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[sorry this is so long].
As someone alluded to, I think if you're aware of 'it' (whatever it is), question it, it's likely not psychosis. I hesitate to say something is *always* the case, but I think mostly it will be something others will notice and you likely will not, because you will fully believe in it.
This is when I was started on Seroquel (before that, just Lamictal and klonopin): The episode began somewhat typically (for me) with pressured speech, feeling like I was brilliant and unstoppable and everyone else was extremely slow, not sleeping, very sensitive to loud noises, etc. Then I started to get paranoid about some people I work with, believing that they were out to get me.
What followed was very specific to my situation at the time and probably not typical; I suppose in some ways it makes sense that the delusions you have will be affected by/have something to do with your environment at the time, but maybe this isn't always the case, I don't know.
So in the middle of this episode, I had been told by my gynecologist that I had an ovarian cyst, but they weren't sure exactly what kind it was (just that it wasn't cancerous). At some point I started to get the feeling that I had this foreign entity growing inside of me, not part of me, but something that had gotten in there, hard to explain. Over time (maybe a week) it quickly degenerated into me believing that an evil monster was inside of me, it was growing and taking over, it was trying to hurt me. As I became more and more agitated, I starting becoming desperate to get 'it' out of me however I could, I fantasized about tearing my insides out, I was terrified of this monster, raging against it, it had to come out.
I'm extremely lucky that I had/have a therapist (I didn't have a pdoc appt scheduled during that time) because I was fully convinced of all of this and it took him to get me help --he contacted my psychiatrist and ipso facto, knocked into oblivion by boatloads of Seroquel. I took some time off from work (no hospital, no way), little by little came back to myself. Both my therapist and I regretted not medicating this earlier, but we talked about it and have since become far more sensitive to/aware of warning signs (he was aware of my disorder, but this was the first time I had had an episode since starting to see him, it had been a couple of years since I had had an episode).
Maybe if there hadn't been the ovary thing I would have fixated on/become deluded about something else, but that was the situation at the time and that's how it happened. I had had paranoia before (and once since) but never such a bizarre delusion. It was absolutely terrifying. Towards the end I literally felt myself separating from myself, like I was being taken over by someone/something else (that has happened once before, and I think was independent of the ovary thing).
Again, probably not a typical example, but I thought I'd share. Maybe the take-home point was that I evidently had a very loose grip on reality and the whole thing started with the typical symptoms and degenerated with time. Uhh, it makes me shudder to think about it -I hope something like that never happens again, but I think with the stronger meds, self-care, and more awareness, it hopefully will not.
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