Psychosis | Azimuth Check

Psychosis describes experiences in which a person's perception of reality is altered. These may include hearing or seeing things others do not, holding beliefs that others do not share, or finding thoughts and speech difficult to organise. Such experiences can be frightening, confusing or isolating. They are symptoms that deserve careful assessment, not a reason to dismiss or ridicule a person.

1. What can psychosis involve?

Hallucinations are perceptions that occur without an external stimulus, such as hearing voices. Delusions are beliefs held with strong conviction despite evidence that others find inconsistent with them. Some people experience disorganised thinking, difficulty concentrating or changes in motivation. The content and intensity of experiences vary, and a person may be aware that something feels unusual.

2. Why can psychosis occur?

Psychosis can occur in different circumstances, including schizophrenia-spectrum conditions, bipolar disorder, severe depression, substance use, sleep deprivation, medication effects and some physical or neurological illnesses. Context is important: one episode does not by itself establish a particular diagnosis. Urgent assessment may be needed to identify treatable or time-sensitive causes.

3. Assessment and early help

Assessment considers the nature and onset of experiences, safety, sleep, mood, substance use, medication, physical health and any changes in functioning. It may include input from family or trusted people with the person's agreement. Early specialist support can be valuable, particularly when experiences are new or rapidly worsening.

4. Treatment and recovery

Treatment depends on the cause and may involve antipsychotic medication, psychological interventions, family support and help with housing, education or work. Physical health and substance use may also need attention. The person should be involved in decisions, including discussion of benefits, side effects and alternatives.

5. Supporting someone experiencing psychosis

Listen calmly and acknowledge the distress without arguing aggressively about beliefs or pretending to share them. Ask what would help them feel safer and encourage professional assessment. If there is immediate danger, severe confusion, inability to care for basic needs or rapid deterioration, seek urgent help. Recovery and stability are possible, although needs differ from person to person.

When to seek urgent help

Seek urgent professional help if psychotic symptoms are new or rapidly worsening, or if safety is in question. In England, contact NHS 111 and select the mental health option for urgent support. If there is immediate danger, call 999 or go to A&E.