What Is Psychosis? Symptoms, Diagnosis And Treatment Explained

'I had to go to hospital because I thought I had blood on my hands – I could feel it and smell it. But there was nothing there.'

Psychosis symptoms can seem so real to those experiencing them that it is one of the harder mental illnesses to treat. Recalling the first time he started hearing voices four years ago, Tom Dunning says: “I lost a grip on reality. There would be voices I hadn’t heard before and they’d be derogatory, saying: ‘No one likes you’ or ‘you’re fat’.”

Dunning likens the experience to being surrounded by a crowd of people talking rather than being bombarded by internal thoughts – and his symptoms soon spiralled into visual hallucinations too. “One night I had to go to hospital because I thought I had blood on my hands – I could feel it and smell it. But there was nothing there,” recalls the 27-year-old from Lincoln.

One in 100 people will experience psychosis, where they perceive or interpret reality in a different way from people around them. But awareness is low and, in turn, stigma surrounding the mental illness is high.

Tom Dunning
Tom Dunning

Dunning experienced post traumatic stress disorder (PTSD) after the death of his brother which, looking back, he believes triggered his psychotic episodes. One particularly harrowing incident was when he hallucinated that his late brother was in the same room, staring at him with a blank expression.

“And then these voices would say ‘throw that against the wall’, ‘punch this’, ‘smash this’ and it was as if someone else had control,” Dunning tells HuffPost UK. “I could see what I was doing but I had no control, up until the house was absolutely destroyed.”

A person’s first episode of psychosis is likely to occur between the ages of 18 and 24, yet research from charity Rethink Mental Illness suggests fewer than one in five (17%) young people would be confident in spotting the early signs. Meanwhile one in four (26%) have never even heard of it.

Dunning, a process technician at British Sugar, says his partner threatened to leave because of his behaviour, but agreed to stay when he told her he would go to the doctors. It was at this point he realised the severity of his situation.

“I was signed off work for a year,” he says. During this time he underwent treatment with a psychiatrist, which included cognitive behavioural therapy (CBT), and a combination of antipsychotic medication and antidepressants.

Symptoms Of Psychosis

There are two main symptoms of psychosis, according to NHS Choices. These are: hallucinations, where a person hears, sees and, in some cases, feels, smells or tastes things that aren’t there; and delusions, where a person has strong beliefs that aren’t shared by others. A common delusion is someone believing there is a conspiracy to harm them.

While for some people hearing voices can be, to a certain degree, comforting (for example, if it’s the voice of a loved one who has passed away), in a lot of instances, hallucinations and delusions cause severe distress, making the person experiencing them feel anxious, scared, threatened or confused.


There isn’t a test to diagnose psychosis, which can make the process difficult. Often a GP will ask a variety of questions to try to get to the bottom of a patient’s symptoms and what is causing them. (Find out more about the types of questions asked here.)

If the GP suspects psychosis, they should refer the patient to a specialist mental health team, which should include a psychiatrist, who will then come up with a tailored treatment plan.


Leaving psychosis untreated can have serious consequences, warns Laura Peters, head of advice and information at Rethink Mental Illness. In the most serious cases, psychosis can become more severe and evolve into schizophrenia.

There’s also an emotional strain linked to hearing negative voices. “Many people who experience voices find that they’re extremely negative and intrusive, and that they never have a moment to themselves because of it,” Peters tells HuffPost UK. “The weight of this can often lead to suicidal thoughts.”

Treatment typically involves a combination of antipsychotic medication (to relieve symptoms of psychosis) and psychological therapies such as cognitive behavioural therapy (CBT), which explores the ways a person thinks, or family therapy, a form of group therapy carried out with loved ones.

After an episode of psychosis, most people will need to take medication for at least a year, according to the NHS. Around half (50%) of people need to take long-term medication to prevent their symptoms from coming back.

If the psychotic episodes are severe, the person may need to be admitted to a psychiatric hospital for treatment.

It’s worth adding that psychosis can impact a person’s ability to drive. People who are diagnosed need to tell the Driver and Vehicle Licensing Agency (DVLA) about any medical condition that could affect their driving ability.

“It’s okay to not be okay,” Dunning concludes. “If you had a broken arm, you’d go to the doctor. If you’re feeling depressed or are experiencing episodes, you’re unwell. And if you’re unwell, you go to a doctor.

“There’s no shame in asking for help.”

Advice For Loved Ones

It can be upsetting for people with psychosis if the people around them – the ones closest to them – dismiss their experiences, especially as these experiences can feel very real.

“Experiencing delusions is actually one of the reasons why treating mental illness can be quite difficult,” says Peters.

“Someone experiencing the delusion that there are cameras watching their every move in their house isn’t likely to be convinced when you show them evidence to the contrary. It’s more likely that they will become distressed because they’re not believed.”

In this instance, one of the most important things is to be patient – talking to your friend or relative is the best way to understand what they’re experiencing.

If their psychosis is particularly bad or the voices are intrusive to the point where they have become a danger to themselves or others around them, you need to call the emergency services.

Useful websites and helplines:

  • Mind, open Monday to Friday, 9am-6pm on 0300 123 3393
  • Samaritans offers a listening service which is open 24 hours a day, on 116 123 (UK and ROI - this number is FREE to call and will not appear on your phone bill.)
  • The Mix is a free support service for people under 25. Call 0808 808 4994 or email: help@themix.org.uk
  • Rethink Mental Illness offers practical help through its advice line which can be reached on 0300 5000 927 (open Monday to Friday 10am-4pm). More info can be found on www.rethink.org.