Psychotic Disorders

Losing Touch with Reality


9 December 2020  |   5 min read

Psychosis happens when a person loses touch with reality. When someone becomes ill in this way, it is called a psychotic episode. Psychosis is a psychiatric syndrome that most commonly occurs in young adults. Around 1 in 50 people will experience a psychotic episode in their lifetime.

Signs and Symptoms

Psychosis is not a specific illness, rather it is a syndrome. The central characteristic of psychosis is a loss of reality testing, resulting in some degree of impairment of judgement and abnormal behaviour. Psychotic symptoms may present with a disturbance of perception, such as hallucinations (where they hear voices or see things that do not exist) or disturbance of thinking, such as disordered thinking or delusions (false beliefs that they are going to be harmed or that people are talking about them).

Even before the onset of clear psychotic symptoms that are characteristic of psychosis, there is usually a period with some changes in mood, thinking or behaviour along with a deterioration in functioning.

Perceptual disturbances such as feelings that things around have changed. The person may

  • experience heightened senses
  • hear voices
  • see things that others cannot see

Mood disturbances such as anxiety, depression, mood swings, irritability and anger. The person may

  • feel sad and irritable more often
  • feel isolated
  • be confused or puzzled
  • feel that he is unable to trust anyone
  • feel that he is being constantly watched

Behavioural disturbances include changes in sleep and appetite patterns, social withdrawal, loss of interest in things, deterioration in occupation and academic functioning. The person may

  • have difficulty sleeping
  • talk or smile to himself
  • neglect his appearance
  • avoid contact with people
  • behave aggressively

Cognitive disturbances include poor attention and concentration, difficulties in thinking, suspiciousness and unusual beliefs

Different people will probably interpret these disturbances differently. Some may see them as symptoms of stress, especially if the changes are associated with some stressful life events. Others may see them as part of the person’s personality. Cultural influences may also play a part in how the symptoms of psychosis are interpreted. Psychotic symptoms are often attributed to supernatural causes rather than biological causes.

One’s personal understanding of the disturbances will determine if an individual will seek help. Even for those who suspect that it may be a mental condition, the stigma of seeking psychiatric help may deter them from consulting a psychiatrist. It is not surprising that there is often a long delay, for sometimes even a few years, before the person reaches out for professional help.


The exact causation of psychosis is thought to be related to neurological and biochemical changes that occur in a person’s brain during their teenage and early adulthood years.

Having a close family member with a psychotic illness, the use of recreational drugs or a history of intermittent brief psychotic symptoms may predispose someone to developing a psychotic disorder. However, most people suffering from a psychotic disorder do not have these risk factors.

If changes in the individual’s behaviour and functioning are observed and the individual also has associated risk factors as mentioned above, it would be best to refer him early for further evaluation to see if he has psychosis, and for treatment if necessary.


Research shows that early detection – and treatment – of psychosis is associated with a better prognosis. It can be treated and most people make a good recovery.

There are new and effective medicines, as well as improved treatment programmes that optimise recovery and functioning and which contribute to a better outcome for individuals with psychosis.

Besides medication, counselling, and psychotherapy, practical assistance such as getting help with school or work and arranging accommodation are other important aspects of treatment.

The Early Psychosis Intervention Programme (EPIP) at the Institute of Mental Health (IMH) emphasises early detection and treatment. The team works closely with healthcare professionals in other hospitals, polyclinics and social agencies to help spot the early signs of psychosis amongst those aged 18 to 40. EPIP also works with educational institutions and youth workers to identify the onset of psychosis amongst the young. For more information, please visit their website or contact EPIP at 6389 2972 between 9am to 5pm on Mondays to Fridays.

IMH also provides assessment and treatment for individuals with psychosis in other age groups. To make an appointment to see a doctor, please call the IMH appointment line at 6389 2200.

Republished with permission from Institute of Mental Health (IMH).