Schizophrenia and Psychosis: What's the Difference?

What is Psychosis?

Psychosis is a psychiatric term for losing touch with reality. It is a very broad term and the severity of it can range from mildly unusual experiences to severely impaired thinking. The main symptoms of psychosis are hallucinations (e.g. hearing voices) and delusions (believing something that is obviously untrue) but it can also result in low moods and stop a person from continuing daily life as normal.

Psychosis can be caused by very different reasons, from mental illness to physical reasons. Parkinson's Disease can bring on an episode of psychosis, as can drugs or alcohol. However, drug and alcohol induced psychosis doesn't usually last very long and can be as short as a few days. When a person is suffering from psychosis, they are said to be having a psychotic episode.

Recovery from psychosis varies, and sufferers can have a one-off episode and never become unwell with psychosis again. Others can have repeated episodes throughout their life but be well in between. Around a quarter of people who have a psychotic episode never experience psychosis again.

What is Schizophrenia?

Schizophrenia is a psychiatric term for losing touch with reality. It is a very broad term and the severity of it can range from mildly unusual experiences to severely impaired thinking. The main symptoms of schizophrenia are hallucinations (e.g. hearing voices) and delusions (believing something that is obviously untrue) and it often results in low moods and stops a person from continuing daily life as normal.

So, What’s the Difference?

Aside from the frustration that sufferers feel when trying to spell those two words, psychosis and schizophrenia have a lot in common. In one sense they are the same thing. However, psychosis isn’t a diagnosis as such. It can be used as a diagnosis though; I was initially diagnosed with psychosis. However, with schizophrenia, a sufferer will have had multiple psychotic episodes within a six-month period, or one long psychotic episode of around that length.

For the diagnosis of schizophrenia to be made, a sufferer would often have other symptoms such as disorganised speech and thinking (such as an inability to a complete sentence or for their speech or thoughts to change subjects multiple times in a short timeframe). However, if the symptoms of psychosis are particularly ‘bizarre’, the other symptoms aren’t always necessary for diagnosis. A ‘bizarre’ symptom of psychosis would be if the sufferer truly believed that they were under investigation from the CIA because they had worn red lipstick when they were sixteen.

Those who have bipolar can also suffer from psychosis. These sufferers usually experience the stereotypical symptoms of bipolar, very high and low moods, along with the classic symptoms of psychosis, hallucinations and delusions.

With schizophrenia, the prognosis varies from person to person. Like psychosis, someone with schizophrenia can suffer for a prolonged period of time but never relapse and remain well for the rest of their life. Others may have relapses but remain well in between. However, some never recover to a suitable standard of living. Estimates at the percentage of this group vary from between a quarter of sufferers to a third.

How Are They Treated?

Schizophrenia and psychosis always require treatment but opinions as to what the treatment should be varies widely across the world. In the UK, the treatment of choice is antipsychotics and talking therapy but other countries use other types of medications alongside therapy. There are also specialist teams available. The success rates of all treatments vary and therefore, a person should always have a say in their treatment.

As the symptoms of schizophrenia and psychosis vary from person to person, it would make sense that treatment would vary from person to person. Sadly, that is not always the case in this country. However, with several different medications and talking therapy available, it is possible to find a treatment that is highly effective.

Unfortunately, as psychiatry can be like a guessing game at times, finding the effective treatment can take time. The best thing to do, is if you find a treatment that works, stick with it. If it is medication, stay on it for as long as you feel is necessary, even if that is many years. If you choose to come off medication, always do it under supervision from a doctor or psychiatrist and always reduce slowly. If talking therapy is what you find effective, keep attending until the therapist says that you are strong enough to finish. That doesn’t mean that you will be without any support though.

Even after a person is stable and in long-term recovery, community support will usually be given for a lengthy period of time. Regular reviews with a psychiatrist should also occur, at least twice a year for a few years. This is to ensure that a person does not become unwell and suffer another psychotic episode.

How to Stay Well

When in recovery, a person should always make a list of their early warning signs (see below) and formulate a plan with their care team (psychiatrist, CPN (Community Psychiatric Nurse) for example) for what to do if they think they are becoming unwell again. The basic plan should be that if a person notices that they are experiencing some of their early warning signs, they should contact their care team immediately. However, it would be useful for the person along with their care team to detail what steps will be taken if the early warning signs start showing.

This could be having more intensive support in the community for a while, or it could be increasing a medication. It may feel like a setback, but as with any illness, it is better to catch it early. Catching it early can prevent a full-blown psychotic episode, and with support, a person can continue to live as before.

The Prognosis

The prognosis for psychosis and schizophrenia, the latter in particularly, used to be very poor. Sufferers weren’t expected to be able to live decent or fulfilling lives and essentially, it was like their life was over.

However, there is no reason anymore to stop a sufferer from working, living independently or starting a family if they feel able. Many people with schizophrenic and psychotic diagnoses do live these sorts of lives to great success, with and without support.

If you receive a poor prognosis, just remember that the doctor or psychiatrist isn’t always right. Six months before I came off antipsychotic medication, I was told that I would be on it for the foreseeable future, several years at least. They were wrong!

The life you want to live is possible. Keep fighting your illness, and that life can be yours!