Most people think of psychosis as a break with reality. In a way it is. Psychosis is characterized as disruptions to a person’s thoughts and perceptions that make it difficult for them to recognize what is real and what isn’t. These disruptions are often experienced as seeing, hearing and believing things that aren’t real or having strange, persistent thoughts, behaviors and emotions. While everyone’s experience is different, most people say psychosis is frightening and confusing.
Psychosis is a symptom, not an illness, and it is more common than you may think. In the U.S., approximately 100,000 young people experience psychosis each year. As many as three in 100 people will have an episode at some point in their lives.
Early or first-episode psychosis (FEP) refers to when a person first shows signs of beginning to lose contact with reality. Acting quickly to connect a person with the right treatment during early psychosis or FEP can be life-changing and radically alter that person’s future.
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Early Warning Signs Before Psychosis
Early psychosis or FEP rarely comes suddenly. Usually, a person has gradual, non-specific changes in thoughts and perceptions, but doesn’t understand what’s going on. Early warning signs can be difficult to distinguish from typical teen or young adult behavior. While such signs should not be cause for alarm, they may indicate the need to get an assessment from a doctor.
Encouraging people to seek help for early psychosis is important. Families are often the first to see early signs of psychosis and the first to address the issue of seeking treatment. However, a person’s willingness to accept help is often complicated by delusions, fears, stigma and feeling unsettled. In this case, families can find the situation extremely difficult, but there are engagement strategies to help encourage a person to seek help.
It’s important to get help quickly since early treatment provides the best hope of recovery by slowing, stopping and possibly reversing the effects of psychosis. Early warning signs include the following:
- A worrisome drop in grades or job performance
- Trouble thinking clearly or concentrating
- Suspiciousness or uneasiness with others
- A decline in self-care or personal hygiene
- Spending a lot more time alone than usual
- Strong, inappropriate emotions or having no feelings at all
Signs Of Early Or First-Episode Psychosis
Determining exactly when the first episode of psychosis begins can be hard, but these signs and symptoms strongly indicate an episode of psychosis:
- Hearing, seeing, tasting or believing things that others don’t
- Persistent, unusual thoughts or beliefs that can’t be set aside regardless of what others believe
- Strong and inappropriate emotions or no emotions at all
- Withdrawing from family or friends
- A sudden decline in self-care
- Trouble thinking clearly or concentrating
Such warning signs often point to a person’s deteriorating health, and a physical and neurological evaluation can help find the problem. A mental health professional performing a psychological evaluation can determine if a mental health condition is involved and discuss next steps. If the psychosis is a symptom of a mental health condition, early action helps to keep lives on track.
Psychosis includes a range of symptoms but typically involves one of these two major experiences:
Hallucinations are seeing, hearing or feeling things that aren’t there, such as the following:
- Hearing voices (auditory hallucinations)
- Strange sensations or unexplainable feelings
- Seeing glimpses of objects or people that are not there or distortions
Delusions are strong beliefs that are not consistent with the person’s culture, are unlikely to be true and may seem irrational to others, such as the following:
- Believing external forces are controlling thoughts, feelings and behaviors
- Believing that trivial remarks, events or objects have personal meaning or significance
- Thinking you have special powers, are on a special mission or even that you are God.
We are still learning about how and why psychosis develops, but several factors are likely involved. We do know that teenagers and young adults are at increased risk of experiencing an episode of psychosis because of hormonal changes in their brain during puberty.
Several factors that can contribute to psychosis:
- Genetics. Many genes can contribute to the development of psychosis, but just because a person has a gene doesn’t mean they will experience psychosis. Ongoing studies will help us better understand which genes play a role in psychosis.
- Trauma. A traumatic event such as a death, war or sexual assault can trigger a psychotic episode. The type of trauma—and a person’s age—affects whether a traumatic event will result in psychosis.
- Substance use. The use of marijuana, LSD, amphetamines and other substances can increase the risk of psychosis in people who are already vulnerable.
- Physical illness or injury. Traumatic brain injuries, brain tumors, strokes, HIV and some brain diseases such as Parkinson’s, Alzheimer’s and dementia can sometimes cause psychosis.
- Mental health conditions. Sometimes psychosis is a symptom of a condition like schizophrenia, schizoaffective disorder, bipolar disorder or depression.
A diagnosis identifies an illness; symptoms are components of an illness. Health care providers draw on information from medical and family history and a physical examination to diagnose someone. If causes such as a brain tumor, infection or epilepsy are ruled out, a mental illness might be the reason.
If the cause is related to a mental health condition, early diagnosis and treatment provide the best hope of recovery. Research shows that the earlier people experiencing psychosis receive treatment, the better their long-term quality of life.
Early Psychosis And Psychosis
The most effective treatment for early psychosis is Coordinated Specialty Care (CSC). The earlier a person experiencing psychosis receives CSC, the better his or her quality of life becomes. CSC’s team-based approach encourages the individual experiencing early psychosis to share in decisions about treatment and recovery goals.
CSC programs have six components:
- Case management—helping the individual develop problem-solving skills, manage medication and coordinate services
- Family support and education—giving families information and skills to support a loved one’s treatment and recovery
- Psychotherapy—learning to focus on resiliency, managing the condition, promoting wellness and developing coping skills
- Medication management—finding the best medication at the lowest possible dose
- Supported education and employment—supporting someone to continue or return to school or work
- Peer support—connecting the person with others who have been through similar experiences
Each component is provided by a team of specially trained healthcare professionals who help individuals get their lives back on track and realize their goals, such as finishing school or returning to work.
Treatment for psychosis often involves a combination of psychotherapy and medication. Several types of therapy can help individuals learn to manage their condition, while medication targets symptoms and helps to reduce their impact. How well treatment works depends on the cause(s) of the psychosis, its severity and its duration.
Therapy is essential in treating psychosis. Common therapies include the following:
- Cognitive behavioral therapy (CBT)—teaches people to observe and change ineffective patterns of thinking. For psychosis, CBT teaches someone to critically evaluate an experience to determine whether or not the experience is real.
- Supportive psychotherapy—teaches a person to cope with developing and living with psychosis. The therapist attempts to reinforce a person’s healthy ways of thinking and reduce internal conflict.
- Cognitive enhancement therapy (CET)—builds brain capacity through the use of computer exercises and group work. Increasing cognitive functions, such as the ability to organize thoughts, is the ultimate goal.
- Family psychoeducation and support—gives families skills and support to help a loved one reach recovery. NAMI Basics, NAMI Family-To-Family and NAMI Family Support Groups are examples of programs the help people develop skills in collaboration, problem-solving and recovery support.
- Peer support and support—connects people with others who have been through similar experiences. NAMI Peer-To-Peer and NAMI Connection are examples of peer-led programs that equip individuals with the tools they need to realize recovery while building supportive, caring relationships.