2.4 Describe the symptoms of a common psychosis

This guide will help you answer 2.4 Describe the symptoms of a common psychosis.

Psychosis describes a serious mental health condition where someone loses touch with reality. This can affect the way a person thinks, feels, and behaves. Psychosis often involves two main symptoms: hallucinations and delusions. Other symptoms may affect a person’s speech, emotional state, and movement. These symptoms can be distressing for both the person and those around them.

To better support people with psychosis, it helps to recognise what symptoms might look like.

Definition of Psychosis

Psychosis is not a diagnosis on its own. Instead, it describes a cluster of symptoms that can be part of mental illnesses such as schizophrenia, bipolar disorder, or severe depression. Sometimes, psychosis can result from physical health problems or the use of drugs and alcohol.

A person experiencing psychosis can lose the ability to distinguish between what is real and what is not. This leads to difficulties in daily life, relationships, and self-care.

Hallucinations

Hallucinations are when someone senses things that are not present. These are not the result of imagination, dreaming, or daydreaming. Hallucinations feel very real to the person, but other people cannot see, hear, or feel the things sensed.

Types of Hallucinations

• Auditory hallucinations: Hearing voices, sounds, or music that others cannot hear. Voices may talk to the person, comment on their actions, or speak to each other. The voices are often negative, threatening, or commanding. Less often, they may offer comfort or guidance.
• Visual hallucinations: Seeing things, people, lights, or shapes that are not there. These visions may be detailed or vague.
• Olfactory hallucinations: Smelling odours that do not exist. The smell may be pleasant or unpleasant.
• Gustatory hallucinations: Tasting things with no physical source.
• Tactile hallucinations: Feeling sensations on or under the skin, such as bugs crawling, when there is no cause.

Auditory hallucinations are the most common in psychosis. People may talk back to the voices or respond based on what they hear. Others may become distressed or fearful if the hallucinations are unpleasant or hostile.

Delusions

Delusions are fixed, false beliefs. They persist despite clear evidence or reason to the contrary. These beliefs are not shared by others in the same culture or community.

Types of Delusions

• Paranoid delusions: Believing others are plotting to harm, watch, or control them. People may feel persecuted, spied upon, or targeted by strangers, neighbours, or even the government.
• Delusions of reference: Thinking that public events or media messages are directly related to them. For example, believing that a TV presenter is sending hidden messages or that songs on the radio are meant specifically for them.
• Grandiose delusions: Believing they have special powers, talents, or identity. Someone may think they are famous, have a special mission, or possess secret knowledge.
• Delusions of control: Feeling that outside forces are controlling their thoughts or actions. This includes feeling that thoughts are being inserted into or removed from their mind, or broadcast so others can hear.
• Somatic delusions: Believing something is wrong with their body despite medical reassurance. For instance, thinking they have a serious disease or physical abnormality with no evidence.

Delusions can lead to unusual behaviour or decisions. A person may act on these beliefs, such as calling the police because they believe they are in danger or withdrawing from friends and family out of fear.

Disorganised Thinking and Speech

Psychosis often affects thought processes. The person may struggle to organise ideas in a logical way. Their speech can reflect disorganised thinking, making it hard for others to follow what they are saying.

Signs of Disorganised Thinking and Speech

• Jumping from topic to topic with no clear link
• Speaking in sentences that are difficult to understand
• Using made-up words (neologisms)
• Giving answers that do not match the question
• Having trouble concentrating on a single task or conversation

This symptom can sometimes lead to frustration for both the person and those trying to communicate with them.

Disturbed Emotions

Psychosis can affect a person’s emotional responses. This might mean showing less emotion or having emotions that seem inappropriate to the situation.

Examples of Disturbed Emotions

• Reduced facial expression, speech tone, or gesture (flat affect)
• Laughing or smiling at sad news
• Appearing indifferent to important events or loved ones
• Sudden outbursts of anger or tears without clear reason

Others may notice that the person seems detached, “blank”, or emotionally unpredictable.

Changes in Behaviour

Behaviour changes can be obvious or subtle. People experiencing psychosis may act in new or unexpected ways, sometimes linked to their hallucinations or delusions.

Behavioural Changes May Include

• Withdrawing from friends, family, or social activities
• Neglecting personal hygiene or self-care
• Being unable to complete work or household tasks
• Displaying repeated, ritualistic, or odd movements (such as pacing or rubbing hands)
• Speaking to themselves or appearing to listen to unseen voices
• Becoming very agitated or very still (catatonia)

These changes can make it difficult for the person to keep relationships, hold a job, or live independently.

Loss of Insight

Many people with psychosis cannot recognise that their experiences are symptoms of illness. This is called loss of insight. They may be convinced that their delusions or hallucinations are real, and may become defensive or suspicious if someone disagrees.

Loss of insight can make it hard for people to accept help or treatment. Carers and professionals may need patience and understanding to offer support.

Negative Symptoms

Negative symptoms refer to things the person no longer does, rather than things they experience. These are often less visible but can be disabling.

Examples of Negative Symptoms

• Loss of motivation (avolition): Not starting or finishing activities
• Lack of interest in social contact (asociality)
• Speaking less or only giving brief answers (poverty of speech)
• Not showing pleasure (anhedonia)

Negative symptoms may persist after positive symptoms, like hallucinations, have improved.

Other Features

Sometimes, psychosis is linked with confusion, memory problems, or difficulty planning. This can make everyday life much harder.

Physical symptoms may happen if the person is very agitated or hardly moving. Catatonia is a rare but serious symptom, where the person remains motionless and does not respond to the environment for a long period.

How Symptoms Affect Daily Life

Symptoms can make the world seem frightening and confusing. The person may struggle with:

• School, work, or daily tasks
• Keeping up with washing, eating, and dressing
• Managing money or looking after their home
• Maintaining friendships and family contact
• Risk of self-neglect or harm, sometimes caused by what they see or believe

Every person experiences psychosis differently. The type, severity, and duration of symptoms can vary.

Early Signs of Psychosis

Spotting early changes helps with early treatment and better outcomes. Early signs are sometimes called the “prodromal phase” and may develop gradually.

Early signs to look out for:

• Withdrawing from social life
• Losing interest in work, school, or hobbies
• Doing worse at school or work
• Finding it hard to focus or remember things
• Becoming suspicious or anxious without clear reason
• Unusual ideas or beliefs
• Sudden mood changes or odd behaviour

Family, friends, or colleagues may notice changes before the person themselves.

Examples of a Common Psychosis: Schizophrenia

Schizophrenia is one of the most well-known types of psychosis. Below are symptoms commonly seen:

• Hallucinations (mainly hearing voices)
• Delusions (paranoid or grandiose beliefs)
• Disorganised speech
• Reduced motivation
• Flattened emotions

A person with schizophrenia might believe their thoughts are controlled by others, hear voices commenting on their actions, or neglect self-care tasks.

Causes of Psychosis

Psychosis can begin for many reasons. It may relate to:

• Severe mental illness (schizophrenia, bipolar disorder, depression)
• Medical conditions (brain injury, dementia, infections)
• Alcohol or drug misuse (especially cannabis, LSD, amphetamines)
• Side effects of medication
• Trauma or extreme stress

Pinpointing the cause helps with making a care plan and choosing support.

Stigma and Misunderstanding

Psychosis can carry stigma, leading to isolation and discrimination. People might feel ashamed or frightened to reach out for help. Workers can support people with psychosis by using non-judgemental language, offering patience, and taking behaviour in context.

Supporting Those with Psychosis

If you notice symptoms:

• Stay calm and listen without judgement
• Offer reassurance and a sense of safety
• Encourage seeking support from mental health professionals
• Respect the person’s experience, even if you do not share their beliefs

Avoid arguing about delusions. Instead, focus on how the person is feeling and what might help them feel better.

Documenting Symptoms

Health and social care workers should record observed symptoms and behaviour factually.

For example, write:

• “Client stated that he heard two male voices in his flat overnight.”
• “Missed two appointments, not answering phone calls.”
• “Believes neighbours are monitoring her phone.”

Recording supports assessment, care planning, and risk management.

Final Thoughts

Psychosis means a loss of contact with reality. The main symptoms include hallucinations and delusions. People may also have disorganised thinking and speech, emotional changes, and behaviour that is different from their usual self. Negative symptoms reflect a drop in usual activity, motivation, and communication.

Many conditions can cause psychosis. Symptoms vary widely in type, severity, and duration. Workers should take all symptoms seriously, record their observations, and support people to get specialist help.

Caring for someone with psychosis requires patience, respect, and a focus on safety. Understanding these symptoms is the first step in offering effective support for people experiencing mental illness.