Psychosis is a medical condition characterized by a disruption in a person’s thoughts and perceptions, leading to a loss of contact with reality. Individuals experiencing psychosis may have hallucinations, such as hearing or seeing things that are not present, or delusions, which are firm beliefs not based in reality. This article provides an overview of key statistics related to the occurrence, patterns, associated conditions, and outcomes of psychosis.
Overall Occurrence of Psychosis
Psychosis affects a significant portion of the global population. Pooled median global prevalence rates for psychotic disorders are estimated at 4.6 per 1,000 people. The point prevalence, or the number of cases at a specific time, is approximately 3.89 per 1,000 persons, and the 12-month prevalence is around 4.03 per 1,000 persons. The median lifetime prevalence is 7.49 per 1,000 individuals.
In the United States, about 3% of the population will experience at least one psychotic episode in their lifetime. Annually, approximately 100,000 teenagers and young adults in the U.S. experience a first psychotic episode. Estimates for diagnosed psychotic disorders in the U.S. range from 0.25% to 0.64%. Globally, around 0.33% to 0.75% of non-institutionalized individuals are affected by schizophrenia.
Incidence rates of psychotic disorders can vary significantly across regions. A large international study found the overall incidence to be 21.4 per 100,000 person-years, with rates differing by almost eight times between areas. For example, rural areas near Santiago, Spain, reported a low of 6.0 per 100,000 person-years, while inner-city Paris and Southeast London showed rates over 45 per 100,000 person-years.
Demographic Patterns and Risk Factors
Psychosis often emerges during late adolescence and early adulthood. The average age of onset for schizophrenia is between 25 and 27 years globally. Males tend to experience an earlier onset, in their late teens to early 20s, while females are more often diagnosed in their late 20s to early 30s. Psychosis is rare before age 12 or after age 40.
While no consistent gender differences are found in the overall prevalence of schizophrenia, incidence studies report higher rates in males. Psychosis incidence has also been associated with younger age and ethnic minority status.
Socioeconomic status (SES) correlates with psychosis statistics. Studies indicate higher rates of schizophrenia in lower SES groups and in low-income areas. Urban living is consistently associated with an increased risk of developing schizophrenia, with the risk estimated to be 2.37 times higher in the most urban environments compared to the most rural.
Genetic factors play a role in the development of psychosis, with twin studies estimating that psychotic experiences are 30-50% heritable. If one identical twin develops psychosis, the other twin has about a 50% chance of developing the same illness. The lifetime risk for schizophrenia is around 0.8-1% in the general population, but increases to 8-10% in siblings of an affected individual and nearly 50% if both parents are affected.
Substance use is a risk factor for psychosis. Cannabis use, particularly early and heavy use, has been linked to an increased risk of psychotic disorders and schizophrenia. Methamphetamine use is also associated with psychosis, with features like hallucinations and paranoid delusions occurring in 15-30% of recreational users and up to 60% in inpatient settings.
Trauma exposure, especially in childhood, is associated with a higher risk of developing a psychotic disorder. Adults who experienced childhood trauma are three times more likely to develop a psychotic disorder. Exposure to multiple types of trauma is linked to a greater risk of psychosis and an increased likelihood of transitioning from clinical high-risk to full psychosis.
Psychosis in Specific Conditions
Psychosis is a symptom that can manifest across various mental health conditions rather than being a standalone diagnosis. Schizophrenia is a condition where psychosis is a core feature, affecting approximately 0.3% to 0.7% of the general population during their lifetime, or about 24 million people worldwide as of 2022. In 2017, there were an estimated 1.1 million new cases globally.
Bipolar disorder includes psychotic features during severe mood episodes. More than half of individuals with bipolar disorder experience psychotic symptoms during their lifetimes. Psychotic symptoms are more common during manic or mixed episodes (40-60%) than during depressive episodes (around 20%).
Major depressive disorder can also present with psychotic features, known as psychotic depression. About 18.5% of individuals with major depressive episodes experience psychotic features, representing a current prevalence of 0.4% in the general population. Feelings of worthlessness or guilt are frequently associated with delusions and hallucinations in these cases.
Substance-induced psychosis is another category, where the use or withdrawal from certain substances triggers psychotic symptoms. Cannabis use is linked to psychotic symptoms, with higher rates in those with severe dependence. Methamphetamine use is also associated with psychotic features. Other substances like cocaine, amphetamines, and opiates are also linked to substance-induced psychosis, with rates varying based on dependence severity.
Medical conditions can also lead to psychotic episodes. These include neurological conditions such as dementia, epilepsy, Huntington’s disease, multiple sclerosis, and stroke. Autoimmune conditions like HIV/AIDS and lupus, as well as brain tumors, severe infections, and hypoglycemia, have also been known to trigger psychosis.
Treatment, Recovery, and Prognosis
Seeking treatment for psychosis can be challenging for individuals. Globally, more than two out of three people with psychosis do not receive specialized mental health care. In the U.S., approximately 30% of individuals reporting 12-month psychosis-like experiences sought mental health treatment within that period. Unawareness of the illness, societal stigma, and financial limitations are common factors contributing to delays in seeking help.
Recovery rates for first-episode psychosis vary. More than half of patients achieve symptomatic remission around four years after the first episode. About one-third of individuals achieve recovery, which includes both symptomatic and functional improvement, after 5.5 years. Recovery rates for individuals with a bipolar diagnosis are higher compared to those with a schizophrenia spectrum diagnosis.
Relapse is a common concern in psychosis. Rates of relapse following a first episode of psychosis are around 28% at one year post-treatment and can increase to 54% at three years post-treatment. Factors that increase the risk of relapse include substance use disorders, poor medication adherence, and high levels of critical comments from family.
Long-term outcomes for psychotic disorders can vary. For individuals with first-episode psychosis, outcomes range from good to poor. Schizophrenia is associated with significant disability and can result in a life expectancy 15-20 years shorter than the general population. Suicide is a serious concern, with about 5% of individuals with schizophrenia dying by suicide during their lifetimes. Cardiovascular diseases are the leading cause of death in people with schizophrenia, accounting for more excess deaths than suicide and occurring at a mean age 10 years younger than in the general population.