Psychosis is a mental health condition that causes a detachment from reality. The main symptoms are delusions and hallucinations. Psychosis episodes can last for different lengths of time, depending on the underlying cause and whether the person receives treatment. With treatment, most acute psychotic episodes will resolve within a month or two. Without treatment, episodes may last much longer or become chronic.
What is psychosis?
Psychosis is a symptom, not a specific diagnosis. It involves losing touch with reality through experiences like:
- Delusions: False beliefs not based in reality.
- Hallucinations: Seeing, hearing, or sensing things that aren’t there.
- Disorganized thinking and speech.
- Abnormal motor behavior.
People experiencing psychosis often have difficulty recognizing that their experiences aren’t real. Psychosis significantly impacts thinking, emotions, and behaviors. It can make it hard for a person to function normally.
What causes psychotic episodes?
Psychotic episodes may occur due to:
- Mental health conditions: Schizophrenia, schizoaffective disorder, bipolar disorder, severe depression, etc.
- Drug use: Stimulants like methamphetamine, hallucinogens like LSD, marijuana, alcohol, etc.
- Medical conditions: Dementia, tumors, stroke, autoimmune disorders, infections, etc.
- Exhaustion: Sleep deprivation.
- Trauma: PTSD or acute traumatic events.
- Nutrient deficiencies: Lack of vitamins/minerals like B12, folate, thiamine, etc.
In many cases, an underlying mental illness is the primary cause. Substance use, medical issues, and other factors may trigger psychotic symptoms or make them worse.
How long do psychotic episodes last?
The duration of psychotic episodes depends on several factors:
Underlying cause
If an underlying mental illness like schizophrenia causes psychosis, episodes may last for weeks or months without treatment. With treatment, they often improve within 4-6 weeks. Substance-induced psychosis tends to be shorter, resolving in days to weeks after stopping drug use.
Whether the person gets treatment
Treatment can significantly shorten psychotic episodes. Antipsychotic medication and psychotherapy help manage symptoms. Without treatment, episodes typically last much longer.
If psychosis recurs
In schizophrenia and related disorders, a single psychotic episode can last weeks to months. But most patients have recurrent episodes over their lifetime. These relapses may occur even with treatment. Stress, drug use, and stopping medication can trigger relapses.
Severity of symptoms
More severe, persistent symptoms tend to be associated with longer psychotic episodes. Milder symptoms may resolve more quickly.
Duration of specific psychotic disorders
Here is the typical duration of psychotic episodes in different psychiatric conditions:
Disorder | Typical duration of untreated episodes | Typical duration of treated episodes |
---|---|---|
Schizophrenia | 4-8 weeks | 2-4 weeks |
Schizoaffective disorder | 2-8 weeks | 1-4 weeks |
Bipolar disorder with psychosis | 2-16 weeks | 1-4 weeks |
Major depression with psychosis | 2-12 weeks | 1-3 weeks |
Drug-induced psychosis | Days to weeks | Hours to days after stopping drug use |
As shown, treatment significantly shortens the duration of psychotic episodes across different disorders. Other factors like stress, symptoms severity, and social support also play a role.
When does an acute episode end?
An acute psychotic episode is considered to have ended when:
- The person realizes hallucinations and delusions aren’t real.
- Disorganized thinking and speech have improved.
- The person can perform daily activities and self-care.
- Symptoms don’t return without a new trigger.
A doctor will evaluate these factors to determine if an episode has resolved. They may slowly reduce and eventually stop antipsychotic medication once symptoms have stabilized.
Can psychosis become chronic?
Without treatment, acute psychotic episodes can transition into chronic, unremitting psychosis. This is most common in schizophrenia. Chronic psychosis involves persistent symptoms like:
- Delusions
- Hallucinations
- Disorganized speech and behavior
- Lack of insight or awareness of illness
Chronic psychosis significantly impairs functioning. Long-term medication and psychosocial therapies are needed to manage it.
What increases chronic psychosis risk?
Factors that make chronic psychosis more likely include:
- Underlying diagnosis like schizophrenia
- Not receiving treatment during initial acute episode
- Experiencing repeated acute episodes
- Persistent symptoms between episodes
- Substance abuse
- Lack of social support
- Stressful living conditions
- Stopping treatment
When to seek emergency help
Seek immediate medical care if someone is experiencing psychosis and:
- Threatens to harm themselves or others
- Appears severely impaired and unable to care for themselves
- Has a high fever, head injury, or other emergent medical issue
- Shows symptoms of a mental health crisis like extreme agitation, paranoia, or catatonia
Prompt treatment in an emergency psychiatric facility can help stabilize acute symptoms and prevent harm. Do not try to reason with someone who is experiencing severe psychosis.
Conclusion
In summary, the duration of psychotic episodes can vary substantially based on the underlying cause, whether the person gets treatment, and other factors. With antipsychotic medication and psychotherapy, acute symptoms often improve within several weeks to months. Without treatment, psychosis may persist for extended periods and become chronic. Seeking prompt help as soon as symptoms appear can lead to the best outcomes and may prevent long-term disability.