While the exact cause of psychosis is unknown, research indicates that it often results from a combination of genetic, biological, environmental, and psychological factors.

Biological factors:

• Genetic traits or chemical imbalances in the brain can increase vulnerability to psychosis.
• Some seniors may be prone to psychosis, and life stresses trigger psychotic episodes. Stresses can include managing work stresses, dealing with family disagreements, financial concerns, and ongoing relationship challenges with loved ones.
• Psychosis can sometimes arise from other medical conditions such as HIV, Alzheimer’s disease, Parkinson's disease, or brain tumours. Moreover, delirium, depression, or dementia can also trigger psychotic symptoms.

Substance abuse:

• Misuse of alcohol or drugs can cause psychotic episodes.
• Withdrawal from long-term alcohol/drugs may also trigger psychosis. Withdrawal symptoms can include headaches, fatigue, difficulty sleeping, and irritability, which may further complicate the recovery process.

Therefore, proper medical supervision and support, such as services offered by the National Addictions Management Service (NAMS) are crucial for seniors undergoing treatment for substance use disorders to minimise the risk of psychosis and other severe withdrawal symptoms.

Psychological factors:

• Mental health conditions like schizophrenia, depression, and bipolar disorder.
• Sleep deprivation.
• Severe prolonged stress or trauma.

Social factors:

• Loneliness.
• Loss of a loved one.
• Financial struggles.

Psychosis can show up in different ways, but common signs include changes in perception, thinking, emotions, and behaviour.

These changes can be distressing and may make it harder to cope with daily activities or connect with others.

Early signs of psychosis:

Early signs of psychosis in individuals can sometimes be mistaken for normal ageing or conditions like dementia.

However, recognising these signs early is crucial for proper intervention. Common early indicators include:

• Changes in perception:
  • Hearing, seeing, or feeling things that others do not (hallucinations), such as hearing voices or seeing figures that aren’t there.
  • Difficulty distinguishing between reality and imagination, which might lead to confusion about familiar people or surroundings.
• Disorganised thinking or speech:
  • Trouble following conversations or remembering what was just said.
  • Jumping between unrelated topics or expressing fragmented, disconnected ideas.
• Paranoia or suspicion:
  • Increased distrust, such as believing family members are stealing or plotting against them.
  • Persistent fears of harm or conspiracy, which may intensify or persist over time.
• Social withdrawal:
  • Avoiding interactions with family and friends, isolating themselves, losing interest in hobbies or activities they once enjoyed.
  • Expressing feelings of loneliness or detachment from others.
• Emotional changes:
  • Rapid mood swings or showing little to no emotional response in situations that usually evoke emotions.
  • Increased irritablility, anxiety, or unexplained signs of depression.
• Decline in daily functioning:
  • Struggling with routine task like personal care, cooking, or managing finances.
  • Neglecting personal hygiene or showing difficulty in caring for themselves.
• Unusual or bizarre behaviour:
  • Behaviours that seem out of character, such as talking to themselves, making strange movements, or having inappropriate reactions to everyday situations.
  • Acting in ways that seem confusing or distressing to caregivers or family members.
• Changes in sleep patterns:
  • Difficulty sleeping, waking frequently at night, or excessive daytime sleeping.
  • Sleep disruptions may worsen confusion and disconnection from reality.

Click here to learn more about the signs and symptoms of dementia.

Later signs of psychosis

As psychosis progresses, symptoms often become more severe, affecting the individual’s daily life and interactions:

• Severe social isolation: Some may withdraw completely, refusing to leave their home or avoiding close family and friends. They might grow increasingly distrustful of others, even those they were once close to.
• Marked cognitive decline: Memory issues, confusion about time or place, and difficulty recognising familiar people or surroundings may worsen. These symptoms can sometimes be mistaken for dementia, but they stem from psychosis.
• Fixed delusions: Paranoid or unusual beliefs become stronger and harder to change. Such as thinking that their home is bugged, that people are trying to harm them, or that they are being followed.
• Disorganised thinking and speech: Individuals may have trouble communicating clearly. They might talk in a confusing way, switch topics suddenly, and seem scattered in their thoughts.
• Intense mood swings: Individuals rapidly shift from being overly happy to deeply depressed or angry. In some cases, they may display little to no emotional response to what’s happening around them.
• Risky or aggressive behaviour: Their behaviour may become unpredictable or unsafe. They might also act aggressively towards others and react to things that aren’t real. Some may even take risks, like wandering outside at night or try to run away from imaginary threats.
• Persistent hallucinations: Some may experience more frequent and realistic hallucinations. They might hear voices, see things that aren’t there, or feel things that have no physical causes. These experiences can be very stressful or scary for them.
• Severe sleep disruption: Sleep problems may worsen, such as lack of sleep due to anxiety or sleeping too much.