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.
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
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.
Medications
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.
Looking after yourself
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.