Schizophrenia and psychosis: signs, causes and treatment
Psychosis is a state in which a person loses touch with reality: they may hear voices other people cannot hear, hold fixed false beliefs such as being poisoned or followed, or speak and behave in a confused way. Schizophrenia is one long-term condition that causes psychosis, but psychosis can also come from bipolar disorder, severe depression, drugs such as cannabis or crystal meth, or a physical illness. Both are treatable with antipsychotic medicine, talking therapy and family support, and the earlier treatment starts, the better the recovery usually is.
Health writers · Aslam Clinic
is a state in which a person's mind stops reliably telling what is real from what is not. They may hear voices no one else hears, become certain of something that is plainly untrue — that neighbours are poisoning their food, that the television is speaking about them — or talk and act in a way that no longer hangs together. is one long-term condition that causes psychosis, but it is not the only one. Both are medical conditions, both are treatable, and a large share of people recover well, especially when treatment starts early.
This page is for families as much as for patients, because in psychosis the person who is ill often does not believe anything is wrong. That is a feature of the illness, not stubbornness, and it is usually a relative who first has to act.
Psychosis and schizophrenia are not the same thing
Psychosis describes a set of symptoms. Schizophrenia is a diagnosis a psychiatrist makes when psychotic symptoms last (for at least a month, and usually much longer) and are not better explained by something else. The World Health Organization describes schizophrenia as a mix of lasting , , disorganised thinking and behaviour, and so-called negative symptoms such as very limited speech and flattened emotion, along with problems with memory and attention.
| Type of symptom | What it looks like | What a family might notice |
|---|---|---|
| Hallucinations | Hearing, seeing or feeling things that are not there; hearing voices is the most common | Talking or laughing to no one, covering ears, asking who is speaking in an empty room |
| Delusions | Fixed, false beliefs that do not change with evidence | Certainty of being watched, followed, poisoned or targeted by magic; refusing food from family |
| Disorganised thinking | Thoughts that jump or do not connect | Speech that is hard to follow, answers that do not fit the question |
| Negative symptoms | Loss of drive, feeling and interest | Staying in the room, stopping bathing, little expression, dropping out of studies or work |
| Cognitive symptoms | Poor concentration and memory | Cannot follow a drama, read a page or keep track of a conversation |
Other causes of psychosis include , very severe depression, psychosis after childbirth, drugs (cannabis, methamphetamine or 'ice', and withdrawal from alcohol), some prescribed medicines, and physical conditions such as brain infections, head injury and tumours. Finding the cause is the first job of the doctor, which is why a person with new psychosis should have a physical examination and blood tests, not only a psychiatric interview.
Early warning signs
Schizophrenia rarely begins overnight. The NHS notes that quieter changes often appear months or even years before the first obvious episode — a period doctors call the prodrome. It usually begins in the late teens or twenties, a little earlier in men than in women, which is why these signs are easily mistaken for ordinary teenage moodiness or 'bad company'.
- Pulling away from friends and family, and spending long hours alone
- A clear fall in studies or work — a good student suddenly failing, a reliable worker stopping going
- Sleeping at odd times or hardly at all
- Growing suspiciousness, or new odd ideas about special meanings and messages
- Neglecting washing, clothes and appearance
- Strange or muddled speech, or hearing faint sounds or whispers
One of these on its own means little. Several together, getting worse over weeks — especially in someone with a close relative who has had psychosis — deserve an assessment. NICE advises that people like this are seen by a specialist without delay; the treatment offered at this stage is and support for any anxiety, depression or drug use, not antipsychotic medicine.
What causes it
There is no single cause. WHO describes schizophrenia as the result of an interaction between genes and a range of environmental factors. Having a parent or sibling with psychosis raises the risk, but most people with a family history never develop it. Stress, trauma and major life upheaval can act as triggers in someone already vulnerable. It is not caused by bad parenting, by weakness of character, or by lack of faith.
Cannabis matters, and in Pakistan that includes charas. In a large study across Europe and Brazil published in The Lancet Psychiatry in 2019, people who used cannabis every day had about three times the odds of a psychotic disorder compared with people who had never used it, and daily use of high-potency cannabis raised the odds nearly fivefold. Stimulants such as crystal meth ('ice') can cause psychosis directly. For someone who has had one episode, continuing to use these drugs is one of the strongest predictors of another.
Treatment for a first episode — and why speed matters
In the UK, NICE expects people with a first episode of psychosis to start treatment with a specialist early-intervention team within two weeks of referral. The reason is simple: the longer psychosis goes untreated, the slower and less complete recovery tends to be. A 2026 study from Peshawar found that young people with psychosis had, on average, already visited three traditional or spiritual healers before reaching a hospital — months in which the illness was entrenching.
In Pakistan, the place to start is the psychiatry department of a district (DHQ) or teaching hospital, or a private psychiatrist. Good first-episode care usually combines:
- An medicine, chosen together with the psychiatrist after discussing likely benefits and side effects.
- Talking therapy — CBT for psychosis helps a person make sense of voices and beliefs, cope with distress and spot early signs of relapse.
- Family intervention — NICE recommends at least ten planned sessions over three months to a year for families living with someone with psychosis.
- Practical help to return to studies or work, and treatment of any drug or alcohol use.
Recovery is realistic. WHO notes that at least one in three people with schizophrenia achieve complete remission of symptoms, and many more live full lives with some ongoing support.
Antipsychotics: what to expect
Commonly used antipsychotics include risperidone, olanzapine, quetiapine, aripiprazole and haloperidol. Some are available as a long-acting injection given every few weeks, which suits people who find daily tablets hard. If two different antipsychotics have been tried properly and have not worked, NICE recommends clozapine, which needs regular blood tests.
Every antipsychotic has possible side effects, and they differ between medicines: drowsiness, stiffness or shaking, an inner restlessness, changes to periods or breast tissue, sexual problems, constipation, and — for several of the newer ones — weight gain and rises in blood sugar and cholesterol. Tell the doctor about any of these; there is usually something that can be changed.
Weight, blood sugar and the heart
People with schizophrenia die, on average, about nine years earlier than the general population, according to WHO — mostly from heart disease, diabetes and other physical illnesses rather than from the mental illness itself. Some antipsychotics, olanzapine and clozapine in particular, can cause marked weight gain and push blood sugar up. In a country where type 2 diabetes is already very common, this monitoring is not optional.
If weight or sugar rises, the answer is not to stop the medicine at home. The psychiatrist can switch to a medicine with fewer metabolic effects, and the family doctor can treat raised sugar or blood pressure like in anyone else. Cutting down on sugary tea and soft drinks, and walking daily, help more than most people expect.
Faith, healers and the family
Many Pakistani families first understand psychosis as jinn, nazar or sehr, and take their relative to a pir, a shrine or a spiritual healer. That is understandable, and prayer, dua and the support of a faith community can be a real comfort. Faith and medical treatment are not in conflict. But hallucinations and delusions need a doctor as well, because the brain illness underneath them responds to treatment and gets harder to treat the longer it is left.
Some practices do direct harm. Families in the Peshawar study described relatives with severe mental illness being locked away out of shame, sometimes in chains, and psychiatrists in Pakistan have documented people with mental illness chained at shrines for long periods; many were able to leave their chains within weeks once they received medicine. Chaining, beating, starving or locking someone away is never treatment. The same study found that shame fell hardest on young women, whose illness was often hidden to protect marriage prospects. Marriage is not a treatment for psychosis, and hiding the illness usually makes it worse for everyone.
Preventing relapse
Most relapses give some warning. With the psychiatrist, write down this person's early signs — often poor sleep, withdrawal, irritability or a return of suspicious ideas — and agree what the family will do if they appear.
- Keep taking the medicine and keep follow-up appointments, even when well.
- Avoid cannabis, charas, ice and alcohol completely.
- Protect sleep; several nights of very little sleep are a common early sign and a trigger.
- Keep home as calm and predictable as you can. Constant criticism and heated arguments are hard on anyone recovering from psychosis; warmth and clear routines help.
- Keep the psychiatrist's number and the nearest emergency department's location somewhere everyone can find them.
How families can help
- Do not argue about the voices or beliefs. You can say, 'I don't hear it, but I can see it is frightening for you', which is honest without being a fight.
- Speak simply and calmly, one thing at a time; a person with psychosis may struggle to follow long conversations.
- Focus on what the person does want — better sleep, less fear, getting back to college — as the reason to see a doctor.
- Go with them to appointments, and ask for for the family: what the illness is, what the medicines do and what relapse looks like.
- Look after yourselves. Caring for someone with psychosis is exhausting, and carers' own stress, depression and deserve attention too.
Common questions
Still not sure what to do?
Reading about a symptom only goes so far. A doctor who can ask you questions and examine you will get further in ten minutes than any article can.
