Desmond Kaplan MD FAPA

Child, Adolescent & Adult Psychiatry

1777 Reisterstown Road, Suite 50
 Baltimore, MD 21208


Psychosis refers to psychiatric disturbance in which the patient loses contact with reality. This may include having delusions, hallucinations and disorganized thinking or speech. Delusions are false beliefs. Hallucinations may be visual, involving seeing things that are not there, or auditory, involving hearing sounds that are not present. Disorganized thinking and speech involve jumbled or irrational thoughts and indecipherable speech.

There are great variations in the severity of psychotic symptoms. One individual may have a transitory hallucinatory experience or make an individual nonsensical verbal connection. Another may appear to be living entirely in another world or babbling incoherently, completely unable to function. In some cases, patient with psychosis become violent, or even suicidal or homicidal. Most psychotic episodes first occur in young adulthood, but may happen at any age. Research has shown that as much as 3 percent of the population suffers from some form of psychosis.

While psychosis may occur suddenly, patients frequently exhibit milder symptoms on their way to a full-blown psychosis. In its early stages psychosis may present with the following symptoms:

  • Depression, anxiety or agitation
  • Sleep disturbances
  • Difficulty concentrating
  • Withdrawal from relationships
  • Increasingly odd or irrational beliefs
  • Suspicion of others

Causes of Psychosis

There are several reasons for experiencing psychosis, some medical and some psychiatric, although the distinction may be moot since psychiatric problems are increasingly being linked to physiology. Medical causes of psychosis may include:

  • Brain tumors or cysts
  • Brain diseases like Huntington's and Parkinson's
  • Anatomical abnormalities, such as hydrocephalus
  • Traumatic brain injury
  • Alcohol and other substance abuse, during use or withdrawal
  • Various types of dementia, such as Alzheimer's disease or cardiovascular dementia
  • HIV and other infections that affect the brain
  • Certain prescription drugs, such as steroids or stimulants
  • Some types of epilepsy
  • Extreme sleep deprivation
  • Extremely elevated body temperature
  • Stroke or transient ischemic attack

Individuals with other forms of psychiatric illness, such as schizophrenia, bipolar disorder, and some personality disorders, may also experience psychotic symptoms. There is some evidence that trauma experienced in early childhood may predispose an individual to a psychotic episode later in life.

Diagnosis of Psychosis

Psychosis, while it may be apparent to casual observers, must be diagnosed based on hard psychiatric evidence. Psychiatrists and psychologists use several means to diagnose psychotic disorders. Personal interviews, psychological examinations, and evaluations of observed behavior are strong indicators, but laboratory and imaging tests will also be administered to uncover underlying causes of psychosis, or to rule them out. These tests may include:

  • Blood tests for infections such as HIV or syphilis
  • Blood tests to check medication, electrolyte and hormone levels
  • Screening for alcohol and drug use
  • MRIs or CT scans

Treatment of Psychosis

There are many types of treatment available for patients with psychosis, depending on the cause of the symptoms. While medications and psychotherapy may be effective, temporary hospitalization is often necessary to ensure the safety of the patient and those in close proximity. Antipsychotic medications can be very helpful in decreasing the frequency and intensity of hallucinations, delusions and disordered thinking.

Depending on its cause, psychosis may be a temporary condition or require ongoing treatment. If the psychosis results from medication, the situation may be resolved relatively rapidly, but for patients with schizophrenia or bipolar disorder medication may be necessary throughout their lives. In some cases, psychosis may necessitate long-term care or periodic intervention or hospitalization during acute episodes.

Additional Resources