Psychosis

Also called Schizophrenia, First episode psychosis

Losing contact with shared reality. Frightening, treatable, and surrounded by a great deal of nonsense.

What it is

Psychosis means experiencing things that are not shared by others: hallucinations, usually voices, and delusions, beliefs held with total conviction against the evidence.

About one in a hundred people experience a psychotic episode. Schizophrenia is one diagnosis within that, and it is not a split personality, and people with it are far more likely to be victims of violence than perpetrators of it.

The evidence that should shape services is about time. The longer psychosis goes untreated, the worse the long-term outcome, which is why Early Intervention in Psychosis teams exist and why access standards require treatment within two weeks of referral.

Signs you might notice

Before the episode, often months of subtle change: withdrawal, dropping out, sleep reversal, odd preoccupations. This is the prodrome, and it is the window that matters.

Hallucinations, most often hearing voices.

Delusions, frequently of being watched, followed, or having special significance.

Disorganised speech and thinking. Difficulty following a thread.

Negative symptoms: flat emotion, no motivation, social withdrawal. These are often the most disabling and the least treated.

How it can affect day-to-day life

Two harms deserve naming. First, physical health: people with severe mental illness die on average 15 to 20 years earlier than the general population, largely from cardiovascular disease and cancer, and largely because their physical health is not monitored. Antipsychotics cause weight gain, diabetes and lipid problems, so annual physical health checks are not optional.

Second, negative symptoms get read as laziness by families, employers and sometimes clinicians. They are part of the illness.

Cannabis, particularly high-potency, meaningfully raises the risk of psychosis in vulnerable people. That is worth saying plainly and without moralising.

Supporting someone well

Do not argue with a delusion and do not pretend to agree. "I can see that feels very real to you, and I don't experience it the same way" is honest and keeps the relationship.

Stay calm, keep the environment low-stimulus, and reduce demands.

Insist on the annual physical health check: weight, blood pressure, glucose, lipids, and a conversation about smoking. This is where the years are lost.

Support medication adherence and take side effects seriously rather than dismissing them. Sedation, weight gain and sexual side effects are the main reasons people stop.

Refer early. Ask specifically for the Early Intervention in Psychosis team, which accepts self and family referrals in many areas.

Watch for post-psychotic depression, which is common and carries real suicide risk.

Fiducia Together keeps physical observations alongside the mental health record, which is exactly the joining-up whose absence causes those lost years.

Where to get help

Ask a GP for urgent referral to Early Intervention in Psychosis. Many teams take direct referrals from families.

Rethink Mental Illness run an advice service, and Hearing Voices Network offer a different and useful approach to living with voices.

In crisis, call 111 and select the mental health option, or 999 if there is immediate risk.