Becoming psychotic means losing touch with reality momentarily and experiencing and handling it in an altered state.
Primarily, the sensory perceptions become “wayward” and thought erratically associative (schizophrenic psychoses) or these changes are rather an expression of wild fluctuations of mood and drive (affective psychosis) in a mostly depressive direction (unipolar) or in both, manic-depressive directions (bipolar).
This losing touch with reality can be a protective mechanism because the reality is too painful, the inconsistencies too great and decisions impossible or feelings difficult to bear. In the case of extreme stress (traumatic experience) or complete sensory deprivation even very stable people can, or rather must, react in this way. In very sensitive people, above all in times of instability, far fewer sensations or social breakups lead to psychotic reactions. This so-called vulnerability should not be seen as a preliminary phase of the disorder, but as the vulnerable flip side of the sensitivity. A specific momentum on a psychic, physical, social, family level can give the situation a life of its own and overall make it more difficult. Certain cognitive patterns can deepen the depression; changes in the cerebral metabolism can boost the sensitivity even further; social anxieties reinforce the isolation, family misunderstandings engross the inconsistencies.
The psychotic symptoms can assume quite various forms independently of inner wishes and anxieties and independently of the context of life. Psychotic symptoms are for example acoustic or optical hallucinations, delusions or change in thought. Persons afflicted hear e.g. voices, feel unrealistically threatened, persecuted or controlled, establish unrealistic connections between experiences and themselves, think that they can "read" the thoughts of other people or report that their thoughts are no longer as structured or ordered as they know from their own experience. Frequently, their behaviour also appears altered; they are no longer so efficient and productive as they once were and withdraw from friends and family. Besides this “symptom-oriented” perspective, other points of view also exist (see chapter “Understanding Psychoses”).