.wikipedia.org/wiki/Early_intervention_in_psychosis "Early intervention in psychosis")
[Early intervention in psychosis](https://en.wikipedia.org/wiki/Early_intervention_in_psychosis "Early intervention in psychosis") is based on the observation that identifying and treating someone in the early stages of a psychosis can improve his or her longer-term outcome.[\[173\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-173) This approach advocates the use of an intensive multi-disciplinary approach during what is known as the [critical period](https://en.wikipedia.org/wiki/Critical_period "Critical period"), where intervention is the most effective, and prevents the long-term morbidity associated with chronic psychotic illness.\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
## History
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=34 "Edit section: History")\]
### Etymology
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=35 "Edit section: Etymology")\]
The word *psychosis* was introduced to the psychiatric literature in 1841 by [Karl Friedrich Canstatt](https://en.wikipedia.org/wiki/Karl_Friedrich_Canstatt "Karl Friedrich Canstatt") in his work *Handbuch der Medizinischen Klinik*. He used it as a shorthand for 'psychic neurosis'. At that time neurosis meant any disease of the [nervous system](https://en.wikipedia.org/wiki/Nervous_system "Nervous system"), and Canstatt was thus referring to what was considered a psychological manifestation of brain disease.[\[174\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Burgy-174) [Ernst von Feuchtersleben](https://en.wikipedia.org/wiki/Ernst_von_Feuchtersleben "Ernst von Feuchtersleben") is also widely credited as introducing the term in 1845,[\[175\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-175) as an alternative to [insanity](https://en.wikipedia.org/wiki/Insanity "Insanity") and [mania](https://en.wikipedia.org/wiki/Mania "Mania").\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
The term stems from [Modern Latin](https://en.wikipedia.org/wiki/Modern_Latin "Modern Latin") *psychosis*, "a giving soul or life to, animating, quickening" and that from [Ancient Greek](https://en.wikipedia.org/wiki/Ancient_Greek "Ancient Greek") ψυχή (*psyche*), "soul" and the suffix -ωσις (-**osis**), in this case "abnormal condition".[\[176\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-176)[\[177\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-177)
In its adjective form "psychotic", references to psychosis can be found in both clinical and non-clinical discussions. However, in a *non*\-clinical context, "psychotic" is a nonspecific colloquialism used to mean "insane".\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
### Classification
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=36 "Edit section: Classification")\]
The word was also used to distinguish a condition considered a disorder of the mind, as opposed to *[neurosis](https://en.wikipedia.org/wiki/Neurosis "Neurosis")*, which was considered a disorder of the nervous system.[\[178\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-178) The psychoses thus became the modern equivalent of the old notion of [madness](https://en.wikipedia.org/wiki/Insanity "Insanity"), and hence there was much debate on whether there was only one ([unitary](https://en.wikipedia.org/wiki/Unitary_psychosis "Unitary psychosis")) or many forms of the new disease.[\[179\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-179) One type of broad usage would later be narrowed down by [Koch](https://en.wikipedia.org/wiki/Julius_Ludwig_August_Koch "Julius Ludwig August Koch") in 1891 to the 'psychopathic inferiorities'—later renamed abnormal personalities by [Schneider](https://en.wikipedia.org/wiki/Kurt_Schneider "Kurt Schneider").[\[174\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Burgy-174)
The division of the major psychoses into manic depressive illness (now called [bipolar disorder](https://en.wikipedia.org/wiki/Bipolar_disorder "Bipolar disorder")) and dementia praecox (now called [schizophrenia](https://en.wikipedia.org/wiki/Schizophrenia "Schizophrenia")) was made by [Emil Kraepelin](https://en.wikipedia.org/wiki/Emil_Kraepelin "Emil Kraepelin"), who attempted to create a synthesis of the various mental disorders identified by 19th-century [psychiatrists](https://en.wikipedia.org/wiki/Psychiatry "Psychiatry"), by grouping diseases together based on classification of common symptoms. Kraepelin used the term 'manic depressive insanity' to describe the whole spectrum of [mood disorders](https://en.wikipedia.org/wiki/Mood_disorder "Mood disorder"), in a far wider sense than it is usually used today.\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
In Kraepelin's classification this would include 'unipolar' [clinical depression](https://en.wikipedia.org/wiki/Clinical_depression "Clinical depression"), as well as bipolar disorder and other mood disorders such as [cyclothymia](https://en.wikipedia.org/wiki/Cyclothymia "Cyclothymia"). These are characterised by problems with mood control and the psychotic episodes appear associated with disturbances in mood, and patients often have periods of normal functioning between psychotic episodes even without medication. [Schizophrenia](https://en.wikipedia.org/wiki/Schizophrenia "Schizophrenia") is characterized by psychotic episodes that appear unrelated to disturbances in mood, and most non-medicated patients show signs of disturbance between psychotic episodes.\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
### Treatment
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=37 "Edit section: Treatment")\]
Written record of supernatural causes and resultant treatments can be traced back to the [New Testament](https://en.wikipedia.org/wiki/New_Testament "New Testament"). [Mark 5](https://en.wikipedia.org/wiki/Mark_5 "Mark 5"):8–13 describes a man displaying what would today be described as psychotic symptoms. [Christ](https://en.wikipedia.org/wiki/Christ "Christ") cured this "[demonic](https://en.wikipedia.org/wiki/Demon "Demon") madness" by casting out the demons and hurling them into a herd of swine. Exorcism is still utilized in some religious circles as a treatment for psychosis presumed to be demonic possession.[\[180\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-180) A research study of out-patients in psychiatric clinics found that 30% of religious patients attributed the cause of their psychotic symptoms to evil spirits. Many of these patients underwent exorcistic healing rituals that, though largely regarded as positive experiences by the patients, had no effect on symptomology. Results did however show a significant worsening of psychotic symptoms associated with exclusion of medical treatment for coercive forms of exorcism.[\[181\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-181)
[](https://en.wikipedia.org/wiki/File:Hippocrates.jpg)
Bust of Hippocrates
The medical teachings of the fourth-century philosopher and physician [Hippocrates of Cos](https://en.wikipedia.org/wiki/Hippocrates_of_Cos "Hippocrates of Cos") proposed a natural, rather than supernatural, cause of human illness. In Hippocrates' work, the [Hippocratic corpus](https://en.wikipedia.org/wiki/Hippocratic_corpus "Hippocratic corpus"), a holistic explanation for health and disease was developed to include madness and other "diseases of the mind". Hippocrates writes:
> Men ought to know that from the brain, and from the brain only, arise our pleasures, joys, laughter, and jests, as well as our sorrows, pains, griefs and tears. Through it, in particular, we think, see, hear, and distinguish the ugly from the beautiful, the bad from the good, the pleasant from the unpleasant.... It is the same thing which makes us mad or delirious, inspires us with dread and fear, whether by night or by day, brings sleeplessness, inopportune mistakes, aimless anxieties, absentmindedness, and acts that are contrary to habit.[\[182\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-182)
Hippocrates espoused a theory of [humoralism](https://en.wikipedia.org/wiki/Humoralism "Humoralism") wherein disease is resultant of a shifting balance in bodily fluids including [blood](https://en.wikipedia.org/wiki/Blood "Blood"), [phlegm](https://en.wikipedia.org/wiki/Phlegm "Phlegm"), [black bile](https://en.wikipedia.org/wiki/Black_bile "Black bile"), and [yellow bile](https://en.wikipedia.org/wiki/Yellow_bile "Yellow bile").[\[183\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-183) According to humoralism, each fluid or "[humour](https://en.wikipedia.org/wiki/Humour "Humour")" has temperamental or behavioral correlates. In the case of psychosis, symptoms are thought to be caused by an excess of both blood and yellow bile. Thus, the proposed surgical intervention for psychotic or manic behavior was [bloodletting](https://en.wikipedia.org/wiki/Bloodletting "Bloodletting").[\[184\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-184)
18th-century physician, educator, and widely considered "founder of American psychiatry", [Benjamin Rush](https://en.wikipedia.org/wiki/Benjamin_Rush "Benjamin Rush"), also prescribed bloodletting as a first-line treatment for psychosis. Although not a proponent of humoralism, Rush believed that active purging and bloodletting were efficacious corrections for disruptions in the circulatory system, a complication he believed was the primary cause of "insanity".[\[185\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-185) Although Rush's treatment modalities are now considered antiquated and brutish, his contributions to psychiatry, namely the biological underpinnings of psychiatric phenomenon including psychosis, have been invaluable to the field. In honor of such contributions, Benjamin Rush's image is in the official seal of the [American Psychiatric Association](https://en.wikipedia.org/wiki/American_Psychiatric_Association "American Psychiatric Association").\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
Early 20th-century treatments for severe and persisting psychosis were characterized by an emphasis on shocking the nervous system. Such therapies include [insulin shock therapy](https://en.wikipedia.org/wiki/Insulin_shock_therapy "Insulin shock therapy"), [cardiazol](https://en.wikipedia.org/wiki/Cardiazol "Cardiazol") shock therapy, and [electroconvulsive therapy](https://en.wikipedia.org/wiki/Electroconvulsive_therapy "Electroconvulsive therapy").[\[186\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-186) Despite considerable risk, shock therapy was considered highly efficacious in the treatment of psychosis including [schizophrenia](https://en.wikipedia.org/wiki/Schizophrenia "Schizophrenia"). The acceptance of high-risk treatments led to more invasive medical interventions including [psychosurgery](https://en.wikipedia.org/wiki/Psychosurgery "Psychosurgery").[\[187\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-187)
[](https://en.wikipedia.org/wiki/File:Gottlieb_Burckhardt_\(1836-1907\).jpg)
Gottlieb Burckhardt (1836–1907)
In 1888, Swiss psychiatrist [Gottlieb Burckhardt](https://en.wikipedia.org/wiki/Gottlieb_Burckhardt "Gottlieb Burckhardt") performed the first medically sanctioned psychosurgery in which the [cerebral cortex](https://en.wikipedia.org/wiki/Cerebral_cortex "Cerebral cortex") was excised. Although some patients showed improvement of symptoms and became more subdued, one patient died and several developed [aphasia](https://en.wikipedia.org/wiki/Aphasia "Aphasia") or seizure disorders. Burckhardt would go on to publish his clinical outcomes in a scholarly paper. This procedure was met with criticism from the medical community and his academic and surgical endeavors were largely ignored.[\[188\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-188) In the late 1930s, [Egas Moniz](https://en.wikipedia.org/wiki/Egas_Moniz "Egas Moniz") conceived the [leucotomy](https://en.wikipedia.org/wiki/Leucotomy "Leucotomy") (AKA [prefrontal lobotomy](https://en.wikipedia.org/wiki/Prefrontal_lobotomy "Prefrontal lobotomy")) in which the fibers connecting the [frontal lobes](https://en.wikipedia.org/wiki/Frontal_lobe "Frontal lobe") to the rest of the brain were severed. Moniz's primary inspiration stemmed from a demonstration by neuroscientists John Fulton and Carlyle's 1935 experiment in which two chimpanzees were given leucotomies and pre- and post-surgical behavior was compared. Prior to the leucotomy, the chimps engaged in typical behavior including throwing feces and fighting. After the procedure, both chimps were pacified and less violent. During the Q\&A, Moniz asked if such a procedure could be extended to human subjects, a question that Fulton admitted was quite startling.[\[189\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Pressman1998-189) Moniz would go on to extend the controversial practice to humans with various psychotic disorders, an endeavor for which he received a [Nobel Prize](https://en.wikipedia.org/wiki/Nobel_Prize "Nobel Prize") in 1949.[\[190\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-190) Between the late 1930s and early 1970s, the leucotomy was a widely accepted practice, often performed in non-[sterile](https://en.wikipedia.org/wiki/Sterilization_\(microbiology\) "Sterilization (microbiology)") environments such as small [outpatient](https://en.wikipedia.org/wiki/Outpatient "Outpatient") clinics and patient homes.[\[189\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Pressman1998-189) Psychosurgery remained standard practice until the discovery of antipsychotic pharmacology in the 1950s.[\[191\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-191)
The first clinical trial of [antipsychotics](https://en.wikipedia.org/wiki/Antipsychotic "Antipsychotic") (also commonly known as neuroleptics) for the treatment of psychosis took place in 1952. [Chlorpromazine](https://en.wikipedia.org/wiki/Chlorpromazine "Chlorpromazine") (brand name: Thorazine) passed clinical trials and became the first antipsychotic medication approved for the treatment of both acute and chronic psychosis. Although the mechanism of action was not discovered until 1963, the administration of chlorpromazine marked the advent of the [dopamine antagonist](https://en.wikipedia.org/wiki/Dopamine_antagonist "Dopamine antagonist"), or first generation antipsychotic.[\[192\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-192) While clinical trials showed a high response rate for both acute psychosis and disorders with psychotic features, the [side effects](https://en.wikipedia.org/wiki/Side_effect "Side effect") were particularly harsh, which included high rates of often irreversible Parkinsonian symptoms such as [tardive dyskinesia](https://en.wikipedia.org/wiki/Tardive_dyskinesia "Tardive dyskinesia"). With the advent of [atypical antipsychotics](https://en.wikipedia.org/wiki/Atypical_antipsychotic "Atypical antipsychotic") (also known as second generation antipsychotics) came a dopamine antagonist with a comparable response rate but a far different, though still extensive, side-effect profile that included a lower risk of Parkinsonian symptoms but a higher risk of cardiovascular disease.[\[193\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-193) Atypical antipsychotics remain the first-line treatment for psychosis associated with various psychiatric and [neurological disorders](https://en.wikipedia.org/wiki/Neurological_disorder "Neurological disorder") including schizophrenia, [bipolar disorder](https://en.wikipedia.org/wiki/Bipolar_disorder "Bipolar disorder"), [major depressive disorder](https://en.wikipedia.org/wiki/Major_depressive_disorder "Major depressive disorder"), [anxiety disorders](https://en.wikipedia.org/wiki/Anxiety_disorder "Anxiety disorder"), [dementia](https://en.wikipedia.org/wiki/Dementia "Dementia"), and some [autism spectrum](https://en.wikipedia.org/wiki/Autism_spectrum "Autism spectrum") disorders.[\[194\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-194)
Dopamine is now one of the primary neurotransmitters implicated in psychotic symptomology. Blocking dopamine receptors (namely, the dopamine D2 receptors) and decreasing dopaminergic activity continues to be an effective but highly unrefined effect of antipsychotics, which are commonly used to treat psychosis. Recent pharmacological research suggests that the decrease in dopaminergic activity does not eradicate psychotic [delusions](https://en.wikipedia.org/wiki/Delusion "Delusion") or [hallucinations](https://en.wikipedia.org/wiki/Hallucination "Hallucination"), but rather attenuates the reward mechanisms involved in the development of delusional thinking; that is, connecting or finding meaningful relationships between unrelated stimuli or ideas.[\[119\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Kapur-119) The author of this research paper acknowledges the importance of future investigation:
> The model presented here is based on incomplete knowledge related to dopamine, schizophrenia, and antipsychotics—and as such will need to evolve as more is known about these.
— Shitij Kapur, From dopamine to salience to psychosis—linking biology, pharmacology and phenomenology of psychosis
[Freud](https://en.wikipedia.org/wiki/Freud "Freud")'s former student Wilhelm Reich explored independent insights into the physical effects of neurotic and traumatic upbringing, and published his holistic psychoanalytic treatment with a schizophrenic. With his incorporation of breathwork and insight with the patient, a young woman, she achieved sufficient self-management skills to end the therapy.[\[195\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-195)
[Lacan](https://en.wikipedia.org/wiki/Lacan "Lacan") extended Freud's ideas to create a psychoanalytic model of psychosis based upon the concept of "[foreclosure](https://en.wikipedia.org/wiki/Foreclosure_\(psychoanalysis\) "Foreclosure (psychoanalysis)")", the rejection of the symbolic concept of the father.\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
Psychiatrist [David Healy](https://en.wikipedia.org/wiki/David_Healy_\(psychiatrist\) "David Healy (psychiatrist)") has criticised pharmaceutical companies for promoting simplified biological theories of mental illness that seem to imply the primacy of pharmaceutical treatments while ignoring social and developmental factors that are known important influences in the etiology of psychosis.[\[196\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-196)
## Society and culture
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=38 "Edit section: Society and culture")\]
Symptoms of psychosis can also include visions or quasi-visual experiences, felt presences, alterations of time, alterations of space, or alterations of spatiotemporal qualities of objects and things.[\[153\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-ReferenceA-153) While there are many overwhelmingly negative experiences of psychosis, some experiences of psychosis can be overwhelmingly positive and can be experienced as uplifting or as healing or as difficult but meaningful.[\[153\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-ReferenceA-153) Jones and Shattell said that mutual dialogue in clinical practice would in theory allow the meaning and complexity of psychotic experiences to emerge.[\[153\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-ReferenceA-153)
### Disability
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=39 "Edit section: Disability")\]
The classification of psychosis as a [social disability](https://en.wikipedia.org/wiki/Social_model_of_disability "Social model of disability") is a common occurrence.
Psychosis is considered to be among the top ten causes of social disability among adults in developed countries.[\[197\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-197) The traditional, negative narrative around disability has been shown to adversely influence employment and education for people experiencing psychosis.[\[198\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-198)
Social disability by way of social disconnection is a significant public health concern and is associated with a broad range of negative outcomes, including premature mortality. Social disconnection refers to the ongoing absence of family or social relationships with marginal participation in social activities.[\[199\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-199)
Research on psychosis found that reduced participation in social networks, not only negatively effects the individual on a physical and mental level, it has been shown that failure to be included in social networks influences the individual's ability to participate in the wider community through employment and education opportunities.[\[200\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Myers_2019-200)[\[201\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Myers_2012-201)[\[202\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-pmid21699009-202)
Equal opportunity to participate in meaningful relationships with friends, family and romantic partners, as well as engaging in social constructs such as employment, can provide significant physical and mental value to people's lives.[\[200\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Myers_2019-200) And how breaking the disability mind-set around people experiencing psychosis is imperative for their overall, long-term health and well-being as well as the contributions they are able to make to their immediate social connections and the wider community.[\[201\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Myers_2012-201)
## Research
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=40 "Edit section: Research")\]
See also: [List of investigational antipsychotics](https://en.wikipedia.org/wiki/List_of_investigational_antipsychotics "List of investigational antipsychotics")
Further research in the form of randomized controlled trials is needed to determine the effectiveness of treatment approaches for helping *adolescents* with psychosis.[\[46\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:3-46) Through 10 randomized clinical trials, studies showed that Early Intervention Services (EIS) for patients with early-phase schizophrenia spectrum disorders have generated promising outcomes.[\[203\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:05-203) EIS are specifically intended to fulfill the needs of patients with early-phase psychosis.[\[203\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:05-203) In addition, one meta-analysis that consisted of four randomized clinical trials has examined and discovered the efficacy of EIS to Therapy as Usual (TAU) for early-phase psychosis, revealing that EIS techniques are superior to TAU.[\[203\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:05-203)
A study suggests that combining cognitive behavioral therapy (CBT) with SlowMo, an application that helps notice their "unhelpful quick-thinking", might be more effective for treating paranoia in people with psychosis than CBT. alone.[\[204\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-204)[\[205\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-205)
## References
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=41 "Edit section: References")\]
1. ^ [***a***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-NIH2018QA_1-0) [***b***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-NIH2018QA_1-1) [***c***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-NIH2018QA_1-2) [***d***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-NIH2018QA_1-3) [***e***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-NIH2018QA_1-4) [***f***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-NIH2018QA_1-5)
["RAISE Questions and Answers"](https://web.archive.org/web/20191008203120/https://www.nimh.nih.gov/health/topics/schizophrenia/raise/raise-questions-and-answers.shtml). *NIMH*. Archived from [the original](https://www.nimh.nih.gov/health/topics/schizophrenia/raise/raise-questions-and-answers.shtml) on 8 October 2019. Retrieved 23 January 2018.
2. ^ [***a***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-NHS2016_2-0) [***b***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-NHS2016_2-1) [***c***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-NHS2016_2-2) [***d***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-NHS2016_2-3) [***e***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-NHS2016_2-4)
["Psychosis"](https://www.nhs.uk/conditions/psychosis/). *NHS*. 23 December 2016. [Archived](https://web.archive.org/web/20181015043847/https://www.nhs.uk/Conditions/Psychosis/Pages/Prevention-OLD.aspx) from the original on 15 October 2018. Retrieved 24 January 2018.
3. ^ [***a***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-Continuum_3-0) [***b***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-Continuum_3-1) [***c***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-Continuum_3-2) [***d***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-Continuum_3-3) [***e***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-Continuum_3-4)
Arciniegas DB (June 2015). ["Psychosis"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4455840). *Continuum*. **21** (3 Behavioral Neurology and Neuropsychiatry): 715–736\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1212/01.CON.0000466662.89908.e7](https://doi.org/10.1212%2F01.CON.0000466662.89908.e7). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [4455840](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4455840). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [26039850](https://pubmed.ncbi.nlm.nih.gov/26039850).
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Blackburn, Ronald (2005). ["Psychopathy as a Personality Construct"](https://psycnet.apa.org/record/2005-04993-015). *American Psychiatric Association*. [Archived](https://web.archive.org/web/20230905192012/https://psycnet.apa.org/record/2005-04993-015) from the original on 5 September 2023. Retrieved 12 June 2024.
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Driessen, Josi M. A.; van Baar, Jeroen M.; Sanfey, Alan G.; Glennon, Jeffrey C.; Brazil, Inti A. (July 2021). "Moral strategies and psychopathic traits". *Journal of Abnormal Psychology*. **130** (5): 550–561\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1037/abn0000675](https://doi.org/10.1037%2Fabn0000675). [hdl](https://en.wikipedia.org/wiki/Hdl_\(identifier\) "Hdl (identifier)"):[2066/236779](https://hdl.handle.net/2066%2F236779). [ISSN](https://en.wikipedia.org/wiki/ISSN_\(identifier\) "ISSN (identifier)") [1939-1846](https://search.worldcat.org/issn/1939-1846). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [34472890](https://pubmed.ncbi.nlm.nih.gov/34472890).
6. **[^](https://en.wikipedia.org/wiki/Psychosis#cite_ref-6)**
["Effects of Co-occurring Psychotic Experiences and Psychopathic"](https://web.archive.org/web/20260318230359/https://livrepository.liverpool.ac.uk/3194051/1/201454799_Jun2024.pdf) (PDF). *livrepository.liverpool.ac.uk*. Archived from [the original](https://livrepository.liverpool.ac.uk/3194051/1/201454799_Jun2024.pdf) (PDF) on 18 March 2026. Retrieved 18 March 2026.
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Radua J, Ramella-Cravaro V, Ioannidis JP, Reichenberg A, Phiphopthatsanee N, Amir T, et al. (February 2018). ["What causes psychosis? An umbrella review of risk and protective factors"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5775150). *World Psychiatry*. **17** (1): 49–66\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1002/wps.20490](https://doi.org/10.1002%2Fwps.20490). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [5775150](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5775150). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [29352556](https://pubmed.ncbi.nlm.nih.gov/29352556).
8. **[^](https://en.wikipedia.org/wiki/Psychosis#cite_ref-8)**
["Korsakoff Psychosis – Special Subjects"](https://www.msdmanuals.com/en-in/professional/special-subjects/illicit-drugs-and-intoxicants/korsakoff-psychosis). *MSD Manual Professional Edition*. Retrieved 2024-04-10.
9. ^ [***a***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-Oxford_Textbook_of_Psychiatry_9-0) [***b***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-Oxford_Textbook_of_Psychiatry_9-1)
Gelder, Michael G.; Gath, Dennis; Mayou, Richard (1983). [*Oxford Textbook of Psychiatry*](https://books.google.com/books?id=pN9rAAAAMAAJ). Oxford University Press. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-19-261294-6](https://en.wikipedia.org/wiki/Special:BookSources/978-0-19-261294-6 "Special:BookSources/978-0-19-261294-6")
.
10. ^ [***a***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-Griswold_10-0) [***b***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-Griswold_10-1) [***c***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-Griswold_10-2) [***d***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-Griswold_10-3)
Griswold KS, Del Regno PA, Berger RC (June 2015). ["Recognition and Differential Diagnosis of Psychosis in Primary Care"](https://www.aafp.org/afp/2015/0615/p856.html). *American Family Physician*. **91** (12): 856–863\. [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [26131945](https://pubmed.ncbi.nlm.nih.gov/26131945). [Archived](https://web.archive.org/web/20210222162048/https://www.aafp.org/afp/2015/0615/p856.html) from the original on 2021-02-22. Retrieved 2021-12-06.
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Cardinal RN, Bullmore ET (2011). [*The Diagnosis of Psychosis*](https://books.google.com/books?id=wE3FXgW9gDkC&pg=PA279). Cambridge University Press. p. 279. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-1-139-49790-9](https://en.wikipedia.org/wiki/Special:BookSources/978-1-139-49790-9 "Special:BookSources/978-1-139-49790-9")
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Foster NL (2011). [*The American Psychiatric Publishing Textbook of Geriatric Neuropsychiatry*](https://books.google.com/books?id=c52vBAAAQBAJ&pg=PA523). American Psychiatric Pub. p. 523. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-1-58562-952-7](https://en.wikipedia.org/wiki/Special:BookSources/978-1-58562-952-7 "Special:BookSources/978-1-58562-952-7")
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Haddad PM, Correll CU (November 2018). ["The acute efficacy of antipsychotics in schizophrenia: a review of recent meta-analyses"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6180374). *Therapeutic Advances in Psychopharmacology*. **8** (11): 303–318\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1177/2045125318781475](https://doi.org/10.1177%2F2045125318781475). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [6180374](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6180374). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [30344997](https://pubmed.ncbi.nlm.nih.gov/30344997).
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Stip E (May 2002). ["Happy birthday neuroleptics! 50 years later: la folie du doute"](https://doi.org/10.1016%2FS0924-9338%2802%2900639-9). *European Psychiatry*. **17** (3): 115–119\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/S0924-9338(02)00639-9](https://doi.org/10.1016%2FS0924-9338%2802%2900639-9). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [12052571](https://pubmed.ncbi.nlm.nih.gov/12052571). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [29883863](https://api.semanticscholar.org/CorpusID:29883863).
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Crossley NA, Constante M, McGuire P, Power P (June 2010). ["Efficacy of atypical v. typical antipsychotics in the treatment of early psychosis: meta-analysis"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2878818). *The British Journal of Psychiatry*. **196** (6): 434–439\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1192/bjp.bp.109.066217](https://doi.org/10.1192%2Fbjp.bp.109.066217). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [2878818](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2878818). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [20513851](https://pubmed.ncbi.nlm.nih.gov/20513851).
194. **[^](https://en.wikipedia.org/wiki/Psychosis#cite_ref-194)**
Maher AR, Maglione M, Bagley S, Suttorp M, Hu JH, Ewing B, et al. (September 2011). ["Efficacy and comparative effectiveness of atypical antipsychotic medications for off-label uses in adults: a systematic review and meta-analysis"](https://doi.org/10.1001%2Fjama.2011.1360). *JAMA*. **306** (12): 1359–1369\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1001/jama.2011.1360](https://doi.org/10.1001%2Fjama.2011.1360). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [21954480](https://pubmed.ncbi.nlm.nih.gov/21954480).
195. **[^](https://en.wikipedia.org/wiki/Psychosis#cite_ref-195)**
Reich W (1980). ["The Schizophrenic Split"](https://books.google.com/books?id=ez7nNDjECOQC&pg=PA437). In Higgins M, Raphael CM (eds.). *Character Analysis*. Translated by Carfango VR. Macmillan. p. 437. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-1-4668-4687-6](https://en.wikipedia.org/wiki/Special:BookSources/978-1-4668-4687-6 "Special:BookSources/978-1-4668-4687-6")
. [Archived](https://web.archive.org/web/20220429013530/https://books.google.com/books?id=ez7nNDjECOQC&pg=PA437) from the original on 2022-04-29. Retrieved 2022-04-29.
196. **[^](https://en.wikipedia.org/wiki/Psychosis#cite_ref-196)**
[Healy D](https://en.wikipedia.org/wiki/David_Healy_\(psychiatrist\) "David Healy (psychiatrist)") (2002). *The Creation of Psychopharmacology*. Cambridge: Harvard University Press. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-674-00619-5](https://en.wikipedia.org/wiki/Special:BookSources/978-0-674-00619-5 "Special:BookSources/978-0-674-00619-5")
.
197. **[^](https://en.wikipedia.org/wiki/Psychosis#cite_ref-197)**
Green MF, Horan WP, Lee J, McCleery A, Reddy LF, Wynn JK (February 2018). ["Social Disconnection in Schizophrenia and the General Community"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5814840). *Schizophrenia Bulletin*. **44** (2): 242–249\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1093/schbul/sbx082](https://doi.org/10.1093%2Fschbul%2Fsbx082). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [5814840](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5814840). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [28637195](https://pubmed.ncbi.nlm.nih.gov/28637195).
198. **[^](https://en.wikipedia.org/wiki/Psychosis#cite_ref-198)**
Blajeski S (September 2020). "Family support, forming careers, and breaking the disability mindset: implications for addressing structural barriers to employment pathways in coordinated specialty care for first-episode psychosis". *Social Work in Mental Health*. **18** (5): 461–81\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1080/15332985.2020.1785603](https://doi.org/10.1080%2F15332985.2020.1785603). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [221380722](https://api.semanticscholar.org/CorpusID:221380722).
199. **[^](https://en.wikipedia.org/wiki/Psychosis#cite_ref-199)**
Green, Michael F.; Lee, Junghee; Wynn, Jonathan K. (June 2020). ["Experimental approaches to social disconnection in the general community: can we learn from schizophrenia research?"](https://onlinelibrary.wiley.com/doi/10.1002/wps.20734). *World Psychiatry*. **19** (2): 177–178\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1002/wps.20734](https://doi.org/10.1002%2Fwps.20734). [ISSN](https://en.wikipedia.org/wiki/ISSN_\(identifier\) "ISSN (identifier)") [1723-8617](https://search.worldcat.org/issn/1723-8617). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [7215060](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7215060). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [32394575](https://pubmed.ncbi.nlm.nih.gov/32394575).
200. ^ [***a***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-Myers_2019_200-0) [***b***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-Myers_2019_200-1)
Myers N (2019). "Beyond the "Crazy House": Mental/Moral Breakdowns and Moral Agency in First-Episode Psychosis". *Ethos*. **47** (1): 13–34\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1111/etho.12225](https://doi.org/10.1111%2Fetho.12225). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [151061439](https://api.semanticscholar.org/CorpusID:151061439).
201. ^ [***a***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-Myers_2012_201-0) [***b***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-Myers_2012_201-1)
Myers NA (May 2012). "Toward an Applied Neuroanthropology of Psychosis: the Interplay of Culture, Brains, and Experience". *Annals of Anthropological Practice*. **36** (1): 113–130\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1111/j.2153-9588.2012.01095.x](https://doi.org/10.1111%2Fj.2153-9588.2012.01095.x).
202. **[^](https://en.wikipedia.org/wiki/Psychosis#cite_ref-pmid21699009_202-0)**
Brown JA (June 2011). "Talking about life after early psychosis: the impact on occupational performance". *Canadian Journal of Occupational Therapy*. **78** (3): 156–163\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.2182/cjot.2011.78.3.3](https://doi.org/10.2182%2Fcjot.2011.78.3.3). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [21699009](https://pubmed.ncbi.nlm.nih.gov/21699009). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [34151007](https://api.semanticscholar.org/CorpusID:34151007).
203. ^ [***a***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-:05_203-0) [***b***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-:05_203-1) [***c***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-:05_203-2)
Correll CU, Galling B, Pawar A, Krivko A, Bonetto C, Ruggeri M, et al. (June 2018). ["Comparison of Early Intervention Services vs Treatment as Usual for Early-Phase Psychosis: A Systematic Review, Meta-analysis, and Meta-regression"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6137532). *JAMA Psychiatry*. **75** (6): 555–565\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1001/jamapsychiatry.2018.0623](https://doi.org/10.1001%2Fjamapsychiatry.2018.0623). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [6137532](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6137532). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [29800949](https://pubmed.ncbi.nlm.nih.gov/29800949).
204. **[^](https://en.wikipedia.org/wiki/Psychosis#cite_ref-204)**
["Mobile app combined with face-to-face therapy helped people with psychosis"](https://evidence.nihr.ac.uk/alert/slowmo-app-reduced-paranoia-in-people-with-psychosis/). *NIHR Evidence* (Plain English summary). National Institute for Health and Care Research. 2022-05-19. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.3310/nihrevidence\_50569](https://doi.org/10.3310%2Fnihrevidence_50569). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [249945572](https://api.semanticscholar.org/CorpusID:249945572).
205. **[^](https://en.wikipedia.org/wiki/Psychosis#cite_ref-205)**
Garety, Philippa; Ward, Thomas; Emsley, Richard; Greenwood, Kathryn; Freeman, Daniel; Fowler, David; Kuipers, Elizabeth; Bebbington, Paul; Dunn, Graham; Hardy, Amy (August 2021). ["Digitally supported CBT to reduce paranoia and improve reasoning for people with schizophrenia-spectrum psychosis: the SlowMo RCT"](https://www.journalslibrary.nihr.ac.uk/eme/eme08110). *Efficacy and Mechanism Evaluation*. **8** (11): 1–90\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.3310/eme08110](https://doi.org/10.3310%2Feme08110). [ISSN](https://en.wikipedia.org/wiki/ISSN_\(identifier\) "ISSN (identifier)") [2050-4365](https://search.worldcat.org/issn/2050-4365). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [34398537](https://pubmed.ncbi.nlm.nih.gov/34398537). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [238644547](https://api.semanticscholar.org/CorpusID:238644547).
## Bibliography
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=42 "Edit section: Bibliography")\]
- Badcock JC, Paulik G, eds. (2019). *A Clinical Introduction to Psychosis: Foundations for Clinical Psychologists and Neuropsychologists* (1st ed.). [Cambridge, Massachusetts](https://en.wikipedia.org/wiki/Cambridge,_Massachusetts "Cambridge, Massachusetts"): [Academic Press](https://en.wikipedia.org/wiki/Academic_Press "Academic Press"), imprint of [Elsevier](https://en.wikipedia.org/wiki/Elsevier "Elsevier"). [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/C2017-0-01829-3](https://doi.org/10.1016%2FC2017-0-01829-3). [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-12-815012-2](https://en.wikipedia.org/wiki/Special:BookSources/978-0-12-815012-2 "Special:BookSources/978-0-12-815012-2")
. [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [243510002](https://api.semanticscholar.org/CorpusID:243510002).
- Lewandowski KE, Moustafa A, eds. (2019). *Social Cognition in Psychosis* (1st ed.). [Cambridge, Massachusetts](https://en.wikipedia.org/wiki/Cambridge,_Massachusetts "Cambridge, Massachusetts"): [Academic Press](https://en.wikipedia.org/wiki/Academic_Press "Academic Press"), imprint of [Elsevier](https://en.wikipedia.org/wiki/Elsevier "Elsevier"). [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/C2017-0-03061-6](https://doi.org/10.1016%2FC2017-0-03061-6). [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-12-815315-4](https://en.wikipedia.org/wiki/Special:BookSources/978-0-12-815315-4 "Special:BookSources/978-0-12-815315-4")
. [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [239126550](https://api.semanticscholar.org/CorpusID:239126550).
- Semple D, Smyth R (2019). "Schizophrenia and related psychoses". In Semple D, Smyth R (eds.). *Oxford Handbook of Psychiatry* (4th ed.). [Oxford](https://en.wikipedia.org/wiki/Oxford "Oxford"): [Oxford University Press](https://en.wikipedia.org/wiki/Oxford_University_Press "Oxford University Press"). pp. 179–240\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1093/med/9780198795551.003.0005](https://doi.org/10.1093%2Fmed%2F9780198795551.003.0005). [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-19-879555-1](https://en.wikipedia.org/wiki/Special:BookSources/978-0-19-879555-1 "Special:BookSources/978-0-19-879555-1")
.
- Tamminga CA, van Os J, Reininghaus U, Ivleva E, eds. (2020). *Psychotic Disorders: Comprehensive Conceptualization and Treatments* (1st ed.). [Oxford](https://en.wikipedia.org/wiki/Oxford "Oxford"): [Oxford University Press](https://en.wikipedia.org/wiki/Oxford_University_Press "Oxford University Press"). [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1093/med/9780190653279.001.0001](https://doi.org/10.1093%2Fmed%2F9780190653279.001.0001). [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-19-065327-9](https://en.wikipedia.org/wiki/Special:BookSources/978-0-19-065327-9 "Special:BookSources/978-0-19-065327-9")
.
- Thompson AD, Broome MR, eds. (2020). *Risk Factors for Psychosis: Paradigms, Mechanisms, and Prevention* (1st ed.). [Cambridge, Massachusetts](https://en.wikipedia.org/wiki/Cambridge,_Massachusetts "Cambridge, Massachusetts"): [Academic Press](https://en.wikipedia.org/wiki/Academic_Press "Academic Press"), imprint of [Elsevier](https://en.wikipedia.org/wiki/Elsevier "Elsevier"). [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/B978-0-12-813201-2.00001-6](https://doi.org/10.1016%2FB978-0-12-813201-2.00001-6). [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-12-813201-2](https://en.wikipedia.org/wiki/Special:BookSources/978-0-12-813201-2 "Special:BookSources/978-0-12-813201-2")
. [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [213499429](https://api.semanticscholar.org/CorpusID:213499429).
## Further reading
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=43 "Edit section: Further reading")\]
- Program for Risk Evaluation and Prevention (PREP) Early Psychosis Clinic (2021). ["Psychosis Spectrum Disorders & Managing Stress during the COVID-19 Pandemic"](https://medicine.umich.edu/dept/psychiatry/michigan-psychiatry-resources-covid-19/specific-mental-health-conditions/psychosis-spectrum-disorders-managing-stress-during-covid-19-pandemic). *Psychiatry*. [Michigan Medicine](https://en.wikipedia.org/wiki/Michigan_Medicine "Michigan Medicine") ([University of Michigan](https://en.wikipedia.org/wiki/University_of_Michigan "University of Michigan")). [Archived](https://web.archive.org/web/20210203193215/https://medicine.umich.edu/dept/psychiatry/michigan-psychiatry-resources-covid-19/specific-mental-health-conditions/psychosis-spectrum-disorders-managing-stress-during-covid-19-pandemic) from the original on 3 February 2021. Retrieved 28 February 2021.
- Sims A (2002). *Symptoms in the mind: An introduction to descriptive psychopathology* (3rd ed.). Edinburgh: Elsevier Science Ltd. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-7020-2627-0](https://en.wikipedia.org/wiki/Special:BookSources/978-0-7020-2627-0 "Special:BookSources/978-0-7020-2627-0")
.
- Murray ED, Buttner N, Price BH (April 2012). "Depression and Psychosis in Neurological Practice". In Bradley WG, Daroff RB, Fenichel GM, Jankovic J (eds.). *Neurology in Clinical Practice* (6th ed.). Butterworth Heinemann. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-1-4377-0434-1](https://en.wikipedia.org/wiki/Special:BookSources/978-1-4377-0434-1 "Special:BookSources/978-1-4377-0434-1")
.
- Williams P (2012). *Rethinking Madness: Towards a Paradigm Shift In Our Understanding and Treatment of Psychosis*. Sky's Edge Publishing. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-9849867-0-5](https://en.wikipedia.org/wiki/Special:BookSources/978-0-9849867-0-5 "Special:BookSources/978-0-9849867-0-5")
.
Personal accounts
- [Dick PK](https://en.wikipedia.org/wiki/Philip_K._Dick "Philip K. Dick") (1981). [*VALIS*](https://en.wikipedia.org/wiki/VALIS "VALIS"). London: Gollancz. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-679-73446-8](https://en.wikipedia.org/wiki/Special:BookSources/978-0-679-73446-8 "Special:BookSources/978-0-679-73446-8")
.
\[Semi-autobiographical\]
- [Jamison KR](https://en.wikipedia.org/wiki/Kay_Redfield_Jamison "Kay Redfield Jamison") (1995). [*An Unquiet Mind: A Memoir of Moods and Madness*](https://archive.org/details/unquietmindmemoi00jami). London: Picador. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-679-76330-7](https://en.wikipedia.org/wiki/Special:BookSources/978-0-679-76330-7 "Special:BookSources/978-0-679-76330-7")
.
- [Schreber DP](https://en.wikipedia.org/wiki/Daniel_Paul_Schreber "Daniel Paul Schreber") (2000). *Memoirs of My Nervous Illness*. New York: New York Review of Books. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-940322-20-2](https://en.wikipedia.org/wiki/Special:BookSources/978-0-940322-20-2 "Special:BookSources/978-0-940322-20-2")
.
- Hinshaw SP (2002). [*The Years of Silence are Past: My Father's Life with Bipolar Disorder*](https://archive.org/details/yearsofsilencear00step). Cambridge: Cambridge University Press. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-521-81780-6](https://en.wikipedia.org/wiki/Special:BookSources/978-0-521-81780-6 "Special:BookSources/978-0-521-81780-6")
.
- McLean R (2003). [*Recovered Not Cured: A Journey Through Schizophrenia*](https://archive.org/details/recoverednotcure00mcle_0). Australia: Allen & Unwin. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-1-86508-974-4](https://en.wikipedia.org/wiki/Special:BookSources/978-1-86508-974-4 "Special:BookSources/978-1-86508-974-4")
.
- [Saks ER](https://en.wikipedia.org/wiki/Elyn_Saks "Elyn Saks") (2007). [*The Center Cannot Hold – My Journey Through Madness*](https://archive.org/details/centercannothold00saks_0). New York: Hyperion. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-1-4013-0138-5](https://en.wikipedia.org/wiki/Special:BookSources/978-1-4013-0138-5 "Special:BookSources/978-1-4013-0138-5")
.
## External links
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=44 "Edit section: External links")\]
- [National Institute of Mental Health](https://web.archive.org/web/20151105074035/http://www.nimh.nih.gov/health/topics/schizophrenia/raise/what-is-psychosis.shtml)
**Psychosis** at Wikipedia's [sister projects](https://en.wikipedia.org/wiki/Wikipedia:Wikimedia_sister_projects "Wikipedia:Wikimedia sister projects"):
- [](https://en.wikipedia.org/wiki/File:Commons-logo.svg)[**Media**](https://commons.wikimedia.org/wiki/Category:Psychosis "c:Category:Psychosis") from Commons
- [**Quotations**](https://en.wikiquote.org/wiki/Psychosis "q:Psychosis") from Wikiquote
- [**Data**](https://www.wikidata.org/wiki/Q170082 "d:Q170082") from Wikidata
| | |
|---|---|
| Classification | [D](https://www.wikidata.org/wiki/Q170082 "d:Q170082") **[ICD](https://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems "International Statistical Classification of Diseases and Related Health Problems")\-[11](https://en.wikipedia.org/wiki/ICD-11 "ICD-11")**: [6A25.0](https://icd.who.int/browse/latest-release/mms/en#521257551), [6A25.1](https://icd.who.int/browse/latest-release/mms/en#1893759206), [6A2Z](https://icd.who.int/browse/latest-release/mms/en#405565289%2Funspecified) **[ICD](https://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems "International Statistical Classification of Diseases and Related Health Problems")\-[10](https://en.wikipedia.org/wiki/ICD-10 "ICD-10")**: [F20](https://icd.who.int/browse10/2019/en#/F20)\-[F29](https://icd.who.int/browse10/2019/en#/F29) **[ICD](https://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems "International Statistical Classification of Diseases and Related Health Problems")\-[9-CM](https://en.wikipedia.org/wiki/List_of_ICD-9_codes "List of ICD-9 codes")**: [290](http://www.icd9data.com/getICD9Code.ashx?icd9=290)\-[299](http://www.icd9data.com/getICD9Code.ashx?icd9=299) **[OMIM](https://en.wikipedia.org/wiki/Online_Mendelian_Inheritance_in_Man "Online Mendelian Inheritance in Man")**: [603342](https://omim.org/entry/603342) |
| External resources | **[MedlinePlus](https://en.wikipedia.org/wiki/MedlinePlus "MedlinePlus")**: [001553](https://www.nlm.nih.gov/medlineplus/ency/article/001553.htm) |
| [v](https://en.wikipedia.org/wiki/Template:Psychiatry "Template:Psychiatry") [t](https://en.wikipedia.org/wiki/Template_talk:Psychiatry "Template talk:Psychiatry") [e](https://en.wikipedia.org/wiki/Special:EditPage/Template:Psychiatry "Special:EditPage/Template:Psychiatry")[Psychiatry](https://en.wikipedia.org/wiki/Psychiatry "Psychiatry") | |
|---|---|
| Subspecialties | [Addiction psychiatry](https://en.wikipedia.org/wiki/Addiction_psychiatry "Addiction psychiatry") [Biological psychiatry](https://en.wikipedia.org/wiki/Biological_psychiatry "Biological psychiatry") [Child and adolescent psychiatry](https://en.wikipedia.org/wiki/Child_and_adolescent_psychiatry "Child and adolescent psychiatry") [Cognitive neuropsychiatry](https://en.wikipedia.org/wiki/Cognitive_neuropsychiatry "Cognitive neuropsychiatry") [Cross-cultural psychiatry](https://en.wikipedia.org/wiki/Cross-cultural_psychiatry "Cross-cultural psychiatry") [Developmental disability](https://en.wikipedia.org/wiki/Developmental_disability "Developmental disability") [Descriptive psychiatry](https://en.wikipedia.org/wiki/Descriptive_psychiatry "Descriptive psychiatry") [Eating disorder](https://en.wikipedia.org/wiki/Eating_disorder "Eating disorder") [Emergency psychiatry](https://en.wikipedia.org/wiki/Emergency_psychiatry "Emergency psychiatry") [Forensic psychiatry](https://en.wikipedia.org/wiki/Forensic_psychiatry "Forensic psychiatry") [Geriatric psychiatry](https://en.wikipedia.org/wiki/Geriatric_psychiatry "Geriatric psychiatry") [Immuno-psychiatry](https://en.wikipedia.org/wiki/Immuno-psychiatry "Immuno-psychiatry") [Liaison psychiatry](https://en.wikipedia.org/wiki/Liaison_psychiatry "Liaison psychiatry") [Military psychiatry](https://en.wikipedia.org/wiki/Military_psychiatry "Military psychiatry") [Nutritional psychiatry](https://en.wikipedia.org/wiki/Nutritional_psychiatry "Nutritional psychiatry") [Narcology](https://en.wikipedia.org/wiki/Narcology "Narcology") [Neuropsychiatry](https://en.wikipedia.org/wiki/Neuropsychiatry "Neuropsychiatry") [Palliative medicine](https://en.wikipedia.org/wiki/Palliative_medicine "Palliative medicine") [Pain medicine](https://en.wikipedia.org/wiki/Pain_management "Pain management") [Psychotherapy](https://en.wikipedia.org/wiki/Psychotherapy "Psychotherapy") [Sleep medicine](https://en.wikipedia.org/wiki/Sleep_medicine "Sleep medicine") [Telepsychiatry](https://en.wikipedia.org/wiki/Telepsychiatry "Telepsychiatry") |
| Organizations | [American Academy of Child and Adolescent Psychiatry](https://en.wikipedia.org/wiki/American_Academy_of_Child_and_Adolescent_Psychiatry "American Academy of Child and Adolescent Psychiatry") [American Board of Psychiatry and Neurology](https://en.wikipedia.org/wiki/American_Board_of_Psychiatry_and_Neurology "American Board of Psychiatry and Neurology") [American Neuropsychiatric Association](https://en.wikipedia.org/wiki/American_Neuropsychiatric_Association "American Neuropsychiatric Association") [American Psychiatric Association](https://en.wikipedia.org/wiki/American_Psychiatric_Association "American Psychiatric Association") [British Neuropsychiatry Association](https://en.wikipedia.org/wiki/British_Neuropsychiatry_Association "British Neuropsychiatry Association") [Campaign Against Psychiatric Abuse](https://en.wikipedia.org/wiki/Campaign_Against_Psychiatric_Abuse "Campaign Against Psychiatric Abuse") [Chinese Society of Psychiatry](https://en.wikipedia.org/wiki/Chinese_Society_of_Psychiatry "Chinese Society of Psychiatry") [Democratic Psychiatry](https://en.wikipedia.org/wiki/Democratic_Psychiatry "Democratic Psychiatry") [European Psychiatric Association](https://en.wikipedia.org/wiki/European_Psychiatric_Association "European Psychiatric Association") [Global Initiative on Psychiatry](https://en.wikipedia.org/wiki/Global_Initiative_on_Psychiatry "Global Initiative on Psychiatry") [Hong Kong College of Psychiatrists](https://en.wikipedia.org/wiki/Hong_Kong_College_of_Psychiatrists "Hong Kong College of Psychiatrists") [Independent Psychiatric Association of Russia](https://en.wikipedia.org/wiki/Independent_Psychiatric_Association_of_Russia "Independent Psychiatric Association of Russia") [Indian Psychiatric Society](https://en.wikipedia.org/wiki/Indian_Psychiatric_Society "Indian Psychiatric Society") [National Institute of Mental Health](https://en.wikipedia.org/wiki/National_Institute_of_Mental_Health "National Institute of Mental Health") [Philadelphia Association](https://en.wikipedia.org/wiki/Philadelphia_Association "Philadelphia Association") [Royal Australian and New Zealand College of Psychiatrists](https://en.wikipedia.org/wiki/Royal_Australian_and_New_Zealand_College_of_Psychiatrists "Royal Australian and New Zealand College of Psychiatrists") [Royal College of Psychiatrists](https://en.wikipedia.org/wiki/Royal_College_of_Psychiatrists "Royal College of Psychiatrists") [Taiwanese Society of Child and Adolescent Psychiatry](https://en.wikipedia.org/wiki/Taiwanese_Society_of_Child_and_Adolescent_Psychiatry "Taiwanese Society of Child and Adolescent Psychiatry") [Working Commission to Investigate the Use of Psychiatry for Political Purposes](https://en.wikipedia.org/wiki/Working_Commission_to_Investigate_the_Use_of_Psychiatry_for_Political_Purposes "Working Commission to Investigate the Use of Psychiatry for Political Purposes") [World Psychiatric Association](https://en.wikipedia.org/wiki/World_Psychiatric_Association "World Psychiatric Association") |
| Related topics | [Behavioral medicine](https://en.wikipedia.org/wiki/Behavioral_medicine "Behavioral medicine") [Clinical neuroscience](https://en.wikipedia.org/wiki/Clinical_neuroscience "Clinical neuroscience") [Controversies about psychiatry](https://en.wikipedia.org/wiki/Controversies_about_psychiatry "Controversies about psychiatry") [Anti-psychiatry](https://en.wikipedia.org/wiki/Anti-psychiatry "Anti-psychiatry") [Biopsychiatry controversy](https://en.wikipedia.org/wiki/Biopsychiatry_controversy "Biopsychiatry controversy") [Electroconvulsive therapy](https://en.wikipedia.org/wiki/Electroconvulsive_therapy "Electroconvulsive therapy") [Insulin shock therapy](https://en.wikipedia.org/wiki/Insulin_shock_therapy "Insulin shock therapy") [Political abuse of psychiatry](https://en.wikipedia.org/wiki/Political_abuse_of_psychiatry "Political abuse of psychiatry") [Psychiatric survivors movement](https://en.wikipedia.org/wiki/Psychiatric_survivors_movement "Psychiatric survivors movement") [Imaging genetics](https://en.wikipedia.org/wiki/Imaging_genetics "Imaging genetics") [Neuroimaging](https://en.wikipedia.org/wiki/Neuroimaging "Neuroimaging") [Neurophysiology](https://en.wikipedia.org/wiki/Neurophysiology "Neurophysiology") [Pentylenetetrazol](https://en.wikipedia.org/wiki/Pentylenetetrazol "Pentylenetetrazol") [Philosophy of psychiatry](https://en.wikipedia.org/wiki/Philosophy_of_psychiatry "Philosophy of psychiatry") [Psychiatric epidemiology](https://en.wikipedia.org/wiki/Psychiatric_epidemiology "Psychiatric epidemiology") [Psychiatric genetics](https://en.wikipedia.org/wiki/Psychiatric_genetics "Psychiatric genetics") [Psychiatric hospital](https://en.wikipedia.org/wiki/Psychiatric_hospital "Psychiatric hospital") [Psychiatrist](https://en.wikipedia.org/wiki/Psychiatrist "Psychiatrist") [Psychoanalysis](https://en.wikipedia.org/wiki/Psychoanalysis "Psychoanalysis") [Psycho-oncology](https://en.wikipedia.org/wiki/Psycho-oncology "Psycho-oncology") [Psychopharmacology](https://en.wikipedia.org/wiki/Psychopharmacology "Psychopharmacology") [Psychosomatic medicine](https://en.wikipedia.org/wiki/Psychosomatic_medicine "Psychosomatic medicine") [Psychosurgery](https://en.wikipedia.org/wiki/Psychosurgery "Psychosurgery") |
| Lists | [Counseling topics](https://en.wikipedia.org/wiki/List_of_counseling_topics "List of counseling topics") [Neurological conditions and disorders](https://en.wikipedia.org/wiki/List_of_neurological_conditions_and_disorders "List of neurological conditions and disorders") [Psychiatric medications](https://en.wikipedia.org/wiki/List_of_psychiatric_medications "List of psychiatric medications") [by condition treated](https://en.wikipedia.org/wiki/List_of_psychiatric_medications_by_condition_treated "List of psychiatric medications by condition treated") [Psychiatric survivors movement](https://en.wikipedia.org/wiki/Outline_of_the_psychiatric_survivors_movement "Outline of the psychiatric survivors movement") [Psychiatrists](https://en.wikipedia.org/wiki/List_of_psychiatrists "List of psychiatrists") [Psychotherapies](https://en.wikipedia.org/wiki/List_of_psychotherapies "List of psychotherapies") |
| [](https://en.wikipedia.org/wiki/File:Symbol_portal_class.svg "Portal") [Portal](https://en.wikipedia.org/wiki/Portal:Psychiatry "Portal:Psychiatry")  [Outline](https://en.wikipedia.org/wiki/Outline_of_psychiatry "Outline of psychiatry") | |
| [v](https://en.wikipedia.org/wiki/Template:Mood_disorders "Template:Mood disorders") [t](https://en.wikipedia.org/wiki/Template_talk:Mood_disorders "Template talk:Mood disorders") [e](https://en.wikipedia.org/wiki/Special:EditPage/Template:Mood_disorders "Special:EditPage/Template:Mood disorders")[Mood disorder](https://en.wikipedia.org/wiki/Mood_disorder "Mood disorder") | |
|---|---|
| [Spectrum](https://en.wikipedia.org/wiki/Affective_spectrum "Affective spectrum") | |
| | |
| [Bipolar disorder](https://en.wikipedia.org/wiki/Bipolar_disorder "Bipolar disorder") | [Bipolar I](https://en.wikipedia.org/wiki/Bipolar_I_disorder "Bipolar I disorder") [Bipolar II](https://en.wikipedia.org/wiki/Bipolar_II_disorder "Bipolar II disorder") [Cyclothymia](https://en.wikipedia.org/wiki/Cyclothymia "Cyclothymia") [Bipolar NOS](https://en.wikipedia.org/wiki/Bipolar_disorder_not_otherwise_specified "Bipolar disorder not otherwise specified") [Childhood](https://en.wikipedia.org/wiki/Bipolar_disorder_in_children "Bipolar disorder in children") [Hypomania](https://en.wikipedia.org/wiki/Hypomania "Hypomania") [Mania](https://en.wikipedia.org/wiki/Mania "Mania") [Mixed affective state](https://en.wikipedia.org/wiki/Mixed_affective_state "Mixed affective state") [Rapid cycling](https://en.wikipedia.org/wiki/Rapid_cycling "Rapid cycling") |
| [Depression](https://en.wikipedia.org/wiki/Depression_\(mood\) "Depression (mood)") | [Major depressive disorder](https://en.wikipedia.org/wiki/Major_depressive_disorder "Major depressive disorder") [Dysthymia](https://en.wikipedia.org/wiki/Dysthymia "Dysthymia") [Seasonal affective disorder](https://en.wikipedia.org/wiki/Seasonal_affective_disorder "Seasonal affective disorder") [Atypical depression](https://en.wikipedia.org/wiki/Atypical_depression "Atypical depression") [Melancholic depression](https://en.wikipedia.org/wiki/Melancholic_depression "Melancholic depression") [Major depressive episode](https://en.wikipedia.org/wiki/Major_depressive_episode "Major depressive episode") [Depression in childhood and adolescence](https://en.wikipedia.org/wiki/Depression_in_childhood_and_adolescence "Depression in childhood and adolescence") |
| Comorbidities | [Schizoaffective disorder](https://en.wikipedia.org/wiki/Schizoaffective_disorder "Schizoaffective disorder") |
| [Symptoms](https://en.wikipedia.org/wiki/Symptom "Symptom") | [Delusion](https://en.wikipedia.org/wiki/Delusion "Delusion") [Depression (differential diagnoses)](https://en.wikipedia.org/wiki/Depression_\(differential_diagnoses\) "Depression (differential diagnoses)") [Emotional dysregulation](https://en.wikipedia.org/wiki/Emotional_dysregulation "Emotional dysregulation") [Anhedonia](https://en.wikipedia.org/wiki/Anhedonia "Anhedonia") [Dysphoria](https://en.wikipedia.org/wiki/Dysphoria "Dysphoria") [Suicidal ideation](https://en.wikipedia.org/wiki/Suicidal_ideation "Suicidal ideation") [Episodic memory](https://en.wikipedia.org/wiki/Episodic_memory "Episodic memory") [Hallucination](https://en.wikipedia.org/wiki/Hallucination "Hallucination") [Mood swing](https://en.wikipedia.org/wiki/Mood_swing "Mood swing") *[Sleep disorder](https://en.wikipedia.org/wiki/Sleep_disorder "Sleep disorder")* [Hypersomnia](https://en.wikipedia.org/wiki/Hypersomnia "Hypersomnia") [Insomnia](https://en.wikipedia.org/wiki/Insomnia "Insomnia") [Psychosis]() [Psychotic depression](https://en.wikipedia.org/wiki/Psychotic_depression "Psychotic depression") [Racing thoughts](https://en.wikipedia.org/wiki/Racing_thoughts "Racing thoughts") [Reduced affect display](https://en.wikipedia.org/wiki/Reduced_affect_display "Reduced affect display") |
| [Diagnosis](https://en.wikipedia.org/wiki/List_of_diagnostic_classification_and_rating_scales_used_in_psychiatry "List of diagnostic classification and rating scales used in psychiatry") | [Bipolar Spectrum Diagnostic Scale](https://en.wikipedia.org/wiki/Bipolar_Spectrum_Diagnostic_Scale "Bipolar Spectrum Diagnostic Scale") [Child Mania Rating Scale](https://en.wikipedia.org/wiki/Child_Mania_Rating_Scale "Child Mania Rating Scale") [General Behavior Inventory](https://en.wikipedia.org/wiki/General_Behavior_Inventory "General Behavior Inventory") [Hypomania Checklist](https://en.wikipedia.org/wiki/Hypomania_Checklist "Hypomania Checklist") [Mood Disorder Questionnaire](https://en.wikipedia.org/wiki/Mood_Disorder_Questionnaire "Mood Disorder Questionnaire") [Rating scales for depression](https://en.wikipedia.org/wiki/Rating_scales_for_depression "Rating scales for depression") [Young Mania Rating Scale](https://en.wikipedia.org/wiki/Young_Mania_Rating_Scale "Young Mania Rating Scale") |
| [Treatment](https://en.wikipedia.org/wiki/Treatment_of_bipolar_disorder "Treatment of bipolar disorder") | |
| | |
| [Anticonvulsants](https://en.wikipedia.org/wiki/Anticonvulsant "Anticonvulsant") | [Carbamazepine](https://en.wikipedia.org/wiki/Carbamazepine "Carbamazepine") [Lamotrigine](https://en.wikipedia.org/wiki/Lamotrigine "Lamotrigine") [Oxcarbazepine](https://en.wikipedia.org/wiki/Oxcarbazepine "Oxcarbazepine") [Valproate](https://en.wikipedia.org/wiki/Valproate "Valproate") [Sodium valproate](https://en.wikipedia.org/wiki/Sodium_valproate "Sodium valproate") [Valproate semisodium](https://en.wikipedia.org/wiki/Valproate_semisodium "Valproate semisodium") |
| [Sympathomimetics](https://en.wikipedia.org/wiki/Sympathomimetic_drug "Sympathomimetic drug"), [SSRIs](https://en.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitor "Selective serotonin reuptake inhibitor") and similar | [Bupropion](https://en.wikipedia.org/wiki/Bupropion "Bupropion") [Dextroamphetamine](https://en.wikipedia.org/wiki/Dextroamphetamine "Dextroamphetamine") [Escitalopram](https://en.wikipedia.org/wiki/Escitalopram "Escitalopram") [Fluoxetine](https://en.wikipedia.org/wiki/Fluoxetine "Fluoxetine") [Methylphenidate](https://en.wikipedia.org/wiki/Methylphenidate "Methylphenidate") [Sertraline](https://en.wikipedia.org/wiki/Sertraline "Sertraline") |
| Other [mood stabilizers](https://en.wikipedia.org/wiki/Mood_stabilizer "Mood stabilizer") | [Antipsychotics](https://en.wikipedia.org/wiki/Antipsychotic "Antipsychotic") [Atypical antipsychotics](https://en.wikipedia.org/wiki/Atypical_antipsychotic "Atypical antipsychotic") [Lithium](https://en.wikipedia.org/wiki/Lithium_\(medication\) "Lithium (medication)") [Lithium carbonate](https://en.wikipedia.org/wiki/Lithium_carbonate "Lithium carbonate") [Lithium citrate](https://en.wikipedia.org/wiki/Lithium_citrate "Lithium citrate") |
| Non-pharmaceutical | [Clinical psychology](https://en.wikipedia.org/wiki/Clinical_psychology "Clinical psychology") [Psychotherapy](https://en.wikipedia.org/wiki/Psychotherapy "Psychotherapy") [Cognitive behavioral therapy](https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy "Cognitive behavioral therapy") [Dialectical behavior therapy](https://en.wikipedia.org/wiki/Dialectical_behavior_therapy "Dialectical behavior therapy") [Electroconvulsive therapy](https://en.wikipedia.org/wiki/Electroconvulsive_therapy "Electroconvulsive therapy") [Involuntary commitment](https://en.wikipedia.org/wiki/Involuntary_commitment "Involuntary commitment") [Light therapy](https://en.wikipedia.org/wiki/Light_therapy "Light therapy") [Transcranial magnetic stimulation](https://en.wikipedia.org/wiki/Transcranial_magnetic_stimulation "Transcranial magnetic stimulation") |
| [History](https://en.wikipedia.org/wiki/History_of_bipolar_disorder "History of bipolar disorder") | [Emil Kraepelin](https://en.wikipedia.org/wiki/Emil_Kraepelin "Emil Kraepelin") [Karl Leonhard](https://en.wikipedia.org/wiki/Karl_Leonhard "Karl Leonhard") [John Cade](https://en.wikipedia.org/wiki/John_Cade "John Cade") [Mogens Schou](https://en.wikipedia.org/wiki/Mogens_Schou "Mogens Schou") [Frederick K. Goodwin](https://en.wikipedia.org/wiki/Frederick_K._Goodwin "Frederick K. Goodwin") [Kay Redfield Jamison](https://en.wikipedia.org/wiki/Kay_Redfield_Jamison "Kay Redfield Jamison") [S. Nassir Ghaemi](https://en.wikipedia.org/wiki/S._Nassir_Ghaemi "S. Nassir Ghaemi") |
| [v](https://en.wikipedia.org/wiki/Template:Mental_disorders "Template:Mental disorders") [t](https://en.wikipedia.org/wiki/Template_talk:Mental_disorders "Template talk:Mental disorders") [e](https://en.wikipedia.org/wiki/Special:EditPage/Template:Mental_disorders "Special:EditPage/Template:Mental disorders")[Mental disorders](https://en.wikipedia.org/wiki/Mental_disorder "Mental disorder") ([Classification](https://en.wikipedia.org/wiki/Classification_of_mental_disorders "Classification of mental disorders")) | |
|---|---|
| Adult personality and behavior | |
| | |
| Sexual | [Ego-dystonic sexual orientation](https://en.wikipedia.org/wiki/Ego-dystonic_sexual_orientation "Ego-dystonic sexual orientation") [Paraphilia](https://en.wikipedia.org/wiki/Paraphilia "Paraphilia") [Fetishism](https://en.wikipedia.org/wiki/Sexual_fetishism "Sexual fetishism") [Voyeurism](https://en.wikipedia.org/wiki/Voyeurism "Voyeurism") [Sexual anhedonia](https://en.wikipedia.org/wiki/Sexual_anhedonia "Sexual anhedonia") [Sexual anorexia](https://en.wikipedia.org/wiki/Sexual_anorexia "Sexual anorexia") [Sexual maturation disorder](https://en.wikipedia.org/wiki/Sexual_maturation_disorder "Sexual maturation disorder") [Sexual relationship disorder](https://en.wikipedia.org/wiki/Sexual_relationship_disorder "Sexual relationship disorder") [Compulsive sexual behaviour disorder](https://en.wikipedia.org/wiki/Compulsive_sexual_behaviour_disorder "Compulsive sexual behaviour disorder") |
| Other | [Factitious disorder](https://en.wikipedia.org/wiki/Factitious_disorder "Factitious disorder") [Munchausen syndrome](https://en.wikipedia.org/wiki/Factitious_disorder_imposed_on_self "Factitious disorder imposed on self") [Fear of intimacy](https://en.wikipedia.org/wiki/Fear_of_intimacy "Fear of intimacy") [Gender dysphoria](https://en.wikipedia.org/wiki/Gender_dysphoria "Gender dysphoria") [Intermittent explosive disorder](https://en.wikipedia.org/wiki/Intermittent_explosive_disorder "Intermittent explosive disorder") [Dermatillomania](https://en.wikipedia.org/wiki/Excoriation_disorder "Excoriation disorder") [Kleptomania](https://en.wikipedia.org/wiki/Kleptomania "Kleptomania") [Pyromania](https://en.wikipedia.org/wiki/Pyromania "Pyromania") [Trichotillomania](https://en.wikipedia.org/wiki/Trichotillomania "Trichotillomania") [Personality disorder](https://en.wikipedia.org/wiki/Personality_disorder "Personality disorder") |
| [Childhood and learning](https://en.wikipedia.org/wiki/Mental_disorders_diagnosed_in_childhood "Mental disorders diagnosed in childhood") | |
| | |
| [Emotional and behavioral](https://en.wikipedia.org/wiki/Emotional_and_behavioral_disorders "Emotional and behavioral disorders") | [ADHD](https://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder "Attention deficit hyperactivity disorder") [Conduct disorder](https://en.wikipedia.org/wiki/Conduct_disorder "Conduct disorder") [ODD](https://en.wikipedia.org/wiki/Oppositional_defiant_disorder "Oppositional defiant disorder") [Emotional and behavioral disorders](https://en.wikipedia.org/wiki/Emotional_and_behavioral_disorders "Emotional and behavioral disorders") [Separation anxiety disorder](https://en.wikipedia.org/wiki/Separation_anxiety_disorder "Separation anxiety disorder") [Movement disorders](https://en.wikipedia.org/wiki/Movement_disorders "Movement disorders") [Stereotypic](https://en.wikipedia.org/wiki/Stereotypic_movement_disorder "Stereotypic movement disorder") Social functioning [DAD](https://en.wikipedia.org/wiki/Disinhibited_attachment_disorder "Disinhibited attachment disorder") [RAD](https://en.wikipedia.org/wiki/Reactive_attachment_disorder "Reactive attachment disorder") [Selective mutism](https://en.wikipedia.org/wiki/Selective_mutism "Selective mutism") [Speech](https://en.wikipedia.org/wiki/Speech_disorder "Speech disorder") [Cluttering](https://en.wikipedia.org/wiki/Cluttering "Cluttering") [Stuttering](https://en.wikipedia.org/wiki/Stuttering "Stuttering") [Tic disorder](https://en.wikipedia.org/wiki/Tic_disorder "Tic disorder") [Tourette syndrome](https://en.wikipedia.org/wiki/Tourette_syndrome "Tourette syndrome") |
| [Intellectual disability](https://en.wikipedia.org/wiki/Intellectual_disability "Intellectual disability") | [X-linked intellectual disability](https://en.wikipedia.org/wiki/X-linked_intellectual_disability "X-linked intellectual disability") [Lujan–Fryns syndrome](https://en.wikipedia.org/wiki/Lujan%E2%80%93Fryns_syndrome "Lujan–Fryns syndrome") |
| Psychological development ([developmental disabilities](https://en.wikipedia.org/wiki/Developmental_disability "Developmental disability")) | [Pervasive](https://en.wikipedia.org/wiki/Pervasive_developmental_disorder "Pervasive developmental disorder") [Specific](https://en.wikipedia.org/wiki/Specific_developmental_disorder "Specific developmental disorder") |
| [Mood](https://en.wikipedia.org/wiki/Mood_disorder "Mood disorder") (affective) | |
| [Bipolar](https://en.wikipedia.org/wiki/Bipolar_disorder "Bipolar disorder") [Bipolar I](https://en.wikipedia.org/wiki/Bipolar_I_disorder "Bipolar I disorder") [Bipolar II](https://en.wikipedia.org/wiki/Bipolar_II_disorder "Bipolar II disorder") [Bipolar NOS](https://en.wikipedia.org/wiki/Bipolar_disorder_not_otherwise_specified "Bipolar disorder not otherwise specified") [Cyclothymia](https://en.wikipedia.org/wiki/Cyclothymia "Cyclothymia") [Depression](https://en.wikipedia.org/wiki/Depression_\(mood\) "Depression (mood)") [Atypical depression](https://en.wikipedia.org/wiki/Atypical_depression "Atypical depression") [Dysthymia](https://en.wikipedia.org/wiki/Dysthymia "Dysthymia") [Major depressive disorder](https://en.wikipedia.org/wiki/Major_depressive_disorder "Major depressive disorder") [Melancholic depression](https://en.wikipedia.org/wiki/Melancholic_depression "Melancholic depression") [Seasonal affective disorder](https://en.wikipedia.org/wiki/Seasonal_affective_disorder "Seasonal affective disorder") [Mania](https://en.wikipedia.org/wiki/Mania "Mania") | |
| Neurological and symptomatic | |
| | |
| [Autism spectrum](https://en.wikipedia.org/wiki/Autism_spectrum "Autism spectrum") | [Autism](https://en.wikipedia.org/wiki/Autism "Autism") [Asperger syndrome](https://en.wikipedia.org/wiki/Asperger_syndrome "Asperger syndrome") [High-functioning autism](https://en.wikipedia.org/wiki/High-functioning_autism "High-functioning autism") [PDD-NOS](https://en.wikipedia.org/wiki/Pervasive_developmental_disorder_not_otherwise_specified "Pervasive developmental disorder not otherwise specified") [Savant syndrome](https://en.wikipedia.org/wiki/Savant_syndrome "Savant syndrome") |
| [Dementia](https://en.wikipedia.org/wiki/Dementia "Dementia") | [AIDS dementia complex](https://en.wikipedia.org/wiki/HIV-associated_neurocognitive_disorder "HIV-associated neurocognitive disorder") [Alzheimer's disease](https://en.wikipedia.org/wiki/Alzheimer%27s_disease "Alzheimer's disease") [Creutzfeldt–Jakob disease](https://en.wikipedia.org/wiki/Creutzfeldt%E2%80%93Jakob_disease "Creutzfeldt–Jakob disease") [Frontotemporal dementia](https://en.wikipedia.org/wiki/Frontotemporal_dementia "Frontotemporal dementia") [Huntington's disease](https://en.wikipedia.org/wiki/Huntington%27s_disease "Huntington's disease") [Mild cognitive impairment](https://en.wikipedia.org/wiki/Mild_cognitive_impairment "Mild cognitive impairment") [Parkinson's disease](https://en.wikipedia.org/wiki/Parkinson%27s_disease "Parkinson's disease") [Pick's disease](https://en.wikipedia.org/wiki/Pick%27s_disease "Pick's disease") [Sundowning](https://en.wikipedia.org/wiki/Sundowning "Sundowning") [Vascular dementia](https://en.wikipedia.org/wiki/Vascular_dementia "Vascular dementia") [Wandering](https://en.wikipedia.org/wiki/Wandering_\(dementia\) "Wandering (dementia)") |
| Other | [Delirium](https://en.wikipedia.org/wiki/Delirium "Delirium") [Organic brain syndrome](https://en.wikipedia.org/wiki/Organic_brain_syndrome "Organic brain syndrome") [Post-concussion syndrome](https://en.wikipedia.org/wiki/Post-concussion_syndrome "Post-concussion syndrome") |
| [Neurotic](https://en.wikipedia.org/wiki/Neurosis "Neurosis"), [stress](https://en.wikipedia.org/wiki/Stress_\(biology\) "Stress (biology)")\-related and [somatoform](https://en.wikipedia.org/wiki/Somatic_symptom_disorder "Somatic symptom disorder") | |
| | |
| [Adjustment](https://en.wikipedia.org/wiki/Adjustment_disorder "Adjustment disorder") | [Adjustment disorder](https://en.wikipedia.org/wiki/Adjustment_disorder "Adjustment disorder") with depressed mood |
| [Anxiety](https://en.wikipedia.org/wiki/Anxiety_disorder "Anxiety disorder") | |
| | |
| [Phobia](https://en.wikipedia.org/wiki/Phobia "Phobia") | [Agoraphobia](https://en.wikipedia.org/wiki/Agoraphobia "Agoraphobia") [Childhood phobia](https://en.wikipedia.org/wiki/Childhood_phobia "Childhood phobia") [Social anxiety](https://en.wikipedia.org/wiki/Social_anxiety "Social anxiety") [Social phobia](https://en.wikipedia.org/wiki/Social_anxiety_disorder "Social anxiety disorder") [Anthropophobia](https://en.wikipedia.org/wiki/Anthropophobia "Anthropophobia") [Specific social phobia](https://en.wikipedia.org/wiki/Specific_social_phobia "Specific social phobia") [Specific phobia](https://en.wikipedia.org/wiki/Specific_phobia "Specific phobia") [Claustrophobia](https://en.wikipedia.org/wiki/Claustrophobia "Claustrophobia") |
| Other | [Generalized anxiety disorder](https://en.wikipedia.org/wiki/Generalized_anxiety_disorder "Generalized anxiety disorder") [OCD](https://en.wikipedia.org/wiki/Obsessive%E2%80%93compulsive_disorder "Obsessive–compulsive disorder") [Panic attack](https://en.wikipedia.org/wiki/Panic_attack "Panic attack") [Panic disorder](https://en.wikipedia.org/wiki/Panic_disorder "Panic disorder") [Paranoia](https://en.wikipedia.org/wiki/Paranoia "Paranoia") [Stress](https://en.wikipedia.org/wiki/Psychological_stress "Psychological stress") [Acute stress reaction](https://en.wikipedia.org/wiki/Acute_stress_reaction "Acute stress reaction") [PTSD](https://en.wikipedia.org/wiki/Post-traumatic_stress_disorder "Post-traumatic stress disorder") |
| [Dissociative](https://en.wikipedia.org/wiki/Dissociative_disorder "Dissociative disorder") | [Depersonalization-derealization disorder](https://en.wikipedia.org/wiki/Depersonalization-derealization_disorder "Depersonalization-derealization disorder") [Dissociative identity disorder](https://en.wikipedia.org/wiki/Dissociative_identity_disorder "Dissociative identity disorder") [Dissociative amnesia](https://en.wikipedia.org/wiki/Dissociative_amnesia "Dissociative amnesia") [Dissociative fugue](https://en.wikipedia.org/wiki/Dissociative_fugue "Dissociative fugue") [Dissociative disorder not otherwise specified](https://en.wikipedia.org/wiki/Dissociative_disorder_not_otherwise_specified "Dissociative disorder not otherwise specified") [Other specified dissociative disorder](https://en.wikipedia.org/wiki/Other_specified_dissociative_disorder "Other specified dissociative disorder") |
| [Somatic symptom](https://en.wikipedia.org/wiki/Somatic_symptom_disorder "Somatic symptom disorder") | [Body dysmorphic disorder](https://en.wikipedia.org/wiki/Body_dysmorphic_disorder "Body dysmorphic disorder") [Conversion disorder](https://en.wikipedia.org/wiki/Conversion_disorder "Conversion disorder") [Ganser syndrome](https://en.wikipedia.org/wiki/Ganser_syndrome "Ganser syndrome") [Globus pharyngeus](https://en.wikipedia.org/wiki/Globus_pharyngeus "Globus pharyngeus") [Psychogenic non-epileptic seizures](https://en.wikipedia.org/wiki/Psychogenic_non-epileptic_seizure "Psychogenic non-epileptic seizure") [False pregnancy](https://en.wikipedia.org/wiki/False_pregnancy "False pregnancy") [Hypochondriasis](https://en.wikipedia.org/wiki/Hypochondriasis "Hypochondriasis") [Mass psychogenic illness](https://en.wikipedia.org/wiki/Mass_psychogenic_illness "Mass psychogenic illness") [Nosophobia](https://en.wikipedia.org/wiki/Nosophobia "Nosophobia") [Psychogenic pain](https://en.wikipedia.org/wiki/Psychogenic_pain "Psychogenic pain") |
| Physiological and physical behavior | |
| | |
| [Eating](https://en.wikipedia.org/wiki/Eating_disorder "Eating disorder") | [Anorexia nervosa](https://en.wikipedia.org/wiki/Anorexia_nervosa "Anorexia nervosa") [Bulimia nervosa](https://en.wikipedia.org/wiki/Bulimia_nervosa "Bulimia nervosa") [Binge eating disorder](https://en.wikipedia.org/wiki/Binge_eating_disorder "Binge eating disorder") [Avoidant/restrictive food intake disorder](https://en.wikipedia.org/wiki/Avoidant/restrictive_food_intake_disorder "Avoidant/restrictive food intake disorder") [Pica](https://en.wikipedia.org/wiki/Pica_\(disorder\) "Pica (disorder)") [Rumination syndrome](https://en.wikipedia.org/wiki/Rumination_syndrome "Rumination syndrome") [Other specified feeding or eating disorder](https://en.wikipedia.org/wiki/Other_specified_feeding_or_eating_disorder "Other specified feeding or eating disorder") |
| Nonorganic [sleep](https://en.wikipedia.org/wiki/Sleep_disorder "Sleep disorder") | [Hypersomnia](https://en.wikipedia.org/wiki/Hypersomnia "Hypersomnia") [Insomnia](https://en.wikipedia.org/wiki/Insomnia "Insomnia") [Parasomnia](https://en.wikipedia.org/wiki/Parasomnia "Parasomnia") [Night terror](https://en.wikipedia.org/wiki/Night_terror "Night terror") [Nightmare](https://en.wikipedia.org/wiki/Nightmare "Nightmare") [REM sleep behavior disorder](https://en.wikipedia.org/wiki/Rapid_eye_movement_sleep_behavior_disorder "Rapid eye movement sleep behavior disorder") |
| [Postnatal](https://en.wikipedia.org/wiki/Psychiatric_disorders_of_childbirth "Psychiatric disorders of childbirth") | [Postpartum depression](https://en.wikipedia.org/wiki/Postpartum_depression "Postpartum depression") [Postpartum psychosis](https://en.wikipedia.org/wiki/Postpartum_psychosis "Postpartum psychosis") |
| [Sexual desire](https://en.wikipedia.org/wiki/Sexual_dysfunction#Sexual_desire_disorders "Sexual dysfunction") | [Hypersexuality](https://en.wikipedia.org/wiki/Hypersexuality "Hypersexuality") [Hypoactive sexual desire disorder](https://en.wikipedia.org/wiki/Hypoactive_sexual_desire_disorder "Hypoactive sexual desire disorder") |
| [Psychoactive](https://en.wikipedia.org/wiki/Psychoactive_drug "Psychoactive drug") substances, [substance abuse](https://en.wikipedia.org/wiki/Substance_abuse "Substance abuse") and substance-related | |
| [Drug overdose](https://en.wikipedia.org/wiki/Drug_overdose "Drug overdose") [Hallucinogen persisting perception disorder](https://en.wikipedia.org/wiki/Hallucinogen_persisting_perception_disorder "Hallucinogen persisting perception disorder") [Intoxication](https://en.wikipedia.org/wiki/Substance_intoxication "Substance intoxication") [Physical dependence](https://en.wikipedia.org/wiki/Physical_dependence "Physical dependence") [Rebound effect](https://en.wikipedia.org/wiki/Rebound_effect "Rebound effect") [Stimulant psychosis](https://en.wikipedia.org/wiki/Stimulant_psychosis "Stimulant psychosis") [Substance dependence](https://en.wikipedia.org/wiki/Substance_dependence "Substance dependence") [Substance-induced psychosis](https://en.wikipedia.org/wiki/Substance-induced_psychosis "Substance-induced psychosis") [Withdrawal](https://en.wikipedia.org/wiki/Drug_withdrawal "Drug withdrawal") | |
| [Schizophrenia](https://en.wikipedia.org/wiki/Schizophrenia "Schizophrenia"), [schizotypal](https://en.wikipedia.org/wiki/Schizotypal_personality_disorder "Schizotypal personality disorder") and [delusional](https://en.wikipedia.org/wiki/Delusional_disorder "Delusional disorder") | |
| | |
| Delusional | [Delusional disorder](https://en.wikipedia.org/wiki/Delusional_disorder "Delusional disorder") [Folie à deux](https://en.wikipedia.org/wiki/Folie_%C3%A0_deux "Folie à deux") |
| [Psychosis]() and schizophrenia-like | [Brief reactive psychosis](https://en.wikipedia.org/wiki/Brief_reactive_psychosis "Brief reactive psychosis") [Schizoaffective disorder](https://en.wikipedia.org/wiki/Schizoaffective_disorder "Schizoaffective disorder") [Schizophreniform disorder](https://en.wikipedia.org/wiki/Schizophreniform_disorder "Schizophreniform disorder") |
| Schizophrenia | [Childhood schizophrenia](https://en.wikipedia.org/wiki/Childhood_schizophrenia "Childhood schizophrenia") [Disorganized (hebephrenic) schizophrenia](https://en.wikipedia.org/wiki/Disorganized_schizophrenia "Disorganized schizophrenia") [Pseudoneurotic schizophrenia](https://en.wikipedia.org/wiki/Pseudoneurotic_schizophrenia "Pseudoneurotic schizophrenia") [Simple-type schizophrenia](https://en.wikipedia.org/wiki/Simple-type_schizophrenia "Simple-type schizophrenia") |
| Other | [Catatonia](https://en.wikipedia.org/wiki/Catatonia "Catatonia") |
| Symptoms and uncategorized | |
| [Impulse-control disorder](https://en.wikipedia.org/wiki/Impulse-control_disorder "Impulse-control disorder") [Klüver–Bucy syndrome](https://en.wikipedia.org/wiki/Kl%C3%BCver%E2%80%93Bucy_syndrome "Klüver–Bucy syndrome") [Psychomotor agitation](https://en.wikipedia.org/wiki/Psychomotor_agitation "Psychomotor agitation") [Stereotypy](https://en.wikipedia.org/wiki/Stereotypy "Stereotypy") [Caregiver burden](https://en.wikipedia.org/wiki/Caregiver_burden "Caregiver burden") | |
|  [Category](https://en.wikipedia.org/wiki/Category:Mental_disorders "Category:Mental disorders") | |
| | |
|---|---|
| [Authority control databases](https://en.wikipedia.org/wiki/Help:Authority_control "Help:Authority control"): National [](https://www.wikidata.org/wiki/Q170082#identifiers "Edit this at Wikidata") | [Israel](https://www.nli.org.il/en/authorities/987007546286305171) |
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Psychosis
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[Add topic](https://en.wikipedia.org/wiki/Psychosis) | |||||||||
| Readable Markdown | | Psychosis | |
|---|---|
| Other names | Psychotic break (*colloquial*), psychotic episode |
| [Specialty](https://en.wikipedia.org/wiki/Medical_specialty "Medical specialty") | [Neurology](https://en.wikipedia.org/wiki/Neurology "Neurology"), [psychiatry](https://en.wikipedia.org/wiki/Psychiatry "Psychiatry"), [emergency medicine](https://en.wikipedia.org/wiki/Emergency_medicine "Emergency medicine"), [clinical psychology](https://en.wikipedia.org/wiki/Clinical_psychology "Clinical psychology") |
| [Symptoms](https://en.wikipedia.org/wiki/Signs_and_symptoms "Signs and symptoms") | [Delusions](https://en.wikipedia.org/wiki/Delusion "Delusion"), [hallucinations](https://en.wikipedia.org/wiki/Hallucination "Hallucination"), incoherent speech and behavior[\[1\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-NIH2018QA-1) |
| [Complications](https://en.wikipedia.org/wiki/Complication_\(medicine\) "Complication (medicine)") | [Self-harm](https://en.wikipedia.org/wiki/Self-harm "Self-harm"), [suicide](https://en.wikipedia.org/wiki/Suicide "Suicide")[\[2\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-NHS2016-2) |
| [Causes](https://en.wikipedia.org/wiki/Cause_\(medicine\) "Cause (medicine)") | [Mental illness](https://en.wikipedia.org/wiki/Mental_illness "Mental illness") ([schizophrenia](https://en.wikipedia.org/wiki/Schizophrenia "Schizophrenia"), [bipolar disorder](https://en.wikipedia.org/wiki/Bipolar_disorder "Bipolar disorder")), [trauma](https://en.wikipedia.org/wiki/Psychological_trauma "Psychological trauma"), [sleep deprivation](https://en.wikipedia.org/wiki/Sleep_deprivation "Sleep deprivation"), some medical conditions, certain [medications](https://en.wikipedia.org/wiki/Medication "Medication"), drugs (including [alcohol](https://en.wikipedia.org/wiki/Alcohol_\(drug\) "Alcohol (drug)"), [caffeine](https://en.wikipedia.org/wiki/Caffeine "Caffeine") and [cannabis](https://en.wikipedia.org/wiki/Cannabis_\(drug\) "Cannabis (drug)"))[\[1\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-NIH2018QA-1) |
| Treatment | [Antipsychotics](https://en.wikipedia.org/wiki/Antipsychotic "Antipsychotic"), [counselling](https://en.wikipedia.org/wiki/Counselling "Counselling"), [social support](https://en.wikipedia.org/wiki/Social_support "Social support")[\[2\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-NHS2016-2) |
| [Prognosis](https://en.wikipedia.org/wiki/Prognosis "Prognosis") | Depends on cause[\[2\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-NHS2016-2) |
| Frequency | 3% of people at some point in their lives (U.S.)[\[1\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-NIH2018QA-1) |
In [psychopathology](https://en.wikipedia.org/wiki/Psychopathology "Psychopathology"), **psychosis** is the inability to distinguish what is or is not [real](https://en.wikipedia.org/wiki/Reality "Reality").[\[3\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Continuum-3) Examples of psychotic symptoms are [delusions](https://en.wikipedia.org/wiki/Delusion "Delusion"), [hallucinations](https://en.wikipedia.org/wiki/Hallucination "Hallucination"), and disorganized or [incoherent thoughts](https://en.wikipedia.org/wiki/Thought_disorder "Thought disorder") or speech.[\[3\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Continuum-3) Psychosis is a description of a person's state or symptoms, rather than a particular [mental illness](https://en.wikipedia.org/wiki/Mental_disorder "Mental disorder"), and it is not related to [psychopathy](https://en.wikipedia.org/wiki/Psychopathy "Psychopathy") (a [personality](https://en.wikipedia.org/wiki/Personality "Personality") [construct](https://en.wikipedia.org/wiki/Construct_\(psychology\) "Construct (psychology)")[\[4\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-4)[\[5\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-5) characterized by impaired [empathy](https://en.wikipedia.org/wiki/Empathy "Empathy") and [remorse](https://en.wikipedia.org/wiki/Remorse "Remorse"), along with [bold](https://en.wikipedia.org/wiki/Boldness "Boldness"), [disinhibited](https://en.wikipedia.org/wiki/Disinhibited "Disinhibited"), and [egocentric](https://en.wikipedia.org/wiki/Egocentrism "Egocentrism") traits).[\[6\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-6)
Common causes of [chronic](https://en.wikipedia.org/wiki/Chronic_condition "Chronic condition") (i.e. ongoing or repeating) psychosis include [schizophrenia](https://en.wikipedia.org/wiki/Schizophrenia "Schizophrenia") or [schizoaffective disorder](https://en.wikipedia.org/wiki/Schizoaffective_disorder "Schizoaffective disorder"), [bipolar disorder](https://en.wikipedia.org/wiki/Bipolar_disorder "Bipolar disorder"), and [brain damage](https://en.wikipedia.org/wiki/Wernicke%E2%80%93Korsakoff_syndrome "Wernicke–Korsakoff syndrome") (usually as a result of [alcoholism](https://en.wikipedia.org/wiki/Alcoholism "Alcoholism")).[\[7\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-7)[\[8\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-8) Acute (temporary) psychosis can also be caused by [severe distress](https://en.wikipedia.org/wiki/Psychological_trauma "Psychological trauma"), [sleep deprivation](https://en.wikipedia.org/wiki/Sleep_deprivation "Sleep deprivation"), [sensory deprivation](https://en.wikipedia.org/wiki/Sensory_deprivation "Sensory deprivation"),[\[9\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Oxford_Textbook_of_Psychiatry-9) some [medications](https://en.wikipedia.org/wiki/Medication "Medication"), and [drug use](https://en.wikipedia.org/wiki/Drug "Drug") (including [alcohol](https://en.wikipedia.org/wiki/Alcohol_\(drug\) "Alcohol (drug)"), [cannabis](https://en.wikipedia.org/wiki/Cannabis_\(drug\) "Cannabis (drug)"), [hallucinogens](https://en.wikipedia.org/wiki/Hallucinogen "Hallucinogen"), and [stimulants](https://en.wikipedia.org/wiki/Stimulant "Stimulant")).[\[10\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Griswold-10) Acute psychosis is termed primary if it results from a psychiatric condition and secondary if it is caused by another medical condition or drugs.[\[10\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Griswold-10) The diagnosis of a mental-health condition requires excluding other potential causes.[\[11\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-11) Tests can be done to check whether psychosis is caused by [central nervous system](https://en.wikipedia.org/wiki/Central_nervous_system "Central nervous system") diseases, toxins, or other health problems.[\[12\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-12)
Treatment may include [antipsychotic medication](https://en.wikipedia.org/wiki/Antipsychotic_medication "Antipsychotic medication"), [psychotherapy](https://en.wikipedia.org/wiki/Psychotherapy "Psychotherapy"), and [social support](https://en.wikipedia.org/wiki/Social_support "Social support").[\[1\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-NIH2018QA-1)[\[2\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-NHS2016-2) Early treatment appears to improve outcomes.[\[1\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-NIH2018QA-1) Medications appear to have a moderate effect.[\[13\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-13) Outcomes depend on the underlying cause.[\[2\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-NHS2016-2)
Psychosis is not well-understood at the [neurological](https://en.wikipedia.org/wiki/Neurological "Neurological") level, but [dopamine](https://en.wikipedia.org/wiki/Dopamine "Dopamine") (along with other [neurotransmitters](https://en.wikipedia.org/wiki/Neurotransmitter "Neurotransmitter")) is known to play an important role.[\[14\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-14)[\[15\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-15)[\[16\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-16) In the United States about 3% of people develop psychosis at some point in their lives.[\[1\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-NIH2018QA-1) Psychosis has been described as early as the 4th century BCE by [Hippocrates](https://en.wikipedia.org/wiki/Hippocrates "Hippocrates") and possibly as early as 1500 BCE in the [Ebers Papyrus](https://en.wikipedia.org/wiki/Ebers_Papyrus "Ebers Papyrus").[\[17\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-17)[\[18\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-18)
A [hallucination](https://en.wikipedia.org/wiki/Hallucination "Hallucination") is defined as a sensory perception in the absence of external stimuli.[\[19\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:9-19) Hallucinations are different from [illusions](https://en.wikipedia.org/wiki/Illusion "Illusion") and perceptual distortions, which are the misperception of external stimuli.[\[20\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-20)[\[21\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-21) Hallucinations may occur in any of the senses and take on almost any form. They may consist of simple sensations (such as lights, colors, sounds, tastes, or smells) or more detailed experiences (such as seeing and interacting with animals and people, [hearing voices](https://en.wikipedia.org/wiki/Auditory_verbal_hallucinations "Auditory verbal hallucinations"), and having complex tactile sensations). Hallucinations are generally characterized as being vivid and uncontrollable.[\[19\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:9-19)[\[22\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-DSM-22) [Auditory hallucinations](https://en.wikipedia.org/wiki/Auditory_hallucination "Auditory hallucination"), particularly experiences of hearing voices, are the most common and often prominent feature of psychosis.\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
Up to 15% of the general population may experience auditory hallucinations (though not all are due to psychosis).[\[23\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-23) The prevalence of auditory hallucinations in patients with [schizophrenia](https://en.wikipedia.org/wiki/Schizophrenia "Schizophrenia") is generally put around 70%.[\[24\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-24) Reported prevalence in [bipolar disorder](https://en.wikipedia.org/wiki/Bipolar_disorder "Bipolar disorder") ranges between 11% and 68%.[\[25\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Toh-25) During the early 20th century, auditory hallucinations were second to [visual hallucinations](https://en.wikipedia.org/wiki/Visual_hallucinations_in_psychosis "Visual hallucinations in psychosis") in frequency, but they are now the most common manifestation of schizophrenia, although rates vary between cultures and regions. Auditory hallucinations are most commonly intelligible voices. When voices are present, the average number has been estimated at three. Content, like frequency, differs significantly, especially across cultures and demographics. People who experience auditory hallucinations can frequently identify the loudness, location of origin, and may settle on identities for voices. Western cultures are associated with auditory experiences concerning religious content, frequently related to sin. Hallucinations may command a person to do something potentially dangerous when combined with delusions.[\[26\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Sadock_Psychosis-26)
So-called "minor hallucinations", such as extracampine hallucinations, or false perceptions of people or movement occurring outside of one's visual field, frequently occur in neurocognitive disorders, such as Parkinson's disease.[\[27\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-27)
Visual hallucinations occur in roughly a third of people with schizophrenia, although certain studies show rates higher than 60%, suggesting that the prevalence of visual hallucinations may be higher in certain samples than traditionally thought.[\[28\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-28) The reported prevalence in bipolar disorder is around 15%.[\[29\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-29) Content commonly involves animate objects, although perceptual abnormalities such as changes in lighting, shading, streaks, or lines may be seen. Visual abnormalities may conflict with [proprioceptive](https://en.wikipedia.org/wiki/Proprioceptive "Proprioceptive") information, and visions may include experiences such as the ground tilting. [Lilliputian hallucinations](https://en.wikipedia.org/wiki/Lilliputian_hallucinations "Lilliputian hallucinations") are less common in schizophrenia, and are more common in various types of [encephalopathy](https://en.wikipedia.org/wiki/Encephalopathy "Encephalopathy"), such as [peduncular hallucinosis](https://en.wikipedia.org/wiki/Peduncular_hallucinosis "Peduncular hallucinosis").[\[26\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Sadock_Psychosis-26)[\[30\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Blom2021-30)
A visceral hallucination, also called a cenesthetic hallucination, is characterized by visceral sensations in the absence of stimuli. Cenesthetic hallucinations may include sensations of burning, or re-arrangement of internal organs.[\[26\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Sadock_Psychosis-26)
A [delusion](https://en.wikipedia.org/wiki/Delusion "Delusion") is a fixed, false, [idiosyncratic](https://en.wikipedia.org/wiki/Idiosyncrasy "Idiosyncrasy") belief, which does not change even when presented with incontrovertible evidence to the contrary.[\[31\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-31)[\[32\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:13-32)[\[33\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:14-33) Delusions are context- and culture-dependent: a belief that inhibits critical functioning and is widely considered delusional in one population may be common (and even adaptive) in another, or in the same population at a later time.[\[33\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:14-33)[\[34\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-34) Since [normative](https://en.wikipedia.org/wiki/Norm_\(philosophy\) "Norm (philosophy)") views may contradict available evidence, a belief need not contravene cultural standards in order to be considered delusional. However, the [DSM-5](https://en.wikipedia.org/wiki/DSM-5 "DSM-5") considers a belief delusional only if it is not widely accepted within a cultural or subcultural context.[\[35\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-35)
Prevalence of delusions in schizophrenia is generally considered around 80-90%, according to [Columbia University](https://en.wikipedia.org/wiki/Columbia_University "Columbia University").[\[36\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-36) A 2022 systematic review found a prevalence of around 70% in bipolar disorder.[\[37\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-37)
The DSM-5 characterizes certain delusions as "bizarre" if they are clearly implausible, or are incompatible with the surrounding cultural context.[\[32\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:13-32) The concept of bizarre delusions has many criticisms, the most prominent being that judging their presence is not highly reliable even among trained individuals.[\[26\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Sadock_Psychosis-26)
A delusion may involve diverse thematic content. The most common type is a [persecutory delusion](https://en.wikipedia.org/wiki/Persecutory_delusion "Persecutory delusion"), in which a person believes that an entity seeks to harm them.[\[32\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:13-32)[\[33\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:14-33) Others include [delusions of reference](https://en.wikipedia.org/wiki/Delusions_of_reference "Delusions of reference") (the belief that some element of one's experience represents a deliberate and specific act by or message from some other entity), [delusions of grandeur](https://en.wikipedia.org/wiki/Delusions_of_grandeur "Delusions of grandeur") (the belief that one possesses special power or influence beyond one's actual limits), [thought broadcasting](https://en.wikipedia.org/wiki/Thought_broadcasting "Thought broadcasting") (the belief that one's thoughts are audible) and [thought insertion](https://en.wikipedia.org/wiki/Thought_insertion "Thought insertion") (the belief that one's thoughts are not one's own).[\[33\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:14-33) A delusion may also involve [misidentification](https://en.wikipedia.org/wiki/Delusional_misidentification_syndrome "Delusional misidentification syndrome") of objects, persons, or environs that the afflicted should reasonably be able to recognize; such examples include [Cotard's syndrome](https://en.wikipedia.org/wiki/Cotard%27s_syndrome "Cotard's syndrome") (the belief that oneself is partly or wholly [dead](https://en.wikipedia.org/wiki/Dead "Dead")) and [clinical lycanthropy](https://en.wikipedia.org/wiki/Clinical_lycanthropy "Clinical lycanthropy") (the belief that oneself is or has transformed into an animal).\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
The subject matter of delusions seems to reflect the current culture in a particular time and location. For example, in the early 1900s in the United States, [syphilis](https://en.wikipedia.org/wiki/Syphilis "Syphilis") was a common theme in delusions. During the Second World War, it was Germany. In the [Cold War](https://en.wikipedia.org/wiki/Cold_War "Cold War") era, communists became a frequent focus. Now, in recent years, technology is a common subject matter of delusions.[\[38\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Cannon_Kramer_pp._323%E2%80%93327-38) Some psychologists, such as those who practice the [Open Dialogue](https://en.wikipedia.org/wiki/Open_Dialogue "Open Dialogue") method, believe that the content of psychosis represents an underlying thought process, that may in part, be responsible for psychosis,[\[39\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Seikkula,_Birgitta_Alakare,_Jukka_A_2001_pp._247%E2%80%93265-39) though the accepted medical position is that psychosis is due to a brain disorder.[\[40\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-40)
Historically, [Karl Jaspers](https://en.wikipedia.org/wiki/Karl_Jaspers "Karl Jaspers") classified psychotic delusions into *primary* and *secondary* types. Primary delusions are defined as arising suddenly and not being comprehensible in terms of normal mental processes, whereas secondary delusions are typically understood as being influenced by the person's background or current situation (e.g., ethnicity, religious, superstitious, or political beliefs).[\[41\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Jaspers-41)
### Disorganized speech/thought and disorganized behavior
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=4 "Edit section: Disorganized speech/thought and disorganized behavior")\]
Disorganization is categorized into either disorganized speech (disorganized speech stemming from disorganized thought), and grossly disorganized motor behavior. Disorganized speech or thought, also formally called [thought disorder](https://en.wikipedia.org/wiki/Thought_disorder "Thought disorder"), is disorganization of thinking that is *inferred* from speech. Characteristics of disorganized speech include rapidly switching topics which is called [derailment](https://en.wikipedia.org/wiki/Derailment_\(thought_disorder\) "Derailment (thought disorder)") or loose [association](https://en.wikipedia.org/wiki/Association_\(psychology\) "Association (psychology)"), switching to topics that are unrelated which is called [tangential thinking](https://en.wikipedia.org/wiki/Tangential_speech "Tangential speech"), incomprehensible speech which is called incoherence and referred to as a [word salad](https://en.wikipedia.org/wiki/Word_salad "Word salad"). Disorganized motor behavior includes repetitive, odd, or sometimes purposeless movement. Disorganized motor behavior rarely includes [catatonia](https://en.wikipedia.org/wiki/Catatonia "Catatonia"), and although it was a prominent symptom historically, it is rarely seen today. Whether this may be due to the use of historical treatments or the lack thereof is unknown.[\[26\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Sadock_Psychosis-26)[\[22\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-DSM-22)
Catatonia describes a profoundly agitated state in which the experience of reality is generally considered impaired. There are two primary manifestations of catatonic behavior. The classic presentation is a person who does not move or interact with the world in any way while awake. This type of catatonia presents with [waxy flexibility](https://en.wikipedia.org/wiki/Waxy_flexibility "Waxy flexibility"). Waxy flexibility is when someone physically moves part of a catatonic person's body and the person stays in the position even if it is bizarre and otherwise nonfunctional (such as moving a person's arm straight up in the air and the arm staying there).[\[42\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-42)
The other type of catatonia is more of an outward presentation of the profoundly agitated state described above. It involves excessive and purposeless motor behaviour, as well as an extreme mental preoccupation that prevents an intact experience of reality. An example is someone walking very fast in circles to the exclusion of anything else with a level of mental preoccupation (meaning not focused on anything relevant to the situation) that was not typical of the person prior to the symptom onset. In both types of catatonia, there is generally no reaction to anything that happens outside of them. It is important to distinguish catatonic agitation from severe bipolar mania, although someone could have both.\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
Negative symptoms include [reduced emotional expression](https://en.wikipedia.org/wiki/Reduced_affect_display "Reduced affect display"), [decreased motivation](https://en.wikipedia.org/wiki/Avolition "Avolition") ([avolition](https://en.wikipedia.org/wiki/Avolition "Avolition")), and [reduced spontaneous speech](https://en.wikipedia.org/wiki/Alogia "Alogia") (poverty of speech, [alogia](https://en.wikipedia.org/wiki/Alogia "Alogia")). Individuals with this condition lack interest and spontaneity, and have the [inability to feel pleasure](https://en.wikipedia.org/wiki/Anhedonia "Anhedonia") ([anhedonia](https://en.wikipedia.org/wiki/Anhedonia "Anhedonia")).[\[43\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-43) Altered Behavioral Inhibition System functioning could possibly cause reduced sustained attention in psychosis and overall contribute to more negative reactions.[\[44\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-44)
### Psychosis in adolescents
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=6 "Edit section: Psychosis in adolescents")\]
Psychosis is relatively rare in adolescents but not uncommon.[\[45\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-45) Young people who have psychosis may have trouble connecting with the world around them and may experience hallucinations or delusions.[\[46\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:3-46) Adolescents with psychosis may also have cognitive deficits that may make it harder for the youth to socialize and work.[\[46\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:3-46) Potential impairments include a reduced speed of mental processing, the lack of ability to focus without getting distracted (limited [attention span](https://en.wikipedia.org/wiki/Attention_span "Attention span")), and deficits in [verbal memory](https://en.wikipedia.org/wiki/Verbal_memory "Verbal memory").[\[46\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:3-46) If an adolescent is experiencing psychosis, they most likely have comorbidity, meaning that they could have multiple mental illnesses.[\[47\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:11-47) Because of this, it may be difficult to determine whether it is psychosis or [autism](https://en.wikipedia.org/wiki/Autism "Autism"), [social](https://en.wikipedia.org/wiki/Social_anxiety_disorder "Social anxiety disorder") or [generalized anxiety disorder](https://en.wikipedia.org/wiki/Generalized_anxiety_disorder "Generalized anxiety disorder"), or [obsessive-compulsive disorder](https://en.wikipedia.org/wiki/Obsessive%E2%80%93compulsive_disorder "Obsessive–compulsive disorder").[\[47\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:11-47)
The symptoms of psychosis may be caused by serious [psychiatric disorders](https://en.wikipedia.org/wiki/Psychiatric_disorders "Psychiatric disorders") such as [schizophrenia](https://en.wikipedia.org/wiki/Schizophrenia "Schizophrenia"), a number of medical illnesses, and [trauma](https://en.wikipedia.org/wiki/Psychological_trauma "Psychological trauma"). Psychosis may also be temporary or transient, and be caused by medications or [substance use disorder](https://en.wikipedia.org/wiki/Substance_use_disorder "Substance use disorder") ([substance-induced psychosis](https://en.wikipedia.org/wiki/Substance-induced_psychosis "Substance-induced psychosis")).\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
Brief hallucinations are not uncommon in those without any psychiatric disease, including healthy children. Causes or triggers include:[\[48\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Cardinal_2011_diagnosis_psychosis-48)
- Falling asleep and waking: [hypnagogic](https://en.wikipedia.org/wiki/Hypnagogic "Hypnagogic") and [hypnopompic](https://en.wikipedia.org/wiki/Hypnopompic "Hypnopompic") hallucinations[\[49\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-49)
- [Bereavement](https://en.wikipedia.org/wiki/Bereavement "Bereavement"), in which hallucinations of a deceased loved one are common[\[48\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Cardinal_2011_diagnosis_psychosis-48)[\[50\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-50)
- Severe [sleep deprivation](https://en.wikipedia.org/wiki/Sleep_deprivation "Sleep deprivation")[\[51\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-51)[\[52\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-52)
- Extreme stress (see below)[\[53\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-53)
- Abnormal brainwaves[\[54\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-54)[\[55\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-55)
- Abnormal brain networks[\[56\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-56)[\[57\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-57)[\[58\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-58)
- [Traumatic brain injury](https://en.wikipedia.org/wiki/Traumatic_brain_injury "Traumatic brain injury")[\[59\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-59)[\[60\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-60)[\[61\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-61)
Traumatic life events have been linked with an elevated risk of developing psychotic symptoms.[\[62\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:1-62) [Childhood trauma](https://en.wikipedia.org/wiki/Childhood_trauma "Childhood trauma") has specifically been shown to be a predictor of adolescent and adult psychosis.[\[63\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:2-63) Individuals with psychotic symptoms are three times more likely to have experienced childhood trauma (e.g., [physical](https://en.wikipedia.org/wiki/Physical_abuse "Physical abuse") or [sexual abuse](https://en.wikipedia.org/wiki/Sexual_abuse#Children "Sexual abuse"), physical or emotional [neglect](https://en.wikipedia.org/wiki/Neglect#Child_neglect "Neglect")) than those in the general population.[\[63\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:2-63) Increased individual vulnerability toward psychosis may interact with traumatic experiences promoting an onset of future psychotic symptoms, particularly during sensitive developmental periods.[\[63\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:2-63) Importantly, the relationship between traumatic life events and psychotic symptoms appears to be dose-dependent in which multiple traumatic life events accumulate, compounding symptom expression and severity.[\[62\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:1-62)[\[63\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:2-63) However, acute, stressful events can also trigger brief psychotic episodes.[\[64\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-64) Trauma prevention and early intervention may be an important target for decreasing the incidence of psychotic disorders and ameliorating its effects.[\[62\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:1-62) A healthy person could become psychotic when inside an empty room with no light and sound. After about 15 minutes, psychosis can occur, this is a phenomenon known as [sensory deprivation](https://en.wikipedia.org/wiki/Sensory_deprivation "Sensory deprivation").[\[9\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Oxford_Textbook_of_Psychiatry-9)
[Neuroticism](https://en.wikipedia.org/wiki/Neuroticism "Neuroticism"), a personality trait associated with vulnerability to stressors, is an independent predictor of the development of psychosis.[\[65\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-NeuroticismMA-65)
### Psychiatric disorders
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=10 "Edit section: Psychiatric disorders")\]
Traditionally psychotic disorders have been believed to have one of two roots: organic (physiological) or functional (mental). Organic disorders being those caused by physical conditions directly affecting the brain with psychosis as a secondary feature, and functional disorders being primary psychological or psychiatric disorders (disorders of the functioning of the mind) in the absence of physiological causes. Subtle physical abnormalities have been found in illnesses traditionally considered functional, such as [schizophrenia](https://en.wikipedia.org/wiki/Schizophrenia "Schizophrenia"). The [DSM-IV-TR](https://en.wikipedia.org/wiki/DSM-IV-TR "DSM-IV-TR") avoids the functional/organic distinction, and instead lists traditional psychotic illnesses, psychosis due to general medical conditions, and substance-induced psychosis.\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
Primary psychiatric causes of psychosis include the following:[\[66\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-ICD-10-66)[\[67\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-67)[\[48\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Cardinal_2011_diagnosis_psychosis-48)
- **Primary psychotic disorders**
- [Schizophrenia](https://en.wikipedia.org/wiki/Schizophrenia "Schizophrenia")
- [Schizoaffective disorder](https://en.wikipedia.org/wiki/Schizoaffective_disorder "Schizoaffective disorder")
- [Schizophreniform disorder](https://en.wikipedia.org/wiki/Schizophreniform_disorder "Schizophreniform disorder")
- [Brief psychotic disorder](https://en.wikipedia.org/wiki/Brief_psychotic_disorder "Brief psychotic disorder")
- [Delusional disorder](https://en.wikipedia.org/wiki/Delusional_disorder "Delusional disorder")
- [Mood disorders](https://en.wikipedia.org/wiki/Mood_disorders "Mood disorders")
- [Psychotic depression](https://en.wikipedia.org/wiki/Psychotic_depression "Psychotic depression"), also known as [major depressive disorder](https://en.wikipedia.org/wiki/Major_depressive_disorder "Major depressive disorder") with psychotic features
- [Bipolar disorder](https://en.wikipedia.org/wiki/Bipolar_disorder "Bipolar disorder")
- [Bipolar I disorder](https://en.wikipedia.org/wiki/Bipolar_I_disorder "Bipolar I disorder") in [manic](https://en.wikipedia.org/wiki/Mania "Mania") and [mixed episodes](https://en.wikipedia.org/wiki/Mixed_episode "Mixed episode"), as well as depressive episodes
- [Bipolar II disorder](https://en.wikipedia.org/wiki/Bipolar_II "Bipolar II") in depressive episodes
Psychotic symptoms may also be seen in:[\[48\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Cardinal_2011_diagnosis_psychosis-48)
- Certain [personality disorders](https://en.wikipedia.org/wiki/Personality_disorders "Personality disorders"): such as [schizotypal personality disorder](https://en.wikipedia.org/wiki/Schizotypal_personality_disorder "Schizotypal personality disorder"), [paranoid personality disorder](https://en.wikipedia.org/wiki/Paranoid_personality_disorder "Paranoid personality disorder"), and [borderline personality disorder](https://en.wikipedia.org/wiki/Borderline_personality_disorder "Borderline personality disorder")
- [Post-traumatic stress disorder](https://en.wikipedia.org/wiki/Post-traumatic_stress_disorder "Post-traumatic stress disorder")
- [Obsessive–compulsive disorder](https://en.wikipedia.org/wiki/Obsessive%E2%80%93compulsive_disorder "Obsessive–compulsive disorder")
- [Dissociative identity disorder](https://en.wikipedia.org/wiki/Dissociative_identity_disorder "Dissociative identity disorder")
- [Paraphrenia](https://en.wikipedia.org/wiki/Paraphrenia "Paraphrenia")
Subtypes of psychosis include:
- [Postpartum psychosis](https://en.wikipedia.org/wiki/Postpartum_psychosis "Postpartum psychosis"),[\[68\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-68) occurring shortly after [giving birth](https://en.wikipedia.org/wiki/Giving_birth "Giving birth"), primarily associated with maternal [bipolar disorder](https://en.wikipedia.org/wiki/Bipolar_disorder "Bipolar disorder")
- [Monothematic delusions](https://en.wikipedia.org/wiki/Monothematic_delusion "Monothematic delusion")
- [Myxedematous psychosis](https://en.wikipedia.org/wiki/Myxedematous_psychosis "Myxedematous psychosis")
- [Stimulant psychosis](https://en.wikipedia.org/wiki/Stimulant_psychosis "Stimulant psychosis")
- [Tardive psychosis](https://en.wikipedia.org/wiki/Tardive_psychosis "Tardive psychosis")
- [Shared psychosis](https://en.wikipedia.org/wiki/Shared_psychosis "Shared psychosis")
Cycloid psychosis is typically an acute, self-limiting form of psychosis with psychotic and mood symptoms that progress from normal to full-blown, usually between a few hours to days, and not related to drug intake or [brain injury](https://en.wikipedia.org/wiki/Brain_injury "Brain injury").[\[69\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:0-69) While proposed as a distinct entity, clinically separate from schizophrenia and affective disorders, cycloid psychosis is not formally acknowledged by current ICD or DSM criteria.[\[69\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:0-69) Its unclear place in psychiatric nosology has likely contributed to the limited scientific investigation and literature on the topic.[\[70\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-70)
#### Postpartum psychosis
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=13 "Edit section: Postpartum psychosis")\]
[Postpartum psychosis](https://en.wikipedia.org/wiki/Postpartum_psychosis "Postpartum psychosis") is a rare yet serious and debilitating form of psychosis.[\[71\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:10-71) Symptoms range from fluctuating moods and insomnia to mood-incongruent delusions related to the individual or the infant.[\[71\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:10-71) Women experiencing postpartum psychosis are at increased risk for suicide or infanticide. Many women who experience first-time psychosis from postpartum often have bipolar disorder, meaning they could experience an increase of psychotic episodes even after postpartum.[\[71\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:10-71)
A very large number of medical conditions can cause psychosis, sometimes called *secondary psychosis*.[\[48\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Cardinal_2011_diagnosis_psychosis-48) Examples include:
- Disorders causing *[delirium](https://en.wikipedia.org/wiki/Delirium "Delirium")* (*toxic psychosis*), in which consciousness is disturbed
- [Neurodevelopmental disorders](https://en.wikipedia.org/wiki/Neurodevelopmental_disorder "Neurodevelopmental disorder") and [chromosomal abnormalities](https://en.wikipedia.org/wiki/Chromosome_abnormality "Chromosome abnormality"), including [velocardiofacial syndrome](https://en.wikipedia.org/wiki/Velocardiofacial_syndrome "Velocardiofacial syndrome")
- [Neurodegenerative disorders](https://en.wikipedia.org/wiki/Neurodegenerative_disease "Neurodegenerative disease"), such as [Alzheimer's disease](https://en.wikipedia.org/wiki/Alzheimer%27s_disease "Alzheimer's disease"), [dementia with Lewy bodies](https://en.wikipedia.org/wiki/Dementia_with_Lewy_bodies "Dementia with Lewy bodies"), and [Parkinson's disease](https://en.wikipedia.org/wiki/Parkinson%27s_disease "Parkinson's disease")[\[72\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-72)
- Focal neurological disease, such as [stroke](https://en.wikipedia.org/wiki/Stroke "Stroke"), [brain tumors](https://en.wikipedia.org/wiki/Brain_tumor "Brain tumor"),[\[73\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Brain_tumor-73) [multiple sclerosis](https://en.wikipedia.org/wiki/Multiple_sclerosis "Multiple sclerosis"),[\[3\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Continuum-3) and some forms of [epilepsy](https://en.wikipedia.org/wiki/Epilepsy "Epilepsy")
- [Malignancy](https://en.wikipedia.org/wiki/Malignancy "Malignancy") (typically via masses in the brain, [paraneoplastic syndromes](https://en.wikipedia.org/wiki/Paraneoplastic_syndrome "Paraneoplastic syndrome"))[\[3\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Continuum-3)
- Infectious and postinfectious syndromes, including infections causing [delirium](https://en.wikipedia.org/wiki/Delirium "Delirium"), [viral encephalitis](https://en.wikipedia.org/wiki/Viral_encephalitis "Viral encephalitis"), [HIV/AIDS](https://en.wikipedia.org/wiki/HIV/AIDS "HIV/AIDS"),[\[74\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Munjal_681%E2%80%93712-74) [malaria](https://en.wikipedia.org/wiki/Malaria "Malaria"),[\[75\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-75) [syphilis](https://en.wikipedia.org/wiki/Syphilis "Syphilis")[\[74\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Munjal_681%E2%80%93712-74)
- [Endocrine disease](https://en.wikipedia.org/wiki/Endocrine_disease "Endocrine disease"), such as [hypothyroidism](https://en.wikipedia.org/wiki/Hypothyroidism "Hypothyroidism"), [hyperthyroidism](https://en.wikipedia.org/wiki/Hyperthyroidism "Hyperthyroidism"), [Cushing's syndrome](https://en.wikipedia.org/wiki/Cushing%27s_syndrome "Cushing's syndrome"), [hypoparathyroidism](https://en.wikipedia.org/wiki/Hypoparathyroidism "Hypoparathyroidism") and [hyperparathyroidism](https://en.wikipedia.org/wiki/Hyperparathyroidism "Hyperparathyroidism");[\[76\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:6-76) sex hormones also affect psychotic symptoms and sometimes giving birth can provoke psychosis, termed [postpartum psychosis](https://en.wikipedia.org/wiki/Postpartum_psychosis "Postpartum psychosis")[\[77\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:7-77)
- Inborn errors of metabolism, such as [Wilson's disease](https://en.wikipedia.org/wiki/Wilson%27s_disease "Wilson's disease"), [porphyria](https://en.wikipedia.org/wiki/Porphyria "Porphyria"), and [homocysteinemia](https://en.wikipedia.org/wiki/Homocysteinemia "Homocysteinemia")[\[78\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-78)
- [Nutritional deficiency](https://en.wikipedia.org/wiki/Nutritional_deficiency "Nutritional deficiency"), such as [vitamin B12 deficiency](https://en.wikipedia.org/wiki/Vitamin_B12_deficiency "Vitamin B12 deficiency")[\[10\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Griswold-10)
- Other acquired [metabolic disorders](https://en.wikipedia.org/wiki/Metabolic_disorder "Metabolic disorder"), including [electrolyte](https://en.wikipedia.org/wiki/Electrolyte "Electrolyte") disturbances such as [hypocalcemia](https://en.wikipedia.org/wiki/Hypocalcemia "Hypocalcemia"), [hypernatremia](https://en.wikipedia.org/wiki/Hypernatremia "Hypernatremia"), [hyponatremia](https://en.wikipedia.org/wiki/Hyponatremia "Hyponatremia"), [hypokalemia](https://en.wikipedia.org/wiki/Hypokalemia "Hypokalemia"), [hypomagnesemia](https://en.wikipedia.org/wiki/Hypomagnesemia "Hypomagnesemia"), [hypermagnesemia](https://en.wikipedia.org/wiki/Hypermagnesemia "Hypermagnesemia"), [hypercalcemia](https://en.wikipedia.org/wiki/Hypercalcemia "Hypercalcemia"), and [hypophosphatemia](https://en.wikipedia.org/wiki/Hypophosphatemia "Hypophosphatemia"), but also [hypoglycemia](https://en.wikipedia.org/wiki/Hypoglycemia "Hypoglycemia"), [hypoxia](https://en.wikipedia.org/wiki/Hypoxia_\(medical\) "Hypoxia (medical)"), and failure of the [liver](https://en.wikipedia.org/wiki/Liver "Liver") or [kidneys](https://en.wikipedia.org/wiki/Kidney "Kidney")[\[76\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:6-76)[\[10\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Griswold-10)
- [Autoimmune and related disorders](https://en.wikipedia.org/wiki/Autoimmune_disease "Autoimmune disease") , such as [systemic lupus erythematosus](https://en.wikipedia.org/wiki/Systemic_lupus_erythematosus "Systemic lupus erythematosus") (lupus, SLE), [sarcoidosis](https://en.wikipedia.org/wiki/Sarcoidosis "Sarcoidosis"), [Hashimoto's encephalopathy](https://en.wikipedia.org/wiki/Hashimoto%27s_encephalopathy "Hashimoto's encephalopathy"), [anti-NMDA-receptor encephalitis](https://en.wikipedia.org/wiki/Anti-NMDA-receptor_encephalitis "Anti-NMDA-receptor encephalitis"), and [non-celiac gluten sensitivity](https://en.wikipedia.org/wiki/Non-celiac_gluten_sensitivity "Non-celiac gluten sensitivity")[\[79\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-LosurdoPrincipi2018-79)[\[80\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-80)
- [Poisoning](https://en.wikipedia.org/wiki/Poisoning "Poisoning") by a range of plants, fungi, metals, organic compounds, and a few animal toxins[\[48\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Cardinal_2011_diagnosis_psychosis-48)
- [Sleep disorders](https://en.wikipedia.org/wiki/Sleep_disorder "Sleep disorder"), such as in [narcolepsy](https://en.wikipedia.org/wiki/Narcolepsy "Narcolepsy") (in which [REM sleep](https://en.wikipedia.org/wiki/REM_sleep "REM sleep") intrudes into wakefulness)[\[48\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Cardinal_2011_diagnosis_psychosis-48)
- [Parasitic diseases](https://en.wikipedia.org/wiki/Parasitic_disease "Parasitic disease"), such as [neurocysticercosis](https://en.wikipedia.org/wiki/Neurocysticercosis "Neurocysticercosis")
Various [psychoactive substances](https://en.wikipedia.org/wiki/Psychoactive_substances "Psychoactive substances") (both legal and illegal) have been implicated in causing, exacerbating, or precipitating psychotic states or disorders in users, with varying levels of evidence.[\[81\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-81) This may be upon intoxication for a more prolonged period after use, or upon [withdrawal](https://en.wikipedia.org/wiki/Drug_withdrawal "Drug withdrawal").[\[48\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Cardinal_2011_diagnosis_psychosis-48) Individuals who experience substance-induced psychosis tend to have a greater awareness of their psychosis and tend to have higher levels of [suicidal thinking](https://en.wikipedia.org/wiki/Suicidal_thinking "Suicidal thinking") compared to those who have a primary psychotic illness.[\[82\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-pmid21728034-82) Drugs commonly alleged to induce psychotic symptoms include [alcohol](https://en.wikipedia.org/wiki/Alcohol_\(drug\) "Alcohol (drug)"), [cannabis](https://en.wikipedia.org/wiki/Cannabis_\(drug\) "Cannabis (drug)"), [cocaine](https://en.wikipedia.org/wiki/Cocaine "Cocaine"), [amphetamines](https://en.wikipedia.org/wiki/Amphetamine "Amphetamine"), [cathinones](https://en.wikipedia.org/wiki/Cathinone "Cathinone"), [psychedelic drugs](https://en.wikipedia.org/wiki/Psychedelic_drug "Psychedelic drug") (such as [LSD](https://en.wikipedia.org/wiki/LSD "LSD") and [psilocybin](https://en.wikipedia.org/wiki/Psilocybin "Psilocybin")), [κ-opioid receptor](https://en.wikipedia.org/wiki/%CE%9A-opioid_receptor "Κ-opioid receptor") [agonists](https://en.wikipedia.org/wiki/Agonist "Agonist") (such as [enadoline](https://en.wikipedia.org/wiki/Enadoline "Enadoline") and [salvinorin A](https://en.wikipedia.org/wiki/Salvinorin_A "Salvinorin A")) and [NMDA receptor antagonists](https://en.wikipedia.org/wiki/NMDA_receptor_antagonist "NMDA receptor antagonist") (such as [phencyclidine](https://en.wikipedia.org/wiki/Phencyclidine "Phencyclidine") and [ketamine](https://en.wikipedia.org/wiki/Ketamine "Ketamine")).[\[48\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Cardinal_2011_diagnosis_psychosis-48)[\[83\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-83) [Caffeine](https://en.wikipedia.org/wiki/Caffeine "Caffeine") may worsen symptoms in those with schizophrenia and cause psychosis at very high doses in people without the condition.[\[84\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-84)[\[85\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-85) Cannabis and other illicit recreational drugs are often associated with psychosis in adolescents and cannabis use before 15 years old may increase the risk of psychosis in adulthood.[\[46\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:3-46)
Approximately 3% of people with [alcoholism](https://en.wikipedia.org/wiki/Alcoholism "Alcoholism") experience psychosis during acute intoxication or withdrawal. Alcohol related psychosis may manifest itself through a [kindling mechanism](https://en.wikipedia.org/wiki/Kindling_\(sedative-hypnotic_withdrawal\) "Kindling (sedative-hypnotic withdrawal)"). The mechanism of alcohol-related psychosis is due to the [long-term effects of alcohol consumption](https://en.wikipedia.org/wiki/Long-term_effects_of_alcohol_consumption "Long-term effects of alcohol consumption") resulting in distortions to neuronal membranes, [gene expression](https://en.wikipedia.org/wiki/Gene_expression "Gene expression"), as well as [thiamine](https://en.wikipedia.org/wiki/Thiamine "Thiamine") deficiency. It is possible that hazardous alcohol use via a kindling mechanism can cause the development of a chronic substance-induced psychotic disorder, i.e. schizophrenia. The effects of an alcohol-related psychosis include an increased risk of depression and suicide as well as causing psychosocial impairments.[\[86\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-86) [Delirium tremens](https://en.wikipedia.org/wiki/Delirium_tremens "Delirium tremens"), a symptom of chronic alcoholism that can appear in the acute withdrawal phase, shares many symptoms with alcohol-related psychosis suggesting a common mechanism.[\[87\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-87)
According to current studies, cannabis use is associated with increased risk of psychotic disorders, and the more often cannabis is used the more likely a person is to develop a psychotic illness.[\[88\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:8-88) Furthermore, people with a history of cannabis use develop psychotic symptoms earlier than those who have never used cannabis.[\[88\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:8-88) Some debate exists regarding the causal relationship between cannabis use and psychosis with some studies suggesting that cannabis use hastens the onset of psychosis primarily in those with pre-existing vulnerability.[\[88\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:8-88)[\[89\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-89)[\[90\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-90) Indeed, cannabis use plays an important role in the development of psychosis in vulnerable individuals, and cannabis use in adolescence should be discouraged.[\[91\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-91) Some studies indicate that the effects of two active compounds in cannabis, [tetrahydrocannabinol](https://en.wikipedia.org/wiki/Tetrahydrocannabinol "Tetrahydrocannabinol") (THC) and [cannabidiol](https://en.wikipedia.org/wiki/Cannabidiol "Cannabidiol") (CBD), have opposite effects with respect to psychosis. While THC can induce psychotic symptoms in healthy individuals, limited evidence suggests that CBD may have antipsychotic effects.[\[92\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-92)
[Methamphetamine](https://en.wikipedia.org/wiki/Methamphetamine "Methamphetamine") induces a psychosis in 26%–46% of heavy users. Some of these people develop a long-lasting psychosis that can persist for longer than six months. Those who have had a short-lived psychosis from methamphetamine can have a relapse of the methamphetamine psychosis years later after a stressful event such as severe insomnia or a period of hazardous alcohol use despite not relapsing back to methamphetamine.[\[93\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-93) Individuals who have a long history of methamphetamine use and who have experienced psychosis in the past from methamphetamine use are highly likely to re-experience methamphetamine psychosis if drug use is recommenced. \[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\] Methamphetamine-induced psychosis is likely gated by genetic vulnerability, which can produce long-term changes in brain neurochemistry following repetitive use.[\[94\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-94) Methamphetamine users with more [ADHD](https://en.wikipedia.org/wiki/ADHD "ADHD")\-related behaviours in childhood experience methamphetamine-related psychosis more frequently.[\[95\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-95)
A 2024 meta-analysis found an incidence of psychedelic-induced psychosis at 0.002% in population studies, 0.2% in uncontrolled clinical trials, and 0.6% in randomised controlled trials.[\[96\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-96) This meta-analysis found that in uncontrolled clinical trials involving only patients with schizophrenia, 3.8% developed prolonged psychotic reactions. A 2024 study found that [psychedelic](https://en.wikipedia.org/wiki/Psychedelic "Psychedelic") use was not generally associated with a change in the number of psychotic symptoms.[\[97\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-97) This study found that psychedelic use interacted with a family history of bipolar disorder, such that in those with a family history of bipolar disorder, psychedelic use was associated with an increase in the number of psychotic symptoms, while in those with a personal history of psychosis but no family history of psychotic disorders, psychedelic use was associated with a decrease in the number of psychotic symptoms. A 2023 study found an interaction between lifetime psychedelic use and family history of psychosis or bipolar disorder on psychotic symptoms over the past two weeks. Psychotic symptoms were highest among those with both a family history of psychosis or bipolar disorder and life-time psychedelic use, while they were lowest among those with life-time psychedelic use but no family history of these disorders.[\[98\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-98)
Administration, or sometimes withdrawal, of a large number of medications may provoke psychotic symptoms.[\[48\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Cardinal_2011_diagnosis_psychosis-48) Drugs that can induce psychosis experimentally or in a significant proportion of people include:
- Stimulants, such as [amphetamine](https://en.wikipedia.org/wiki/Amphetamine "Amphetamine") and other [sympathomimetics](https://en.wikipedia.org/wiki/Sympathomimetics "Sympathomimetics")
- [Dopamine](https://en.wikipedia.org/wiki/Dopamine "Dopamine") agonists
- [Ketamine](https://en.wikipedia.org/wiki/Ketamine "Ketamine")
- [Corticosteroids](https://en.wikipedia.org/wiki/Corticosteroid "Corticosteroid") (often with mood changes in addition)
- Some anticonvulsants such as [vigabatrin](https://en.wikipedia.org/wiki/Vigabatrin "Vigabatrin")[\[99\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-99)[\[100\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-100)[\[101\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-101)
The first brain image of an individual with psychosis was completed as far back as 1935 using a technique called [pneumoencephalography](https://en.wikipedia.org/wiki/Pneumoencephalography "Pneumoencephalography")[\[102\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-102) (a painful and now obsolete procedure where [cerebrospinal fluid](https://en.wikipedia.org/wiki/Cerebrospinal_fluid "Cerebrospinal fluid") is drained from around the brain and replaced with air to allow the structure of the brain to show up more clearly on an [X-ray](https://en.wikipedia.org/wiki/X-ray "X-ray") picture).\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
Both [first episode psychosis](https://en.wikipedia.org/wiki/Antipsychotic#First_episode_psychosis "Antipsychotic"), and high risk status is associated with reductions in [grey matter](https://en.wikipedia.org/wiki/Grey_matter "Grey matter") volume (GMV). First episode psychotic and high risk populations are associated with similar but distinct abnormalities in GMV. Reductions in the right [middle temporal gyrus](https://en.wikipedia.org/wiki/Middle_temporal_gyrus "Middle temporal gyrus"), right [superior temporal gyrus](https://en.wikipedia.org/wiki/Superior_temporal_gyrus "Superior temporal gyrus") (STG), right [parahippocampus](https://en.wikipedia.org/wiki/Parahippocampus "Parahippocampus"), right [hippocampus](https://en.wikipedia.org/wiki/Hippocampus "Hippocampus"), right [middle frontal gyrus](https://en.wikipedia.org/wiki/Middle_frontal_gyrus "Middle frontal gyrus"), and left [anterior cingulate cortex](https://en.wikipedia.org/wiki/Anterior_cingulate_cortex "Anterior cingulate cortex") (ACC) are observed in high risk populations. Reductions in first episode psychosis span a region from the right STG to the right insula, left insula, and [cerebellum](https://en.wikipedia.org/wiki/Cerebellum "Cerebellum"), and are more severe in the right ACC, right STG, insula and cerebellum.[\[103\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-103)[\[104\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-104)
Another meta analysis reported bilateral reductions in insula, operculum, STG, medial frontal cortex, and ACC, but also reported increased GMV in the right [lingual gyrus](https://en.wikipedia.org/wiki/Lingual_gyrus "Lingual gyrus") and left [precentral gyrus](https://en.wikipedia.org/wiki/Precentral_gyrus "Precentral gyrus").[\[105\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Radua-105) The [Kraepelinian dichotomy](https://en.wikipedia.org/wiki/Kraepelinian_dichotomy "Kraepelinian dichotomy") is made questionable\[*[clarification needed](https://en.wikipedia.org/wiki/Wikipedia:Please_clarify "Wikipedia:Please clarify")*\] by grey matter abnormalities in bipolar and schizophrenia; schizophrenia is distinguishable from bipolar in that regions of grey matter reduction are generally larger in magnitude, although adjusting for gender differences reduces the difference to the left [dorsomedial prefrontal cortex](https://en.wikipedia.org/wiki/Dorsomedial_prefrontal_cortex "Dorsomedial prefrontal cortex") (dmPFC), and right [dorsolateral prefrontal cortex](https://en.wikipedia.org/wiki/Dorsolateral_prefrontal_cortex "Dorsolateral prefrontal cortex") (dlPFC).[\[106\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-106)
During attentional tasks, first episode psychosis is associated with hypoactivation in the right middle frontal gyrus, a region generally described as encompassing the dlPFC. Altered Behavioral Inhibition System functioning could possibly cause reduced sustained attention in psychosis and overall contribute to more negative reactions.[\[107\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-107) In congruence with studies on grey matter volume, hypoactivity in the right insula, and right inferior parietal lobe is also reported.[\[108\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-108) During cognitive tasks, hypoactivities in the right insula, dorsal anterior cingulate cortex, and the left [precuneus](https://en.wikipedia.org/wiki/Precuneus "Precuneus"), as well as reduced deactivations in the right [basal ganglia](https://en.wikipedia.org/wiki/Basal_ganglia "Basal ganglia"), right [thalamus](https://en.wikipedia.org/wiki/Thalamus "Thalamus"), right [inferior frontal gyrus](https://en.wikipedia.org/wiki/Inferior_frontal_gyrus "Inferior frontal gyrus") and left [precentral gyrus](https://en.wikipedia.org/wiki/Precentral_gyrus "Precentral gyrus") are observed. These results are highly consistent and replicable possibly except the abnormalities of the right inferior frontal gyrus.[\[109\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-109) Decreased grey matter volume in conjunction with bilateral hypoactivity is observed in anterior insula, dorsal medial frontal cortex, and dorsal anterior cingulate cortex. Decreased grey matter volume and bilateral hyperactivity is reported in posterior insula, ventral medial frontal cortex, and ventral anterior cingulate cortex.[\[110\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-110)
Studies during acute experiences of hallucinations demonstrate increased activity in primary or secondary sensory cortices. As auditory hallucinations are most common in psychosis, most robust evidence exists for increased activity in the left [middle temporal gyrus](https://en.wikipedia.org/wiki/Middle_temporal_gyrus "Middle temporal gyrus"), left [superior temporal gyrus](https://en.wikipedia.org/wiki/Superior_temporal_gyrus "Superior temporal gyrus"), and left [inferior frontal gyrus](https://en.wikipedia.org/wiki/Inferior_frontal_gyrus "Inferior frontal gyrus") (i.e. [Broca's area](https://en.wikipedia.org/wiki/Broca%27s_area "Broca's area")). Activity in the [ventral striatum](https://en.wikipedia.org/wiki/Ventral_striatum "Ventral striatum"), [hippocampus](https://en.wikipedia.org/wiki/Hippocampus "Hippocampus"),[\[111\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-111) and ACC are related to the lucidity of hallucinations, and indicate that activation or involvement of emotional circuitry are key to the impact of abnormal activity in sensory cortices. Together, these findings indicate abnormal processing of internally generated sensory experiences, coupled with abnormal emotional processing, results in hallucinations. One proposed model involves a failure of feedforward networks from sensory cortices to the inferior frontal cortex, which normally cancel out sensory cortex activity during internally generated speech. The resulting disruption in expected and perceived speech is thought to produce lucid hallucinatory experiences.[\[112\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-112)
The two-factor model of delusions posits that dysfunction in both belief formation systems and belief evaluation systems are necessary for delusions. Dysfunction in evaluations systems localized to the right lateral prefrontal cortex, regardless of delusion content, is supported by neuroimaging studies and is congruent with its role in conflict monitoring in healthy persons. Abnormal activation and reduced volume is seen in people with delusions, as well as in disorders associated with delusions such as [frontotemporal dementia](https://en.wikipedia.org/wiki/Frontotemporal_dementia "Frontotemporal dementia"), psychosis and [Lewy body dementia](https://en.wikipedia.org/wiki/Lewy_body_dementia "Lewy body dementia"). Furthermore, lesions to this region are associated with "jumping to conclusions", damage to this region is associated with post-stroke delusions, and hypometabolism this region associated with caudate strokes presenting with delusions.\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
The [aberrant salience model](https://en.wikipedia.org/wiki/Aberrant_salience "Aberrant salience") suggests that delusions are a result of people assigning excessive importance to irrelevant stimuli. In support of this hypothesis, regions normally associated with the [salience network](https://en.wikipedia.org/wiki/Salience_network "Salience network") demonstrate reduced grey matter in people with delusions, and the neurotransmitter [dopamine](https://en.wikipedia.org/wiki/Dopamine "Dopamine"), which is widely implicated in salience processing, is also widely implicated in psychotic disorders.\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
Specific regions have been associated with specific types of delusions. The volume of the hippocampus and parahippocampus is related to paranoid delusions in [Alzheimer's disease](https://en.wikipedia.org/wiki/Alzheimer%27s_disease "Alzheimer's disease"), and has been reported to be abnormal post mortem in one person with delusions. [Capgras delusions](https://en.wikipedia.org/wiki/Capgras_delusion "Capgras delusion") have been associated with occipito-temporal damage, and may be related to failure to elicit normal emotions or memories in response to faces.[\[113\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-113)
Psychosis is associated with the [ventral striatum](https://en.wikipedia.org/wiki/Ventral_striatum "Ventral striatum") (VS), which is the part of the brain that is involved with the desire to naturally satisfy the body's needs.[\[114\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:02-114) When high reports of [negative symptoms](https://en.wikipedia.org/wiki/Symptom#Negative_symptoms "Symptom") were recorded, there were significant irregularities in the left VS. Anhedonia, defined as the inability to feel joy or pleasure,[\[115\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-115) is a commonly reported symptom in psychosis; experiences with the condition are present in most people with schizophrenia.[\[116\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:12-116) Previous research has indicated that a deficiency in the [neural representation](https://en.wikipedia.org/wiki/Neural_representation "Neural representation") in regards to goals and the motivation to achieve them, has demonstrated that when a reward is not present, a strong reaction is noted in the ventral striatum; reinforcement learning is intact when contingencies about stimulus-reward are implicit, but not when they require explicit neural processing; reward prediction errors are what the actual reward is versus what the reward was predicted to be.[\[117\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:22-117) In most cases positive prediction errors are considered an abnormal occurrence. A positive prediction error response occurs when there is an increased activation in a brain region, typically the [striatum](https://en.wikipedia.org/wiki/Striatum "Striatum"), in response to unexpected rewards. A negative prediction error response occurs when there is a decreased activation in a region when predicted rewards do not occur. The [anterior cingulate cortex](https://en.wikipedia.org/wiki/Anterior_cingulate_cortex "Anterior cingulate cortex") (ACC) response, taken as an indicator of effort allocation, does not increase with reward or reward probability increase, and is associated with negative symptoms; deficits in dorsolateral prefrontal cortex (dlPFC) activity and failure to improve performance on cognitive tasks when offered monetary incentives are present; and dopamine mediated functions are abnormal.\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
Psychosis has been traditionally linked to the overactivity of the [neurotransmitter](https://en.wikipedia.org/wiki/Neurotransmitter "Neurotransmitter") [dopamine](https://en.wikipedia.org/wiki/Dopamine "Dopamine"), in particular to its effect in the [mesolimbic pathway](https://en.wikipedia.org/wiki/Mesolimbic_pathway "Mesolimbic pathway"), spanning from the [ventral tegmental area](https://en.wikipedia.org/wiki/Ventral_tegmental_area "Ventral tegmental area") to the ventral [striatum](https://en.wikipedia.org/wiki/Striatum "Striatum"). Additionally, recent evidence suggests a crucial involvement of the pathway spanning from the [substantia nigra](https://en.wikipedia.org/wiki/Substantia_nigra "Substantia nigra") to the dorsal [striatum](https://en.wikipedia.org/wiki/Striatum "Striatum").[\[118\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-118) The two major sources of evidence given to support this theory are that [dopamine receptor D2](https://en.wikipedia.org/wiki/Dopamine_receptor_D2 "Dopamine receptor D2") blocking drugs (i.e., [antipsychotics](https://en.wikipedia.org/wiki/Antipsychotic "Antipsychotic")) tend to reduce the intensity of psychotic symptoms, and that drugs that accentuate dopamine release, or inhibit its reuptake (such as [amphetamines](https://en.wikipedia.org/wiki/Amphetamine "Amphetamine") and [cocaine](https://en.wikipedia.org/wiki/Cocaine "Cocaine")) can trigger psychosis in some people (see [stimulant psychosis](https://en.wikipedia.org/wiki/Stimulant_psychosis "Stimulant psychosis")).[\[119\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Kapur-119) However, there is substantial evidence that dopaminergic overactivity does not fully explain psychosis, and that neurodegerative pathophysiology plays a significant role. This is evidenced by the fact that psychosis commonly occurs in neurodegenerative diseases of the dopaminergic nervous system, such as Parkinson's disease, which involved reduced, rather than increased, dopaminergic activity.[\[120\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-120)
The [endocannabinoid system](https://en.wikipedia.org/wiki/Endocannabinoid_system "Endocannabinoid system") is also implicated in psychosis. This is evidenced by the propensity of [CB1 receptor](https://en.wikipedia.org/wiki/Cannabinoid_receptor_1 "Cannabinoid receptor 1") agonists such as [THC](https://en.wikipedia.org/wiki/THC "THC") to induce psychotic symptoms,[\[121\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-121) and the efficacy of [CB1 receptor](https://en.wikipedia.org/wiki/Cannabinoid_receptor_1 "Cannabinoid receptor 1") antagonists such as [CBD](https://en.wikipedia.org/wiki/Cannabidiol "Cannabidiol") in ameliorating psychosis.[\[122\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-122)
NMDA receptor dysfunction has been proposed as a mechanism in psychosis.[\[123\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-123) This theory is reinforced by the fact that [dissociative](https://en.wikipedia.org/wiki/Dissociative "Dissociative") [NMDA receptor antagonists](https://en.wikipedia.org/wiki/NMDA_receptor_antagonist "NMDA receptor antagonist") such as [ketamine](https://en.wikipedia.org/wiki/Ketamine "Ketamine"), [PCP](https://en.wikipedia.org/wiki/Phencyclidine "Phencyclidine") and [dextromethorphan](https://en.wikipedia.org/wiki/Dextromethorphan "Dextromethorphan") (at large overdoses) induce a psychotic state. The symptoms of dissociative [intoxication](https://en.wikipedia.org/wiki/Substance_intoxication "Substance intoxication") are also considered to mirror the symptoms of schizophrenia, including [negative symptoms](https://en.wikipedia.org/wiki/Schizophrenia#Negative_symptoms "Schizophrenia").[\[124\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-124) NMDA receptor antagonism, in addition to producing symptoms reminiscent of psychosis, mimics the neurophysiological aspects, such as reduction in the amplitude of [P50](https://en.wikipedia.org/wiki/P50_\(neuroscience\) "P50 (neuroscience)"), [P300](https://en.wikipedia.org/wiki/P300_\(neuroscience\) "P300 (neuroscience)"), and [MMN](https://en.wikipedia.org/wiki/Mismatch_negativity "Mismatch negativity") [evoked potentials](https://en.wikipedia.org/wiki/Evoked_potential "Evoked potential").[\[125\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-125) Hierarchical Bayesian neurocomputational models of sensory feedback, in agreement with neuroimaging literature, link NMDA receptor hypofunction to delusional or hallucinatory symptoms via proposing a failure of NMDA mediated top down predictions to adequately cancel out enhanced bottom up AMPA mediated predictions errors.[\[126\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-126) Excessive prediction errors in response to stimuli that would normally not produce such a response is thought to root from conferring excessive salience to otherwise mundane events.[\[127\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-127) Dysfunction higher up in the hierarchy, where representation is more abstract, could result in delusions.[\[128\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-128) The common finding of reduced [GAD67](https://en.wikipedia.org/wiki/GAD67 "GAD67") expression in psychotic disorders may explain enhanced AMPA mediated signaling, caused by reduced GABAergic inhibition.[\[129\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-129)[\[130\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-130)
The connection between dopamine and psychosis is generally believed to be complex. While dopamine receptor D2 suppresses [adenylate cyclase](https://en.wikipedia.org/wiki/Adenylate_cyclase "Adenylate cyclase") activity, the [D1](https://en.wikipedia.org/wiki/Dopamine_receptor_D1 "Dopamine receptor D1") receptor increases it. If D2\-blocking drugs are administered, the blocked dopamine spills over to the D1 receptors. The increased adenylate cyclase activity affects [genetic expression](https://en.wikipedia.org/wiki/Genetic_expression "Genetic expression") in the nerve cell, which takes time. Hence antipsychotic drugs take a week or two to reduce the symptoms of psychosis. Moreover, newer and equally effective antipsychotic drugs actually block slightly less dopamine in the brain than older drugs whilst also blocking 5-HT2A receptors, suggesting the 'dopamine hypothesis' may be oversimplified.[\[131\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-131) Soyka and colleagues found no evidence of dopaminergic dysfunction in people with alcohol-induced psychosis[\[132\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-132) and Zoldan et al. reported moderately successful use of [ondansetron](https://en.wikipedia.org/wiki/Ondansetron "Ondansetron"), a 5-HT3 receptor antagonist, in the treatment of [levodopa](https://en.wikipedia.org/wiki/Levodopa "Levodopa") psychosis in [Parkinson's disease](https://en.wikipedia.org/wiki/Parkinson%27s_disease "Parkinson's disease") patients.[\[133\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Zoldan_et_al_1995-133)
A review found an association between a first-episode of psychosis and prediabetes.[\[134\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-134)
Prolonged or high dose use of [psychostimulants](https://en.wikipedia.org/wiki/Psychostimulants "Psychostimulants") can alter normal functioning, making it similar to the manic phase of bipolar disorder.[\[135\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-135) NMDA antagonists replicate some of the so-called "negative" symptoms like [thought disorder](https://en.wikipedia.org/wiki/Thought_disorder "Thought disorder") in subanesthetic doses (doses insufficient to induce [anesthesia](https://en.wikipedia.org/wiki/Anesthesia "Anesthesia")), and [catatonia](https://en.wikipedia.org/wiki/Catatonia "Catatonia") in high doses. Psychostimulants, especially in one already prone to psychotic thinking, can cause some "positive" symptoms, such as delusional beliefs, particularly those persecutory in nature.\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
Cross-cultural studies into schizophrenia have found that individual experiences of psychosis and 'hearing voices' vary across cultures.[\[136\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:5-136)[\[137\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-137) In countries such as the [United States](https://en.wikipedia.org/wiki/United_States "United States") where there exists a predominantly biomedical understanding of the body, the mind and in turn, mental health, subjects were found to report their hallucinations as having 'violent content' and self-describing as 'crazy'.[\[136\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:5-136) This experience is at odds with the experiences of subjects in [Accra, Ghana](https://en.wikipedia.org/wiki/Accra,_Ghana "Accra, Ghana"), who describe the voices they hear as having 'spiritual meaning' and are often reported as positive in nature; or subjects in [Chennai, India](https://en.wikipedia.org/wiki/Chennai,_India "Chennai, India"), who describe their hallucinations as kin, family members or close friends, and offering guidance.[\[136\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:5-136)
These differences are attributed to 'social kindling' or how one's social context shapes the way they interpret and experience sensations such as hallucinations. This concept aligns with preexisting cognitive theory such as reality modelling and is supported by recent research that demonstrates that individuals with psychosis can be taught to attend to their hallucinations differently, which in turn alters the hallucinations themselves.[\[138\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-138) Such research creates pathways for social or community-based treatment, such as reality monitoring, for individuals with schizophrenia and other psychotic disorders, providing alternatives to, or supplementing traditional pharmacologic management.\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
Cross-cultural studies explore the way in which psychosis varies in different cultures, countries and religions. The cultural differences are based on the individual or shared illness narratives surrounding cultural meanings of illness experience.[\[139\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Jenkins_J_2018-139) In countries such as [India](https://en.wikipedia.org/wiki/India "India"), [Cambodia](https://en.wikipedia.org/wiki/Cambodia "Cambodia") and [Muslim](https://en.wikipedia.org/wiki/Muslim "Muslim") majority countries, they each share alternative epistemologies. These are known as knowledge systems that focus on the connections between mind, body, culture, nature and society.[\[140\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-140) Cultural perceptions of mental disorders such as psychosis or schizophrenia are believed to be caused by [jinn](https://en.wikipedia.org/wiki/Jinn "Jinn") (spirits) in Muslim majority countries.[\[141\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-doi.org-141) Furthermore, those in [Arab](https://en.wikipedia.org/wiki/Arab "Arab")\-Muslim societies perceive those who act differently than the social norm as "crazy" or as abnormal behaviour.[\[141\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-doi.org-141) This differs from the experiences of individuals in India and how they attain their perspectives on mental health issues through a variety of spiritual and healing traditions.[\[142\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-142) In Cambodia, hallucinations are linked with spirit visitation, a term they call "cultural kindling".[\[143\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-143) These examples of differences are attributed to culture and the way it shapes conceptions of mental disorders.[\[141\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-doi.org-141) These cultural differences can be useful in bridging the gap of cultural understanding and psychiatric signs and symptoms.[\[139\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Jenkins_J_2018-139)
To make a diagnosis of a mental illness in someone with psychosis [other potential causes must be excluded](https://en.wikipedia.org/wiki/Diagnosis_of_exclusion "Diagnosis of exclusion").[\[144\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Ol2012-144) An initial assessment includes a comprehensive history and physical examination by a health care provider. Tests may be done to exclude substance use, medication, toxins, surgical complications, or other medical illnesses.
[Delirium](https://en.wikipedia.org/wiki/Delirium "Delirium") should be ruled out, which can be distinguished by visual hallucinations, acute onset and fluctuating level of consciousness, indicating other underlying factors, including medical illnesses.[\[145\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Med_News-145) Excluding medical illnesses associated with psychosis is performed by using blood tests to measure:
- [Thyroid-stimulating hormone](https://en.wikipedia.org/wiki/Thyroid-stimulating_hormone "Thyroid-stimulating hormone") to exclude [hypo-](https://en.wikipedia.org/wiki/Hypothyroidism "Hypothyroidism") or [hyperthyroidism](https://en.wikipedia.org/wiki/Hyperthyroidism "Hyperthyroidism")
- [Vitamin B12](https://en.wikipedia.org/wiki/Vitamin_B12 "Vitamin B12") serum and urinary [MMA](https://en.wikipedia.org/wiki/Methylmalonic_acid "Methylmalonic acid") to role out [pernicious anemia](https://en.wikipedia.org/wiki/Pernicious_anemia "Pernicious anemia") or [vitamin B12 deficiency](https://en.wikipedia.org/wiki/Vitamin_B12_deficiency "Vitamin B12 deficiency")
- [Basic electrolytes](https://en.wikipedia.org/wiki/Blood_tests#Blood_chemistry_tests "Blood tests") and [serum calcium](https://en.wikipedia.org/wiki/Serum_calcium "Serum calcium") to rule out a metabolic disturbance
- [Full blood count](https://en.wikipedia.org/wiki/Full_blood_count "Full blood count") including [ESR](https://en.wikipedia.org/wiki/Erythrocyte_sedimentation_rate "Erythrocyte sedimentation rate") to rule out a systemic infection or chronic disease
- [Serology](https://en.wikipedia.org/wiki/Serology "Serology") to exclude [syphilis](https://en.wikipedia.org/wiki/Syphilis "Syphilis") or [HIV](https://en.wikipedia.org/wiki/HIV "HIV") infection.
Other investigations include:
- [EEG](https://en.wikipedia.org/wiki/EEG "EEG") to exclude [epilepsy](https://en.wikipedia.org/wiki/Epilepsy "Epilepsy")
- [MRI](https://en.wikipedia.org/wiki/MRI "MRI") or [CT scan](https://en.wikipedia.org/wiki/CT_scan "CT scan") of the head to exclude brain lesions
Because psychosis may be precipitated or exacerbated by common classes of medications, medication-induced psychosis should be [ruled out](https://en.wikipedia.org/wiki/Diagnosis_of_exclusion "Diagnosis of exclusion"), particularly for first-episode psychosis. Both substance- and medication-induced psychosis can be [excluded](https://en.wikipedia.org/wiki/Diagnosis_of_exclusion "Diagnosis of exclusion") to a high level of certainty, using toxicology screening.\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
Because some [dietary supplements](https://en.wikipedia.org/wiki/Dietary_supplement "Dietary supplement") may also induce psychosis or mania, but cannot be ruled out with laboratory tests, a psychotic individual's family, partner, or friends should be asked whether the patient is currently taking any dietary supplements.[\[146\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-146)
Common mistakes made when diagnosing people who are psychotic include:[\[144\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Ol2012-144)
- Not properly excluding [delirium](https://en.wikipedia.org/wiki/Delirium "Delirium")
- Not appreciating medical abnormalities (e.g., [vital signs](https://en.wikipedia.org/wiki/Vital_signs "Vital signs"))
- Not obtaining a medical history and family history
- Indiscriminate screening without an organizing framework
- Missing a toxic psychosis by not screening for substances *and* medications
- Not asking their families or others about dietary supplements
- Premature diagnostic closure
- Not revisiting or questioning the initial diagnostic impression of primary psychiatric disorder
Only after relevant and known causes of psychosis are excluded, a mental health clinician may make a psychiatric [differential diagnosis](https://en.wikipedia.org/wiki/Differential_diagnosis "Differential diagnosis") using a person's family history, incorporating information from the person with psychosis, and information from family, friends or romantic partners.\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
Types of psychosis in psychiatric disorders may be established by formal rating scales. The [Brief Psychiatric Rating Scale](https://en.wikipedia.org/wiki/Brief_Psychiatric_Rating_Scale "Brief Psychiatric Rating Scale") (BPRS)[\[147\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-147) assesses the level of 18 symptom constructs of psychosis such as [hostility](https://en.wikipedia.org/wiki/Hostility "Hostility"), [suspicion](https://en.wikipedia.org/wiki/Suspicion_\(emotion\) "Suspicion (emotion)"), [hallucination](https://en.wikipedia.org/wiki/Hallucination "Hallucination"), and [grandiosity](https://en.wikipedia.org/wiki/Grandiosity "Grandiosity"). It is based on the clinician's interview with the patient and observations of the patient's behavior over the previous 2–3 days. The patient's family can also answer questions on the behavior report. During the initial assessment and the follow-up, both positive and negative symptoms of psychosis can be assessed using the 30 item [Positive and Negative Syndrome Scale](https://en.wikipedia.org/wiki/Positive_and_Negative_Syndrome_Scale "Positive and Negative Syndrome Scale") (PANSS).[\[148\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-148)
The [DSM-5](https://en.wikipedia.org/wiki/DSM-5 "DSM-5") characterizes disorders as psychotic or on the schizophrenia spectrum if they involve hallucinations, delusions, disorganized thinking, grossly disorganized motor behavior, or negative symptoms.[\[22\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-DSM-22) The DSM-5 does not include psychosis as a definition in the glossary, although it defines "psychotic features", as well as "psychoticism" with respect to personality disorder. The [ICD-10](https://en.wikipedia.org/wiki/ICD-10 "ICD-10") has no specific definition of psychosis.[\[149\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Gaebel-149)
The Psychosis Screening Questionnaire (PSQ) is the most common tool in detecting psychotic symptoms and it includes five root questions that assess the presence of PLE (mania, thought insertion, paranoia, strange experiences and perceptual disturbances)[\[150\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-150) The different tools used to assess symptom severity include the Revised Behavior and Symptom Identification Scale (BASIS-R), a 24-item self-report instrument with six scales: psychosis, depression/functioning, interpersonal problems, alcohol/drug use, self-harm, and emotional lability. The Symptom Checklist-90-Revised (SCL-90-R), a 90-item self assessment tool that measures psychoticism and paranoid ideation in addition to seven other symptom scales. Finally, the Brief Symptom Inventory (BSI), a 53-item self-administered scale developed from the SCL-90-R. The BSI has good psychometric properties and is an acceptable brief alternative to the SCL-90-R.[\[151\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-151) These seem to be the most accurate tools at the moment,\[*[when?](https://en.wikipedia.org/wiki/Wikipedia:Manual_of_Style/Dates_and_numbers#Chronological_items "Wikipedia:Manual of Style/Dates and numbers")*\] but a research in 2007 that focused on quantifying self-reports of auditory verbal hallucinations (AVH) in persons with psychosis, suggest that The Hamilton Program for Schizophrenia Voices Questionnaire (HPSVQ) is also potentially a reliable and useful measure for specifically quantifying AVHs in relation to psychosis.[\[152\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-152)
[Factor analysis](https://en.wikipedia.org/wiki/Factor_analysis "Factor analysis") of symptoms generally regarded as psychosis frequently yields a five factor solution, albeit five factors that are distinct from the five domains defined by the DSM-5 to encompass [psychotic](https://en.wikipedia.org/wiki/Psychotic "Psychotic") or schizophrenia spectrum disorders. The five factors are frequently labeled as hallucinations, delusions, disorganization, excitement, and emotional distress.[\[149\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Gaebel-149) The DSM-5 emphasizes a [psychotic spectrum](https://en.wikipedia.org/wiki/Psychotic_spectrum "Psychotic spectrum"), wherein the low end is characterized by schizoid personality disorder, and the high end is characterized by schizophrenia.[\[3\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Continuum-3)
Gouzoulis-Mayfrank et al. said that the pleasant or emotionally positive experiences that are common in psychosis, particularly in the early stages, are more easily overlooked in clinical practice than the negative experiences.[\[153\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-ReferenceA-153) Nev Jones and Mona Shattel wrote that there is less curiosity towards the complications, or towards the richness of the good things as well as the bad things.[\[153\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-ReferenceA-153)
The evidence for the effectiveness of early interventions to [prevent](https://en.wikipedia.org/wiki/Mental_disorder#Prevention "Mental disorder") psychosis appeared inconclusive.[\[154\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-154) But psychosis caused by drugs can be prevented.[\[155\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-155) Whilst early intervention in those with a psychotic episode might improve short-term outcomes, little benefit was seen from these measures after five years.[\[156\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Lancet09-156) However, there is evidence that [cognitive behavioral therapy](https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy "Cognitive behavioral therapy") (CBT) may reduce the risk of becoming psychotic in those at high risk,[\[157\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-157) and in 2014 the U.K. [National Institute for Health and Care Excellence](https://en.wikipedia.org/wiki/National_Institute_for_Health_and_Care_Excellence "National Institute for Health and Care Excellence") (NICE) recommended preventive CBT for people at risk of psychosis.[\[158\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-158)[\[159\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-159)
The treatment of psychosis depends on the specific diagnosis (such as schizophrenia, bipolar disorder or substance intoxication). The first-line treatment for many psychotic disorders is antipsychotic medication, [\[160\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-fn_72-160) which can reduce the positive symptoms of psychosis in about 7 to 14 days. For youth or adolescents, treatment options include medications, psychological interventions, and social interventions.[\[46\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:3-46)
The choice of which [antipsychotic](https://en.wikipedia.org/wiki/Antipsychotic "Antipsychotic") to use is based on benefits, risks, and costs.[\[156\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Lancet09-156) It is debatable whether, as a class, [typical](https://en.wikipedia.org/wiki/Typical_antipsychotic "Typical antipsychotic") or [atypical antipsychotics](https://en.wikipedia.org/wiki/Atypical_antipsychotic "Atypical antipsychotic") are better.[\[161\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-161)[\[162\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-162) Tentative evidence supports that [amisulpride](https://en.wikipedia.org/wiki/Amisulpride "Amisulpride"), [olanzapine](https://en.wikipedia.org/wiki/Olanzapine "Olanzapine"), [risperidone](https://en.wikipedia.org/wiki/Risperidone "Risperidone") and [clozapine](https://en.wikipedia.org/wiki/Clozapine "Clozapine") may be more effective for positive symptoms but result in more side effects.[\[163\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-barry_2012-163) Typical antipsychotics have equal drop-out and symptom relapse rates to atypicals when used at low to moderate dosages.[\[164\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-AFP07-164) There is a good response in 40–50%, a partial response in 30–40%, and treatment resistance (failure of symptoms to respond satisfactorily after six weeks to two or three different antipsychotics) in 20% of people.[\[165\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-AFP10-165) Clozapine is an effective treatment for those who respond poorly to other drugs ("treatment-resistant" or "refractory" schizophrenia),[\[166\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-166) but it has the potentially serious side effect of [agranulocytosis](https://en.wikipedia.org/wiki/Agranulocytosis "Agranulocytosis") (lowered [white blood cell](https://en.wikipedia.org/wiki/White_blood_cell "White blood cell") count) in less than 4% of people.[\[156\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Lancet09-156)[\[167\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-BMJ07-167)[\[168\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-168)
Most people on antipsychotics get side effects. People on typical antipsychotics tend to have a higher rate of [extrapyramidal side effects](https://en.wikipedia.org/wiki/Extrapyramidal_side_effects "Extrapyramidal side effects") while some atypicals are associated with considerable weight gain, diabetes and risk of [metabolic syndrome](https://en.wikipedia.org/wiki/Metabolic_syndrome "Metabolic syndrome"); this is most pronounced with olanzapine, while risperidone and [quetiapine](https://en.wikipedia.org/wiki/Quetiapine "Quetiapine") are also associated with weight gain.[\[163\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-barry_2012-163) Risperidone has a similar rate of extrapyramidal symptoms to haloperidol.[\[163\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-barry_2012-163)
Psychological treatments such as [acceptance and commitment therapy](https://en.wikipedia.org/wiki/Acceptance_and_commitment_therapy "Acceptance and commitment therapy") (ACT) are possibly useful in the treatment of psychosis, helping people to focus more on what they can do in terms of valued life directions despite challenging symptomology.[\[169\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-169) [Metacognitive training](https://en.wikipedia.org/wiki/Metacognitive_training "Metacognitive training") (MCT) is associated with reduced [delusions](https://en.wikipedia.org/wiki/Delusion "Delusion"), [hallucinations](https://en.wikipedia.org/wiki/Hallucination "Hallucination") and [negative symptoms](https://en.wikipedia.org/wiki/Negative_symptoms "Negative symptoms") as well as improved [self-esteem](https://en.wikipedia.org/wiki/Self-esteem "Self-esteem") and functioning in individuals with schizophrenia spectrum disorders.[\[170\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-170)
There are many psychosocial interventions that seek to treat the symptoms of psychosis: [need adapted treatment](https://en.wikipedia.org/w/index.php?title=Need_adapted_treatment&action=edit&redlink=1 "Need adapted treatment (page does not exist)"), [Open Dialogue](https://en.wikipedia.org/wiki/Open_Dialogue "Open Dialogue"), psychoanalysis/psychodynamic psychotherapy, [major role therapy](https://en.wikipedia.org/w/index.php?title=Major_role_therapy&action=edit&redlink=1 "Major role therapy (page does not exist)"), [soteria](https://en.wikipedia.org/wiki/Soteria_\(psychiatric_treatment\) "Soteria (psychiatric treatment)"), psychosocial outpatient and inpatient treatment, [milieu therapy](https://en.wikipedia.org/wiki/Milieu_therapy "Milieu therapy"), and [cognitive behavioral therapy](https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy "Cognitive behavioral therapy") (CBT). In relation to the success of CBT for psychosis, a randomized controlled trial for a web-based Cognitive Behavioral Therapy for Psychosis (CBT-P) skills program named Coping With Voices (CWV) suggest that the program has promise for increasing access to CBT-P It also associated benefits in the management of distressing psychotic symptoms and improved social functioning. When CBT and the other psychosocial interventions[\[171\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-171) these are used without antipsychotic medications, they may be somewhat effective for some people, especially for CBT, need-adapted treatment, and soteria.[\[172\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Schizophrenia_Research_2019_p.-172)
[Early intervention in psychosis](https://en.wikipedia.org/wiki/Early_intervention_in_psychosis "Early intervention in psychosis") is based on the observation that identifying and treating someone in the early stages of a psychosis can improve his or her longer-term outcome.[\[173\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-173) This approach advocates the use of an intensive multi-disciplinary approach during what is known as the [critical period](https://en.wikipedia.org/wiki/Critical_period "Critical period"), where intervention is the most effective, and prevents the long-term morbidity associated with chronic psychotic illness.\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
The word *psychosis* was introduced to the psychiatric literature in 1841 by [Karl Friedrich Canstatt](https://en.wikipedia.org/wiki/Karl_Friedrich_Canstatt "Karl Friedrich Canstatt") in his work *Handbuch der Medizinischen Klinik*. He used it as a shorthand for 'psychic neurosis'. At that time neurosis meant any disease of the [nervous system](https://en.wikipedia.org/wiki/Nervous_system "Nervous system"), and Canstatt was thus referring to what was considered a psychological manifestation of brain disease.[\[174\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Burgy-174) [Ernst von Feuchtersleben](https://en.wikipedia.org/wiki/Ernst_von_Feuchtersleben "Ernst von Feuchtersleben") is also widely credited as introducing the term in 1845,[\[175\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-175) as an alternative to [insanity](https://en.wikipedia.org/wiki/Insanity "Insanity") and [mania](https://en.wikipedia.org/wiki/Mania "Mania").\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
The term stems from [Modern Latin](https://en.wikipedia.org/wiki/Modern_Latin "Modern Latin") *psychosis*, "a giving soul or life to, animating, quickening" and that from [Ancient Greek](https://en.wikipedia.org/wiki/Ancient_Greek "Ancient Greek") ψυχή (*psyche*), "soul" and the suffix -ωσις (-**osis**), in this case "abnormal condition".[\[176\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-176)[\[177\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-177)
In its adjective form "psychotic", references to psychosis can be found in both clinical and non-clinical discussions. However, in a *non*\-clinical context, "psychotic" is a nonspecific colloquialism used to mean "insane".\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
The word was also used to distinguish a condition considered a disorder of the mind, as opposed to *[neurosis](https://en.wikipedia.org/wiki/Neurosis "Neurosis")*, which was considered a disorder of the nervous system.[\[178\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-178) The psychoses thus became the modern equivalent of the old notion of [madness](https://en.wikipedia.org/wiki/Insanity "Insanity"), and hence there was much debate on whether there was only one ([unitary](https://en.wikipedia.org/wiki/Unitary_psychosis "Unitary psychosis")) or many forms of the new disease.[\[179\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-179) One type of broad usage would later be narrowed down by [Koch](https://en.wikipedia.org/wiki/Julius_Ludwig_August_Koch "Julius Ludwig August Koch") in 1891 to the 'psychopathic inferiorities'—later renamed abnormal personalities by [Schneider](https://en.wikipedia.org/wiki/Kurt_Schneider "Kurt Schneider").[\[174\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Burgy-174)
The division of the major psychoses into manic depressive illness (now called [bipolar disorder](https://en.wikipedia.org/wiki/Bipolar_disorder "Bipolar disorder")) and dementia praecox (now called [schizophrenia](https://en.wikipedia.org/wiki/Schizophrenia "Schizophrenia")) was made by [Emil Kraepelin](https://en.wikipedia.org/wiki/Emil_Kraepelin "Emil Kraepelin"), who attempted to create a synthesis of the various mental disorders identified by 19th-century [psychiatrists](https://en.wikipedia.org/wiki/Psychiatry "Psychiatry"), by grouping diseases together based on classification of common symptoms. Kraepelin used the term 'manic depressive insanity' to describe the whole spectrum of [mood disorders](https://en.wikipedia.org/wiki/Mood_disorder "Mood disorder"), in a far wider sense than it is usually used today.\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
In Kraepelin's classification this would include 'unipolar' [clinical depression](https://en.wikipedia.org/wiki/Clinical_depression "Clinical depression"), as well as bipolar disorder and other mood disorders such as [cyclothymia](https://en.wikipedia.org/wiki/Cyclothymia "Cyclothymia"). These are characterised by problems with mood control and the psychotic episodes appear associated with disturbances in mood, and patients often have periods of normal functioning between psychotic episodes even without medication. [Schizophrenia](https://en.wikipedia.org/wiki/Schizophrenia "Schizophrenia") is characterized by psychotic episodes that appear unrelated to disturbances in mood, and most non-medicated patients show signs of disturbance between psychotic episodes.\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
Written record of supernatural causes and resultant treatments can be traced back to the [New Testament](https://en.wikipedia.org/wiki/New_Testament "New Testament"). [Mark 5](https://en.wikipedia.org/wiki/Mark_5 "Mark 5"):8–13 describes a man displaying what would today be described as psychotic symptoms. [Christ](https://en.wikipedia.org/wiki/Christ "Christ") cured this "[demonic](https://en.wikipedia.org/wiki/Demon "Demon") madness" by casting out the demons and hurling them into a herd of swine. Exorcism is still utilized in some religious circles as a treatment for psychosis presumed to be demonic possession.[\[180\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-180) A research study of out-patients in psychiatric clinics found that 30% of religious patients attributed the cause of their psychotic symptoms to evil spirits. Many of these patients underwent exorcistic healing rituals that, though largely regarded as positive experiences by the patients, had no effect on symptomology. Results did however show a significant worsening of psychotic symptoms associated with exclusion of medical treatment for coercive forms of exorcism.[\[181\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-181)
[](https://en.wikipedia.org/wiki/File:Hippocrates.jpg)
Bust of Hippocrates
The medical teachings of the fourth-century philosopher and physician [Hippocrates of Cos](https://en.wikipedia.org/wiki/Hippocrates_of_Cos "Hippocrates of Cos") proposed a natural, rather than supernatural, cause of human illness. In Hippocrates' work, the [Hippocratic corpus](https://en.wikipedia.org/wiki/Hippocratic_corpus "Hippocratic corpus"), a holistic explanation for health and disease was developed to include madness and other "diseases of the mind". Hippocrates writes:
> Men ought to know that from the brain, and from the brain only, arise our pleasures, joys, laughter, and jests, as well as our sorrows, pains, griefs and tears. Through it, in particular, we think, see, hear, and distinguish the ugly from the beautiful, the bad from the good, the pleasant from the unpleasant.... It is the same thing which makes us mad or delirious, inspires us with dread and fear, whether by night or by day, brings sleeplessness, inopportune mistakes, aimless anxieties, absentmindedness, and acts that are contrary to habit.[\[182\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-182)
Hippocrates espoused a theory of [humoralism](https://en.wikipedia.org/wiki/Humoralism "Humoralism") wherein disease is resultant of a shifting balance in bodily fluids including [blood](https://en.wikipedia.org/wiki/Blood "Blood"), [phlegm](https://en.wikipedia.org/wiki/Phlegm "Phlegm"), [black bile](https://en.wikipedia.org/wiki/Black_bile "Black bile"), and [yellow bile](https://en.wikipedia.org/wiki/Yellow_bile "Yellow bile").[\[183\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-183) According to humoralism, each fluid or "[humour](https://en.wikipedia.org/wiki/Humour "Humour")" has temperamental or behavioral correlates. In the case of psychosis, symptoms are thought to be caused by an excess of both blood and yellow bile. Thus, the proposed surgical intervention for psychotic or manic behavior was [bloodletting](https://en.wikipedia.org/wiki/Bloodletting "Bloodletting").[\[184\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-184)
18th-century physician, educator, and widely considered "founder of American psychiatry", [Benjamin Rush](https://en.wikipedia.org/wiki/Benjamin_Rush "Benjamin Rush"), also prescribed bloodletting as a first-line treatment for psychosis. Although not a proponent of humoralism, Rush believed that active purging and bloodletting were efficacious corrections for disruptions in the circulatory system, a complication he believed was the primary cause of "insanity".[\[185\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-185) Although Rush's treatment modalities are now considered antiquated and brutish, his contributions to psychiatry, namely the biological underpinnings of psychiatric phenomenon including psychosis, have been invaluable to the field. In honor of such contributions, Benjamin Rush's image is in the official seal of the [American Psychiatric Association](https://en.wikipedia.org/wiki/American_Psychiatric_Association "American Psychiatric Association").\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
Early 20th-century treatments for severe and persisting psychosis were characterized by an emphasis on shocking the nervous system. Such therapies include [insulin shock therapy](https://en.wikipedia.org/wiki/Insulin_shock_therapy "Insulin shock therapy"), [cardiazol](https://en.wikipedia.org/wiki/Cardiazol "Cardiazol") shock therapy, and [electroconvulsive therapy](https://en.wikipedia.org/wiki/Electroconvulsive_therapy "Electroconvulsive therapy").[\[186\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-186) Despite considerable risk, shock therapy was considered highly efficacious in the treatment of psychosis including [schizophrenia](https://en.wikipedia.org/wiki/Schizophrenia "Schizophrenia"). The acceptance of high-risk treatments led to more invasive medical interventions including [psychosurgery](https://en.wikipedia.org/wiki/Psychosurgery "Psychosurgery").[\[187\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-187)
[](https://en.wikipedia.org/wiki/File:Gottlieb_Burckhardt_\(1836-1907\).jpg)
Gottlieb Burckhardt (1836–1907)
In 1888, Swiss psychiatrist [Gottlieb Burckhardt](https://en.wikipedia.org/wiki/Gottlieb_Burckhardt "Gottlieb Burckhardt") performed the first medically sanctioned psychosurgery in which the [cerebral cortex](https://en.wikipedia.org/wiki/Cerebral_cortex "Cerebral cortex") was excised. Although some patients showed improvement of symptoms and became more subdued, one patient died and several developed [aphasia](https://en.wikipedia.org/wiki/Aphasia "Aphasia") or seizure disorders. Burckhardt would go on to publish his clinical outcomes in a scholarly paper. This procedure was met with criticism from the medical community and his academic and surgical endeavors were largely ignored.[\[188\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-188) In the late 1930s, [Egas Moniz](https://en.wikipedia.org/wiki/Egas_Moniz "Egas Moniz") conceived the [leucotomy](https://en.wikipedia.org/wiki/Leucotomy "Leucotomy") (AKA [prefrontal lobotomy](https://en.wikipedia.org/wiki/Prefrontal_lobotomy "Prefrontal lobotomy")) in which the fibers connecting the [frontal lobes](https://en.wikipedia.org/wiki/Frontal_lobe "Frontal lobe") to the rest of the brain were severed. Moniz's primary inspiration stemmed from a demonstration by neuroscientists John Fulton and Carlyle's 1935 experiment in which two chimpanzees were given leucotomies and pre- and post-surgical behavior was compared. Prior to the leucotomy, the chimps engaged in typical behavior including throwing feces and fighting. After the procedure, both chimps were pacified and less violent. During the Q\&A, Moniz asked if such a procedure could be extended to human subjects, a question that Fulton admitted was quite startling.[\[189\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Pressman1998-189) Moniz would go on to extend the controversial practice to humans with various psychotic disorders, an endeavor for which he received a [Nobel Prize](https://en.wikipedia.org/wiki/Nobel_Prize "Nobel Prize") in 1949.[\[190\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-190) Between the late 1930s and early 1970s, the leucotomy was a widely accepted practice, often performed in non-[sterile](https://en.wikipedia.org/wiki/Sterilization_\(microbiology\) "Sterilization (microbiology)") environments such as small [outpatient](https://en.wikipedia.org/wiki/Outpatient "Outpatient") clinics and patient homes.[\[189\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Pressman1998-189) Psychosurgery remained standard practice until the discovery of antipsychotic pharmacology in the 1950s.[\[191\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-191)
The first clinical trial of [antipsychotics](https://en.wikipedia.org/wiki/Antipsychotic "Antipsychotic") (also commonly known as neuroleptics) for the treatment of psychosis took place in 1952. [Chlorpromazine](https://en.wikipedia.org/wiki/Chlorpromazine "Chlorpromazine") (brand name: Thorazine) passed clinical trials and became the first antipsychotic medication approved for the treatment of both acute and chronic psychosis. Although the mechanism of action was not discovered until 1963, the administration of chlorpromazine marked the advent of the [dopamine antagonist](https://en.wikipedia.org/wiki/Dopamine_antagonist "Dopamine antagonist"), or first generation antipsychotic.[\[192\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-192) While clinical trials showed a high response rate for both acute psychosis and disorders with psychotic features, the [side effects](https://en.wikipedia.org/wiki/Side_effect "Side effect") were particularly harsh, which included high rates of often irreversible Parkinsonian symptoms such as [tardive dyskinesia](https://en.wikipedia.org/wiki/Tardive_dyskinesia "Tardive dyskinesia"). With the advent of [atypical antipsychotics](https://en.wikipedia.org/wiki/Atypical_antipsychotic "Atypical antipsychotic") (also known as second generation antipsychotics) came a dopamine antagonist with a comparable response rate but a far different, though still extensive, side-effect profile that included a lower risk of Parkinsonian symptoms but a higher risk of cardiovascular disease.[\[193\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-193) Atypical antipsychotics remain the first-line treatment for psychosis associated with various psychiatric and [neurological disorders](https://en.wikipedia.org/wiki/Neurological_disorder "Neurological disorder") including schizophrenia, [bipolar disorder](https://en.wikipedia.org/wiki/Bipolar_disorder "Bipolar disorder"), [major depressive disorder](https://en.wikipedia.org/wiki/Major_depressive_disorder "Major depressive disorder"), [anxiety disorders](https://en.wikipedia.org/wiki/Anxiety_disorder "Anxiety disorder"), [dementia](https://en.wikipedia.org/wiki/Dementia "Dementia"), and some [autism spectrum](https://en.wikipedia.org/wiki/Autism_spectrum "Autism spectrum") disorders.[\[194\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-194)
Dopamine is now one of the primary neurotransmitters implicated in psychotic symptomology. Blocking dopamine receptors (namely, the dopamine D2 receptors) and decreasing dopaminergic activity continues to be an effective but highly unrefined effect of antipsychotics, which are commonly used to treat psychosis. Recent pharmacological research suggests that the decrease in dopaminergic activity does not eradicate psychotic [delusions](https://en.wikipedia.org/wiki/Delusion "Delusion") or [hallucinations](https://en.wikipedia.org/wiki/Hallucination "Hallucination"), but rather attenuates the reward mechanisms involved in the development of delusional thinking; that is, connecting or finding meaningful relationships between unrelated stimuli or ideas.[\[119\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Kapur-119) The author of this research paper acknowledges the importance of future investigation:
> The model presented here is based on incomplete knowledge related to dopamine, schizophrenia, and antipsychotics—and as such will need to evolve as more is known about these.
— Shitij Kapur, From dopamine to salience to psychosis—linking biology, pharmacology and phenomenology of psychosis
[Freud](https://en.wikipedia.org/wiki/Freud "Freud")'s former student Wilhelm Reich explored independent insights into the physical effects of neurotic and traumatic upbringing, and published his holistic psychoanalytic treatment with a schizophrenic. With his incorporation of breathwork and insight with the patient, a young woman, she achieved sufficient self-management skills to end the therapy.[\[195\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-195)
[Lacan](https://en.wikipedia.org/wiki/Lacan "Lacan") extended Freud's ideas to create a psychoanalytic model of psychosis based upon the concept of "[foreclosure](https://en.wikipedia.org/wiki/Foreclosure_\(psychoanalysis\) "Foreclosure (psychoanalysis)")", the rejection of the symbolic concept of the father.\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
Psychiatrist [David Healy](https://en.wikipedia.org/wiki/David_Healy_\(psychiatrist\) "David Healy (psychiatrist)") has criticised pharmaceutical companies for promoting simplified biological theories of mental illness that seem to imply the primacy of pharmaceutical treatments while ignoring social and developmental factors that are known important influences in the etiology of psychosis.[\[196\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-196)
## Society and culture
\[[edit](https://en.wikipedia.org/w/index.php?title=Psychosis&action=edit§ion=38 "Edit section: Society and culture")\]
Symptoms of psychosis can also include visions or quasi-visual experiences, felt presences, alterations of time, alterations of space, or alterations of spatiotemporal qualities of objects and things.[\[153\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-ReferenceA-153) While there are many overwhelmingly negative experiences of psychosis, some experiences of psychosis can be overwhelmingly positive and can be experienced as uplifting or as healing or as difficult but meaningful.[\[153\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-ReferenceA-153) Jones and Shattell said that mutual dialogue in clinical practice would in theory allow the meaning and complexity of psychotic experiences to emerge.[\[153\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-ReferenceA-153)
The classification of psychosis as a [social disability](https://en.wikipedia.org/wiki/Social_model_of_disability "Social model of disability") is a common occurrence.
Psychosis is considered to be among the top ten causes of social disability among adults in developed countries.[\[197\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-197) The traditional, negative narrative around disability has been shown to adversely influence employment and education for people experiencing psychosis.[\[198\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-198)
Social disability by way of social disconnection is a significant public health concern and is associated with a broad range of negative outcomes, including premature mortality. Social disconnection refers to the ongoing absence of family or social relationships with marginal participation in social activities.[\[199\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-199)
Research on psychosis found that reduced participation in social networks, not only negatively effects the individual on a physical and mental level, it has been shown that failure to be included in social networks influences the individual's ability to participate in the wider community through employment and education opportunities.[\[200\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Myers_2019-200)[\[201\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Myers_2012-201)[\[202\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-pmid21699009-202)
Equal opportunity to participate in meaningful relationships with friends, family and romantic partners, as well as engaging in social constructs such as employment, can provide significant physical and mental value to people's lives.[\[200\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Myers_2019-200) And how breaking the disability mind-set around people experiencing psychosis is imperative for their overall, long-term health and well-being as well as the contributions they are able to make to their immediate social connections and the wider community.[\[201\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-Myers_2012-201)
Further research in the form of randomized controlled trials is needed to determine the effectiveness of treatment approaches for helping *adolescents* with psychosis.[\[46\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:3-46) Through 10 randomized clinical trials, studies showed that Early Intervention Services (EIS) for patients with early-phase schizophrenia spectrum disorders have generated promising outcomes.[\[203\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:05-203) EIS are specifically intended to fulfill the needs of patients with early-phase psychosis.[\[203\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:05-203) In addition, one meta-analysis that consisted of four randomized clinical trials has examined and discovered the efficacy of EIS to Therapy as Usual (TAU) for early-phase psychosis, revealing that EIS techniques are superior to TAU.[\[203\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-:05-203)
A study suggests that combining cognitive behavioral therapy (CBT) with SlowMo, an application that helps notice their "unhelpful quick-thinking", might be more effective for treating paranoia in people with psychosis than CBT. alone.[\[204\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-204)[\[205\]](https://en.wikipedia.org/wiki/Psychosis#cite_note-205)
1. ^ [***a***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-NIH2018QA_1-0) [***b***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-NIH2018QA_1-1) [***c***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-NIH2018QA_1-2) [***d***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-NIH2018QA_1-3) [***e***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-NIH2018QA_1-4) [***f***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-NIH2018QA_1-5)
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Gelder, Michael G.; Gath, Dennis; Mayou, Richard (1983). [*Oxford Textbook of Psychiatry*](https://books.google.com/books?id=pN9rAAAAMAAJ). Oxford University Press. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
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189. ^ [***a***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-Pressman1998_189-0) [***b***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-Pressman1998_189-1)
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200. ^ [***a***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-Myers_2019_200-0) [***b***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-Myers_2019_200-1)
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201. ^ [***a***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-Myers_2012_201-0) [***b***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-Myers_2012_201-1)
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203. ^ [***a***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-:05_203-0) [***b***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-:05_203-1) [***c***](https://en.wikipedia.org/wiki/Psychosis#cite_ref-:05_203-2)
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Personal accounts
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\[Semi-autobiographical\]
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- [Saks ER](https://en.wikipedia.org/wiki/Elyn_Saks "Elyn Saks") (2007). [*The Center Cannot Hold – My Journey Through Madness*](https://archive.org/details/centercannothold00saks_0). New York: Hyperion. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
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- [National Institute of Mental Health](https://web.archive.org/web/20151105074035/http://www.nimh.nih.gov/health/topics/schizophrenia/raise/what-is-psychosis.shtml) | |||||||||
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} | |||||||||
| ML Page Types |
Raw JSON{
"/Article": 999,
"/Article/Wiki": 934
} | |||||||||
| ML Intent Types |
Raw JSON{
"Informational": 999
} | |||||||||
| Content Metadata | ||||||||||
| Language | en | |||||||||
| Author | null | |||||||||
| Publish Time | not set | |||||||||
| Original Publish Time | 2013-08-08 18:57:53 (12 years ago) | |||||||||
| Republished | No | |||||||||
| Word Count (Total) | 20,717 | |||||||||
| Word Count (Content) | 18,586 | |||||||||
| Links | ||||||||||
| External Links | 1,045 | |||||||||
| Internal Links | 965 | |||||||||
| Technical SEO | ||||||||||
| Meta Nofollow | No | |||||||||
| Meta Noarchive | No | |||||||||
| JS Rendered | No | |||||||||
| Redirect Target | null | |||||||||
| Performance | ||||||||||
| Download Time (ms) | 206 | |||||||||
| TTFB (ms) | 118 | |||||||||
| Download Size (bytes) | 137,619 | |||||||||
| Shard | 152 (laksa) | |||||||||
| Root Hash | 17790707453426894952 | |||||||||
| Unparsed URL | org,wikipedia!en,/wiki/Psychosis s443 | |||||||||