psychosis

Psychosis is a mental state characterized by a loss of contact with reality. Core features include delusions, hallucinations (often hearing voices), disorganized thinking or speech, and disorganized or abnormal behavior. Negative symptoms such as reduced motivation or flat affect may occur. Psychosis may occur in various disorders or be caused by medical conditions, substances, or stress, and it can be brief or chronic.

Causes are diverse. Primary psychotic disorders in the schizophrenia spectrum and mood disorders with psychotic features are common. Other conditions include brief psychotic disorder, schizoaffective disorder, delirium, and substance-induced psychosis from stimulants, cannabis, or alcohol withdrawal. Medical conditions such as infections, tumors, autoimmune diseases, and metabolic disturbances can also trigger psychosis. Genetic and environmental risk factors contribute as well.

Diagnosis relies on clinical assessment and history. There is no single laboratory test for psychosis. Clinicians use DSM-5-TR or ICD-11 criteria to classify conditions and to distinguish psychosis from other causes of altered perception. Evaluation includes ruling out medical or substance-related causes and assessing symptom duration to differentiate brief psychotic disorder, schizophreniform disorder, schizophrenia, and schizoaffective disorder.

Treatment aims to relieve symptoms, restore function, and prevent relapse. Antipsychotic medications (typical and atypical) are the mainstay. Psychosocial interventions such as cognitive behavioral therapy for psychosis, family therapy, psychoeducation, and supported employment are important. Early intervention and ongoing treatment planning improve outcomes; hospitalization may be needed for safety when necessary.

Prognosis varies with diagnosis, duration of untreated psychosis, treatment adherence, and comorbid conditions. Some people experience full remission; others have persistent symptoms with relapses. Overall life expectancy is modestly reduced in schizophrenia spectrum disorders, partly due to comorbidities. Integrated, continuous care and adherence to treatment improve long-term outcomes.