The key is hallucinations and clearly false beliefs.
When Joey Sklar was 18, he came home from a trip and walked into his parents’ home on a hot summer day in New Jersey wearing a heavy jacket. He flew into a rage when he saw them. “We thought someone had slipped him” a drug, says his mother, Dusty Sklar. She called the police, hoping he would be hospitalized.
Psychosis is the term we use when a person is out of touch with reality. Joey felt cold on a hot day, and didn’t understand that he was frightening his family.
Psychotic episodes can be brief, or seem so. By the time the police arrived, Joey convinced them that he was fine. Then he “ran away,” his mother says. When his brother and father found him in Boston, he told them that he was Jesus. This time he agreed to check into McLean Hospital, a famous psychiatric hospital affiliated with Harvard Medical School. At the hospital, “when he found that all the other young men thought they were Jesus he gave up the idea,” Dusty says. Some rationality had come back.
The symptoms of psychosis are delusions, clearly false beliefs like “I’m Jesus,” or “You’re the devil,” and hallucinations, which can involve any of the senses. You might see, hear, taste, smell, or have tactile sensations in a world all your own. You might speak nonsense, or break social rules, walking into the street naked. The vast majority of psychotic people are sad and confused rather than violent.
We tend to associate psychosis with schizophrenia, or bipolar disorder, Joey’s diagnosis. But psychotic symptoms can arise for many reasons. You can hallucinate and develop delusions from sleep disorders. One over-nighter can give you symptoms similar to those suffered by people with schizophrenia, some research found. People withdrawing from alcohol or cocaine or methamphetamines often hallucinate crawling insects. Up to half of people with Parkinson’s disease, and about 20 percent of people with dementia with Lewy bodies, have visual hallucinations, studies suggest.
Around three out of 100 Americans will experience psychosis at some time in their lives. Each year, about 100,000 adolescents and young adults experience their first psychotic episode. Many don’t get help for as long as a year.
To be diagnosed with schizophrenia, you must experience psychotic symptoms for at least six months. Some of the warning signs are lack of concentration, bad hygiene, feeling suspicious, spending more time alone, feeling emotionless or struck intensely by new ideas, and falling behind in school or at work. If you or someone you love matches several items on this checklist, consult a psychologist, psychiatrist, or trained social worker — especially if the symptoms intensify or persist. Early treatment of psychosis increases the chance of a successful recovery. Many people never have another psychotic episode. Some can live complete lives, although symptoms occasionally return.
Psychosis can accompany depression. If you ever suspect that someone you love is in danger of suicide or might have such poor judgment they could endanger themselves or others, act early. Avoid a confrontation, but secretly take away car keys, guns, alcohol, street drugs, or prescription medications that could cause an overdose. Call 9-1-1 or the police and ask for a “mental health wellness check.”
Medication is standard care for someone with repeated episodes. Your loved one may have a choice between a daily pill or a monthly injection, and side effects to manage. A number of programs can help coordinate care, which will include support.
- Early Assessment & Support Alliance (EASA) offers an EASA Program Directory that lists early psychosis programs nationwide.
- Prodrome and Early Psychosis Program Network (PEPPNET) offers the Early Intervention for Psychosis Directory.
- National Alliance on Mental Illness (NAMI) has a hotline (1-800-950-NAMI (6264), Monday – Friday, 10 a.m. – 6 p.m. EST) and staff to answer emails at email@example.com. The NAMI Helpline web page can connect you with the NAMI office in your state to find local help.
November 29, 2016
Christopher Nystuen, MD, MBA