FAQ

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If you are experiencing distress in any way, please direct yourself to your family doctor or local emergency department where you can get help. This website offers general information only and does not provide clinical services.

About Psychosis

What is Psychosis?

The medical community uses the term psychosis to describe a variety of medical conditions that affect an individual’s ability to distinguish between what is real and what is not.1 This experience is what is known as a psychotic episode, and most often emerges in late adolescence and early adulthood (CAMH guide).

Psychosis is not a specific disease or disorder, but a group of symptoms that indicate something to be wrong (cite heretohelp).

Psychosis does not mean being “crazy”, “mad”, or “insane”. Rather, psychosis is a medical condition from which people may recover with proper treatment!

What Causes Psychosis?

Around 3 out of 100 people will experience a psychosis episode in their lifetime, and can affect people of all genders, ethno-racial backgrounds, and socioeconomic statuses (CAMH guide).

Although we do not know the exact cause for psychosis to appear, some potential causes include:

Genetic factors
- Genetic factors may result in some individuals being predisposed to developing psychosis. However, just because a family member had an episode of psychosis, it does not doesn’t mean that other members of the family will necessarily have the same problem. In fact, most family members of people with psychosis, including their children, will not develop psychosis in their lifetime!
Substance abuse
- Certain drugs can induce psychotic symptoms such as cannabis, alcohol, cocaine, ecstasy, ketamine, LSD and amphetamines (CITE). Doctors recommend that they drugs should be avoided by individuals that have a history of psychotic episodes or are in recovery.
Severe stress or trauma
- Stressful life events can sometimes trigger psychosis, including a recent death in the family, migration to a new country, or experiences of abuse. Social factors and stressors like unemployment and unstable housing can also be linked to psychotic episodes.
Other mental and physical illnesses
- Psychosis can also occur because of mental or physical disorders that impact the body and mind. For example, psychical illnesses like brain diseases, tumours, or cysts can cause psychosis (CITE), or mental illnesses like schizophrenia.

WHAT ARE THE SYMPTOMS OF PSYCHOSIS?

The symptoms of psychosis vary greatly between people and are organized into “positive” and “negative” symptoms by the medical community. Most people experiencing psychosis will have different symptoms, which may also depend on the cause of their psychosis. The most important thing to remember is that these symptoms are treatable.

Positive symptoms These are symptoms that ADD an individual’s experience, like thoughts, behaviours, or actions.

Common positive symptoms include:

Hallucinations
- Where an individual may see or hear things that others don’t see or hear (e.g., hearing voices, seeing objects or people that are not there, etc.)
Delusions
- These are false beliefs that are not shared by other individuals (e.g., convinced that they are being poisoned or followed, delusions of grandeur, etc.)
Disorganized speech and thoughts
- It might be very difficult to understand someone experiencing psychosis, as they struggle to form coherent sentences due to their speech being jumbled.
- The logical flow of their speech and thought patterns may also be difficult to understand as well.
Disorganized behaviours
- An individual may struggle to complete tasks that used to be easy to accomplish, such as getting dressed, making dinner, completing their studies, etc.
- An individual’s movements may be more rigid and slow, or the opposite, and are very fast.

Negative symptoms These are symptoms that REMOVE typical thoughts, behaviours, or actions. These symptoms are less obvious, and can sometimes look like other mood disorders, such as depression or bipolar disorder, or even like side effects of medications.

Common negative symptoms include:

Reduced facial expressions
- For example, an individual may not be able to react to stories or demonstrate appropriate emotions.
Reduced speech
- Some individuals speak less than they used to or stop talking at all.
Reduced motivation
- An individual may struggle to motivate themselves to go to work or school, participate in family events, etc.
Reduced socialization
- Some individuals may withdraw from social life and isolate themselves from loved ones.

If you believe you are experiencing any of these symptoms, please contact your doctor. These symptoms could also be a sign of other mental or physical health concerns that your doctor can help you identify and treat.

IS PSYCHOSIS TREATABLE?

Yes, psychosis is treatable!

Psychosis is a lot easier to treat if it’s caught early. Many people can recover after an episode, especially if they receive treatment early after the initial onset of symptoms [1, 3]. With treatment, some people may never experience psychosis again, but it is very dependent on their diagnosis and cause of psychosis.

Examples of the types of treatments available for psychosis include:

Medications such as antipsychotics help relieve psychotic symptoms and prevent further psychotic episodes.
- Depending on the person and the severity of the psychotic symptoms, treatment may be administered on an outpatient basis (e.g., without needing to stay in the hospital), while others require staying at the hospital for a period of time.
Counselling (e.g., individual, family or group psychotherapy).
Support to access social services (e.g., to help an individual return to work or school) [6].
Support and education for family members
- This support is sometimes referred to as psychoeducation, which is short for psychological education or learning about the psychological aspects of psychosis.
- Family members are encouraged to attend psychoeducation, as they can learn more about psychosis and its treatment, as well as how to cope and take care of oneself while supporting a loved one during their treatment and recovery process for psychosis.

WHAT is AN EPISODE OF PSYCHOSIS?

Doctors define an episode of psychosis, or psychotic episode, as a period of time when symptoms of psychosis are strong and interfere with daily life. The duration of psychotic episodes varies from person-to-person. Psychotic episodes may only last a few hours or days but can continue for several weeks or years without treatment.

Although there are psychotic disorders, like schizophrenia or schizoaffective disorder, which may result in more chronic psychotic symptoms, some people may have only one episode of psychosis in their lifetime and fully recover from it.

WHAT DOES AN EPISODE OF PSYCHOSIS MEAN?

First episode psychosis (FEP) is used to describe the first time a person experiences a psychotic episode [2].

While experiencing a first episode of psychosis may leave someone at higher risk for another episode, this does not mean that an individual will have more psychotic episodes in the future. It’s important to remember that treating psychosis as soon as possible, can help the recovery process!

WHAT ARE THE DIFFERENT PHASES OF PSYCHOSIS?

There are 3 phases of psychosis: prodromal, acute, and recovery [4].

Prodromal Phase
- May last several months
- It is a period in which the individual may be experiencing changes in feelings, thoughts, and behaviours, BEFORE positive* symptoms, such as hallucinations and delusions emerge
- Symptoms in this phase may be less obvious and may include more non-specific symptoms* like social withdrawal, mood changes, poor motivation, and sleep disturbances
Acute or “Active” Phase
- This is a critical period in which positive* symptoms of psychosis like hallucinations and delusions are prominent.
- Active symptoms often interfere with a person’s normal life and function, but how long they continue depends on the cause of the psychotic episode and how quickly treatment is administered
Recovery or “Residual” Phase
- Acute symptoms decrease in intensity
- The recovery process is of variable length, and can be affected by the environment, medication, psychological therapies, and social factors such as family and community support
- Important Note: Experiencing a psychosis is a risk factor for having a second one

*Please refer to the “What are the symptoms of psychosis?” tab above for more information on positive and negative symptoms.

ARE PSYCHOSIS AND SCHIZOPHRENIA THE SAME THING?

No, psychosis and schizophrenia are not the same.

No, psychosis and schizophrenia are not the same. Schizophrenia is one of many mental illnesses that include psychotic symptoms. However, a person may experience psychosis and never be diagnosed with schizophrenia.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) defines schizophrenia as the presence of delusions, hallucinations, disorganized speech and behaviour, and other symptoms that impair function in school, work, or relationships. For a psychiatrist to diagnose someone with schizophrenia, two or more symptoms must be present for 6 months, meaning delusions, hallucinations, disorganized speech or behavior, and negative symptoms. [5].

WHAT ARE THE EARLY WARNING SIGNS OF PSYCHOSIS?

Early warning signs are unique for each person and need to be reviewed with the treatment team. After the first episode of psychosis, the individual may reflect on what symptoms led to the acute crisis and/or hospitalization. Some of these symptoms may include poor sleep, irritability, social withdrawal, and mood changes.

When individuals learn to recognize their unique pattern of early warning signs, they may prevent recurrence of psychosis by notifying their clinical team, family, and friends to get help as early as possible!

WHAT TO DO IF YOU OR SOMEONE ELSE MIGHT BE EXPERIENCING PSYCHOSIS?

When an individual experiences a psychotic episode, it is often family members or friends who are first to notice symptoms [8]. Some people may refuse treatment initially, so it is important that family members ask their doctor for an assessment or referral.

Overall, be patient, supportive, and persistent. Avoid open conflict and reassure the family member that the earlier they receive treatment, the better the chances of recovery. If an individual has serious symptoms of psychosis and is refusing to get help, family members can seek a court ordered psychiatric evaluation which would ensure that the individual will be assessed by a psychiatrist, usually in a hospital emergency setting. This will make sure that the person with psychotic symptoms is brought to the hospital to get help. In the most urgent situations, in which someone is in danger, calling 911 will bring the police and ambulance to the home.

If you are concerned that you may be experiencing psychosis, please contact your doctor or reach out to family and friends for help. You can also refer to the list of resources *below/here/on this page** to get additional support and information.

About Supporting a Loved One with Psychosis

WHAT IS it like to BE A CAREGIVER OF AN INDIVIDUAL EXPERIENCING PSYCHOSIS?

Families, caregivers, and friends are the main allies of patients with first-episode psychosis and have tremendous power to aid and advocate for them (Leff et al., 1990). The caregiver role is not the same for everyone. As many first-episode psychosis patients are young adults, parents are commonly the main caregivers, but siblings may also play an important role

Caregivers provide support and act as communication bridges between patients and the treatment team.

WHAT DO I DO IF I AM STRUGGLING TO COPE AS A CAREGIVER?

Families of affected individuals undergo many challenges, which can lead to marital conflict and strained coping behaviours. Caregivers often report feeling many negative emotions, such as guilt, anger, embarrassment, fear, and sadness, all of which can negatively impact their own wellbeing. Caregivers can experience feelings of helplessness or loss of control, with many struggling to understand what is happening to their loved one (Sagut & Duman, 2016). Another concern that many caregivers feel is social prejudice and stigma from others, regarding the condition of their loved one.

It is important to remember that all caregivers are doing their best to support their loved one and that the caregiver’s needs may differ greatly, especially given their social, economic, and family status. However, some techniques to help empower and support caregivers, include interventions like family psychoeducation (described below), reaching across one’s social network for support, and structuring time for social and leisure activities. Acts of self-care, such as social and leisure activities, including going for walks or talking to trusted friends, may be one way to alleviate the many stressors that come with supporting an individual with psychosis.

Remember, you are not alone, and if you need more support and resources for your own wellbeing, please refer to some of the services below:

LIST RESOURCES – ex. Ami Quebec

WHAT IS FAMILY PSYCHOEDUCATION?

In first episode psychosis (FEP) services, family psychoeducation is one of the most important interventions, and is known to improve clinical outcomes for the individual experiencing psychosis, like reducing relapse and re-hospitalization rates2, decreasing family burden3, and reducing positive symptoms of psychosis (MF, remember to cite from proposal).4

Family psychoeducation sessions are often facilitated by the clinical team, who provide a series of information sessions for groups of caregivers, to provide information about psychosis, listen to caregiver concerns and questions, support family wellbeing, help improve communication skills, and teach positive coping mechanisms.

Ask your loved one’s clinical team to find out when their next sessions will be hosted!

HOW CAN I HELP SOMEONE WHO IS EXPERIENCING A DELUSION, LIKE A FALSE BELIEF? SHOULD I TRY TO CHANGE THEIR WRONG IDEA?

Try to come across as non-confrontational and calm, expressing concern as a form of opinion, rather than judgement. It is best to talk to your loved one about your concern when they are not in the middle of their delusion. Try to stay neutral, calm, and patient. Even though you may not understand their delusion and become frustrated, it is not recommended to try and convince your loved one that their delusions are not real.

Encourage your loved one to talk about their beliefs or ideas with you and others who understand them. You do not need to pretend to agree with a delusion, and can say something like, “I understand that you believe these things, but I don’t understand/see it that way”. If the delusion is magical or supernatural, you can note that you do not know much about the topic. Most importantly, try to acknowledge how these thoughts might make your loved feel. For instance, if an individual was feeling paranoid about being followed by cameras and other technology, you could try saying, “It must be so scary to feel like your laptop camera is recording you”.

CAN MY LOVED ONE BECOME PREGNANT FOLLOWING A DIAGNOSIS OF FIRST EPISODE PSYCHOSIS?

Yes, one may become pregnant after being diagnosed with FEP, or begin to start their own family. Appropriate protection during sexual encounters should always be used to prevent unexpected pregnancy and sexually transmitted infections.

Individuals who desire to become pregnant should consult their physician for guidance. If someone suspects that they may be pregnant, it is recommended for them to immediately notify their physician, as some of the medications that are used to treat psychosis may not be safe in pregnancy. How to proceed with needed treatment during pregnancy is a delicate clinical decision that needs to be made with the treating team.

WHAT DO I DO ABOUT MY LOVED ONE USING SUBSTANCES LIKE CANNABIS OR ALCOHOL?

People with psychotic symptoms may be highly distressed and may turn to substances like cannabis and other substances to calm their anxiety or lift up their low mood. Unfortunately, any benefits of these substances are usually short-lived and only act to worsen the psychosis over the long term.

WHEN EXPERIENCING PSYCHOSIS, WILL MY LOVED ONE BECOME VIOLENT OR AGGRESSIVE?

No, most people with psychosis are not violent or aggressive. However, for some, during the Acute or “Active” stage of the first episode of psychosis, there may be increased risk of aggressivity and violence (Coid et al., 2013).

WHY DO THE POLICE GET INVOLVED IN CASES WITH INDIVIDUALS WITH PSYCHOSIS?

Sometimes the police are called by family, friends, or neighbors when a person with psychosis is not accepting to get help and their symptoms are getting worse. The police in these situations may bring someone with psychosis to the hospital emergency department to make sure that the individual is safe and can start treatment. When the police arrive in these circumstances, it is important that a family member carefully explain what is happening and help the psychotic person to go with the Police calmly and without struggle.

WHAT DO I DO IF MY LOVED ONE IS SUICIDAL?

Unfortunately, suicide is more common in young people with first episode psychosis than in non-psychotic youth. Suicide threats should always be taken seriously, and any loved one with suicidal thoughts, plans, or actions should be immediately referred to health care professionals for evaluation and treatment.

If you or a loved one are feeling suicidal, please contact …. Check out these resources for additional support:

About Psychosis, Community and Culture

WHAT IS CULTURE?

Culture is unique to human beings. Although there are many definitions of culture, all have to do with describing ways of thinking, feeling, and behaving that are learned and shared by a group. Culture can affect outward behaviours like our customs and traditions, but also internal ones like values, attitudes, and priorities.

HOW ARE PSYCHOSIS, COMMUNITY, AND CULTURE RELATED?

It is important to understand the relationship between culture and psychosis when helping people with psychotic disorders. For example, culture significantly influences the experience and expression of hallucinations and delusions. It is also important for clinicians to recognize the role of traditional therapies, religion, and spirituality, which may offer important ways to understand psychosis and provide tools to cope and obtain support. Other aspects of culture that may be important for patients and families include the role of stigma, systemic racism, illness beliefs, family structure, gender roles, attitudes to medication, and migration experiences.

WHAT IS STIGMA?

Stigma refers to negative beliefs about someone because of a personal characteristic, such as mental illness or psychosis. Examples of stigma may include the belief that people with psychotic symptoms are bad or evil, that they should not marry, that they will bring dishonor to the family, or that their mental health problems can be transmitted to other people, including children. Stigma is common in many cultures and societies and causes unnecessary harm to people with psychosis and other mental health problems.

HOW CAN PSYCHOSIS BE RELATED TO IMMIGRATION/MIGRATION?

Recently arrived immigrants may feel alone and unsupported. They have left their country of origin to courageously start a new life far from family and friends. Their new country may have unfamiliar customs, languages, and standards all of which are stressful to learn and know. When a family member develops psychosis, the usual distress may be magnified for migrant families because of language and communication difficulties, reduced access to extended family support, lack of knowledge of mental health services, as well as cultural differences regarding the cause of mental illness and issues relating to stigma. Because immigrants experience these social stresses and challenges they might be at a higher risk for developing psychosis. (Bourque, van der Ven & Malla, 2011; Cantor-Graae & Selten, 2005).