Truths and Misconceptions: Psychosis

Irnes Zeljkovic, Clinical Navigator, PEPP at LHSC

May 24, 2024

Psychosis does not discriminate based on socio-economic status, gender, culture or age.

Psychosis is a condition in which a person loses touch with reality. It is distinguished by symptoms such as hallucinations (i.e., hearing and seeing things that are not there), delusions (fixed beliefs that are not true), a flat affect and a decreased ability to concentrate and form sentences.  The person may exhibit a number of progressively unusual behaviours for them such as sleeping very little, isolating, and exhibiting changes in perceptions of their surroundings.

Psychosis is an often misunderstood diagnosis. There is support for those diagnosed with psychosis, and through early intervention, there is a chance for the individual to get better and lead a fulfilling life.  

Irnes Zeljkovic, a clinical navigator in the Prevention and Early Intervention Program for Psychoses (PEPP) at London Health Sciences Centre (LHSC) shares the truths behind the common misconceptions of psychosis.

Misconception: A psychosis diagnosis means a person is a psychopath.

Truth: Psychosis is a disconnection from reality and is temporary. A psychopath is a person with abnormal social behaviour that can use violence/harm towards another person to attain their own ends. “Psychopaths do not have psychosis,” explains Zeljkovic. “Those diagnosed with psychosis do not deliberately harm others. Their disconnection from reality makes them scared and confused and lessens interactions with others because of that. They are fearful and are more likely to harm themselves than others.”

Misconception: There is a single moment where the person “snaps” and experiences psychosis.

Truth: “We see in many movies where a person snaps because of one, singular event and they become dangerous or behave in an unusual manner. That is not the reality of psychosis,” says Zeljkovic.

For those experiencing psychosis, there is a gradual change in thinking, feeling, behaving and perception, not in personality. “A person may isolate, feel they are being followed or watched because they perceive dangers that are not there, but their personality does not change and they do not suddenly become dangerous,” Zeljkovic shares.

The development of psychosis has known roots in family history, unresolved trauma, anxiety and depression that continue for some time, environmental factors such as stressful school or work environments, unresolved family dynamics, general adversity in life and substance use.

Misconception: Drugs, such as marijuana, cannot induce psychosis.

Truth: Drugs, such as cocaine, crystal methamphetamine and marijuana have been linked to drug induced psychosis.

“When looking at substance induced psychosis with those three substances, we can look at some of the symptoms of their use,” Zeljkovic says. “Sometimes individuals can experience sleep disturbances, inappropriate laughter and paranoia from general use. As use increases with  frequency,duration and intensity, the symptoms from drug use begin to mirror those distinguishing symptoms of psychosis.”  

Misconception: Psychosis is a result of a character flaw.

Truth: Psychosis is not a behavioural problem. There are genetic (e.g., family history), physical (i.e., brain injury) and environmental (i.e. stress) factors that can contribute to the development of psychosis.  

“Developing psychosis does not result from having poor character,” Zeljkovic explains. “There are a number of factors that can contribute to the development of psychosis, but it does not result from any perceived ‘flaw’ in an individual.”

Misconception: When diagnosed with psychosis, one can no longer live a “normal” life.

Truth: Zeljkovic states. “A number of people recover from psychosis and lead productive lives. Some individuals may continue having some symptoms and still lead a good quality of life.”

Misconception: There is nothing you can do to help a loved one experiencing psychosis.

Truth: “There is treatment and there are ways that family and friends can help the individual with psychosis,” explains Zeljkovic. “As a loved one, it’s about being supportive and not confrontational around the individual’s loss of touch with reality. It’s about active listening and learning about the condition and being a part of your loved one’s recovery.”

At LHSC, there is an open referral process to PEPP, which means a doctor, community provider, friend or family member can refer the person experiencing psychosis to PEPP.

A person entering PEPP at LHSC meets with a psychiatrist to determine acuity and level of risk to themselves. The person also speaks with a case manager who meets the person where they’re at and works with them on short- and long-term goals. Within PEPP, there could be referrals to the recreational therapist, educational counsellor, work counsellor, clinical navigator and psychologist as appropriate and determined based on the individual’s needs.  

Often, if a family member or friend comes to the hospital with the individual experiencing psychosis, they will also attend the initial appointment so the psychiatrist and case manager can get a fuller understanding of the person’s psychosis and provide hope for the family and friends for the future of their loved one in recovery.

“Recovery is more likely if we increase social and occupational functioning in the community, bringing practice to reality,” Zeljkovic says. “We have a team of professionals in PEPP and community partners who work together with the aim of attaining the person’s short- and long-term goals. A long-term goal with patients experiencing psychosis is quality of life, and those short-term goals represent steps towards building that greater quality of life.” 

View the "Truths and Misconceptions: Psychosis" video transcript.