Learn about psychosis, causes, signs to look for & treatment options
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Found in: Mental Health Conditions
Date: September 2022

About psychosis

Psychosis is when you perceive reality differently from other people – seeing or hearing things that others can’t (hallucinations) or developing unusual beliefs (delusions). During a psychotic episode, your thoughts and behaviour may be very different from usual.

Psychosis can occur with several mental health conditions, such as schizophrenia, severe depression, bipolar disorder, schizoaffective disorder, certain personality disorders and postpartum psychosis. Episodes of psychosis can also be caused by medical events, drugs and alcohol, and other life events.

Some people experience a psychotic episode just once, or a few times, in their lives. For others, psychotic episodes happen often, with little break in between.

Psychosis can be very distressing and can have a big impact on your relationships and your ability to do everyday things, like taking care of yourself or going to work. However, for some people, things like hearing voices or seeing visions are a source of comfort and meaning, not distress. For example, you might feel you are communicating with your ancestors, and this might have deep spiritual significance for you.

Psychosis is not well understood by many in our society. There is a mistaken belief that people having a psychotic episode are dangerous. The truth is that the huge majority of people who experience psychosis will never be violent. 

Because of these misunderstandings, and the stigma around psychosis and related mental health conditions, it can be hard to seek help – but, if psychosis is having a negative impact on you, it’s really important that you do ask for help. It may be that your whānau and friends see you are having a hard time and start the process of getting help on your behalf.

There are effective treatments for psychosis, and, with the right support, most people will recover. ‘Recovery’ does not necessarily mean you no longer experience psychosis. Instead, it means you are able to live well, with or without psychotic episodes. This will mean something different to each person.

Types of psychosis

The experience of psychosis is different for everyone, and you may find it varies for you at different times. Types of psychosis include hallucinations, delusions and disorganised thinking and speech.

  • Hallucinations – this is when you hear, see, feel, taste or smell something that is not there. Hearing voices is the most common hallucination. These voices might talk about or to you and might command you to do things. 
  • Delusions – unusual beliefs that are real to you but not to those around you. You may experience ‘paranoid delusions’, believing that other people want to harm you (e.g. that the government is trying to hunt you down). Or you may believe you have extraordinary abilities (e.g. being able to read people’s minds).
  • Disorganised thinking and speech – you may feel your thoughts are racing, and friends may notice that you constantly change the topic of conversation, are easily distracted, or laugh at irrational times. You may speak in an unusual way, perhaps using words that only you understand.

It’s important to note that these experiences are relatively common: research suggests that about 1 in 10 of us has heard voices before, and many people have beliefs that others may describe as false or delusional. In most cases, you will only be treated for psychosis if it is causing you distress and preventing you from living well.

What causes psychosis?

There are many reasons you might experience psychosis. These include:

  • Physical illness or injury – for example, fever, head injury, Parkinson’s disease, urinary tract infection, epilepsy, hypothyroidism, certain types of poisoning. Being extremely hungry or tired can also cause psychosis.
  • Recreational drugs – drugs such as LSD, cannabis and synthetic cannabinoids can cause hallucinations and can also make symptoms worse if you already experience psychosis.
  • Medication – taking or withdrawing from certain medications, both prescribed and over-the-counter, can cause psychosis, especially if you take more than the recommended amount. The antipsychotic medication prescribed to treat psychosis (see below) will not make psychotic symptoms worse.
  • Genetics – you are more likely to experience psychosis if someone in your immediate family/whānau has too.
  • Childhood trauma – if you had an extremely stressful experience while you were growing up, such as being abused or neglected, you may be more likely to experience psychosis as an adult.
  • Stressful life events – things like being out of work, losing a loved one, stress at school or university, becoming homeless or being abused could trigger psychosis.
  • Mental health conditions – schizophrenia, severe depression, bipolar disorder, schizoaffective disorder, certain personality disorders and postpartum psychosis and others.

It’s important to remember that even though some of these factors are out of your control, such as your genetics and stressful experiences in your past, there are many things you can do now to support your recovery and your long-term wellbeing. (See ‘Treatment options’ and ‘Other strategies to support recovery’ below.) The first step is to talk to your doctor or another person you trust.

' Being with a group of people who understood what it was like to hear voices and to know I wasn’t alone in my experience was so incredibly valuable. To be able to talk about the voices, what they were saying, how they were distressing me, helped me so much. I felt heard and validated and this supported me on my recovery journey '

– Individual with lived experience of psychosis

Treatment options

If you are experiencing psychosis and it is causing you distress, the first step is to talk to your GP. You may approach them yourself, or your whānau or friends may reach out for help for you. The GP will want to rule out any physical illnesses that could be causing the psychosis. They can also refer you to a specialist (a psychiatrist).

Psychosis is not a condition or diagnosis in itself. After being assessed by the psychiatrist, you may be diagnosed with a mental health condition. However, many people experience psychosis but are not given any specific mental health diagnosis.

Either way, there are effective treatments that can help you manage psychosis and live a fulfilling life. The main components are talking therapies and medication. 

Talking therapies

Talking therapies are effective in the treatment of psychosis. Sessions may be held on a one-to-one basis or include partners or family/whānau.

Cognitive behavioural therapy (CBT) is the main type of therapy used to treat psychosis. During CBT, your therapist will help you identify patterns of thought and behaviour that are unhelpful to you. They will work with you to change these patterns and learn new ways of coping with psychosis, as well as any other challenges you are experiencing.

All types of therapy/counselling should be provided in a manner which is respectful to you and which validates your experiences. You should feel comfortable, listened to, and free to ask questions.

The therapy should be consistent with and incorporate your cultural beliefs and practices.


If you are prescribed medication, it will likely be an ‘atypical antipsychotic’ (e.g. olanzapine, quetiapine, risperidone or aripiprazole) to treat psychotic symptoms, such as hallucinations. You may also be prescribed other medications alongside these, to manage things like anxiety or poor sleep.

You are entitled to know:

  • the names of the medicines
  • what symptoms they are supposed to treat
  • how long it will be before they take effect
  • how long you will have to take them for
  • whether your current dose could change over time
  • possible side effects (both short and long term)
  • possible interactions with other medications, drugs or alcohol
  • what the process of stopping them could look like.

The side effects of antipsychotic medication can be uncomfortable, and some people will want to stop taking them as a result. If this is how you feel, it’s important that you talk to your doctor before you make changes to your medication yourself. They can help you come up with a plan, which might involve finding a way to better manage side effects, safely changing how much medication you take, changing to a new medication, or stopping altogether.

If you are pregnant or breastfeeding, medication may still be an option. Talk to your doctor about what is right for your situation.   

Other strategies to support recovery

Complementary therapies

The term complementary therapy is generally used to indicate therapies and treatments that differ from conventional western medicine and that may be used to complement and support it.

They are not treatments for psychosis, but they may enhance your life and help you to maintain wellbeing. 

In general, mindfulness, meditation, hypnotherapy, yoga, exercise, relaxation, massage, mirimiri and aromatherapy have all been shown to have some effect in alleviating mental distress.

Physical health

It’s also really important to look after your physical wellbeing. Make sure you get an annual check-up with your doctor, and do what you can to reduce stress, get enough sleep, eat a balanced diet and exercise. 

Being in good physical health will also help your mental health.

Avoiding drugs and alcohol

Alcohol and non-prescription drugs may help you feel better in the short term, but in the long term, they can have a major effect on your mental health, making psychotic symptoms worse and reducing your chances of recovery.

It is important that you avoid cannabis if you have experienced psychosis before, as it can cause a relapse.

If you are struggling with drug or alcohol abuse, talk to your doctor about accessing support – there is a lot of help available.

Having a ‘Wellbeing Plan’

Many people find that having a written plan, developed together with your GP/psychiatrist, can help you feel you’re in control during a psychotic episode.  

Make sure others (i.e. family/whānau, partners, and community mental health staff) are aware of your plan and what you’d like to happen if you become unwell.  

Plans can detail (in your own words) symptoms, what can trigger them and what things help you. They can also list the numbers of support people, helplines and more, and outline what you’d like to happen if you need professional support.

As part of your plan, you could choose to create an ‘advance directive’. This is a formal document where you state what treatments you do or do not consent to receiving in the future.

Other ways to support your own wellbeing

Other people who experience psychosis have found these strategies help with their symptoms:

  • try to maintain a stable schedule of meals and sleep times – having a routine through the day is helpful
  • engage in mild activity or exercise to help reduce stress and anxiety
  • set realistic goals for yourself, and reward yourself when you reach them
  • break up large tasks into small ones, set some priorities, and do what you can, as you can
  • try to spend time with other people and confide in a trusted friend or family member
  • tell others about events or situations that may trigger symptoms
  • expect your symptoms to improve gradually, not immediately
  • identify and seek out comforting situations, places, and people
  • join a support group
  • try to regularly do activities you enjoy and get satisfaction from
  • keep in regular contact with your mental health team or GP
  • continue to educate yourself about psychosis, realising that everyone is different.

Thanks to Dr Paul Skirrow, on behalf of the NZ College of Clinical Psychologists, and Chloe Shaw of the Mental Health Foundation's lived experience group for reviewing this content. Date last reviewed: September, 2022.

Thanks also to Sutherland Self-Help Trust for making the 2022 updates possible.