Psychosis is a mental health condition that causes disordered thinking and perceptions. It involves experiencing hallucinations, delusions, and impaired insight that indicates a disconnect from reality. The beginning of psychosis can be subtle and occur gradually, or it may have an abrupt onset. Catching and treating psychosis early is important to improve prognosis and minimize long-term disability.
What are the early warning signs of psychosis?
In the early stages, psychosis symptoms may be vague and not readily apparent as abnormal. However, looking back, the earliest signs may include:
- Social withdrawal and spending more time alone
- Increasing difficulty concentrating and declines in academic or work performance
- Growing difficulty sleeping and appetite changes resulting in weight loss or gain
- Lack of motivation and energy
- Feeling emotionally numb, empty, or cut off from feelings
- Irritability, anxiety, restlessness, or nervousness
- Increasingly warped or unusual thoughts
- Growing distrust of others
- Heightened sensitivity to sights, sounds, smells or touch
As psychosis progresses, more overt symptoms start to emerge:
- Difficulty thinking clearly or carrying on a conversation
- Strange or grandiose ideas not based in reality
- Hearing voices or sounds that are not real
- Seeing things that are not there
- Disorganized speech or behavior
- Strongly disorganized thinking or speech
- Difficulty perceiving reality (psychosis)
- Believing that people are out to harm them (paranoia)
When does psychosis usually begin?
Psychosis most commonly has its first onset in the late teens to mid-twenties. The average age of onset is:
- Males: 18-25 years old
- Females: 25-35 years old
However, psychosis can really begin at any age. Early onset psychosis refers to psychotic symptoms starting before age 18. It affects about 1 in 40,000 children, more often in boys than girls. Late onset psychosis occurs after age 40 and affects about 1 in 1,000 adults. The elderly are most vulnerable to late onset psychosis.
What causes psychosis?
Psychosis itself is not a diagnosis. It is a set of symptoms that can occur in different mental health disorders. The most common causes of psychosis include:
- Schizophrenia: This severe mental illness distorts thinking and perception. Positive symptoms are hallucinations and delusions. Negative symptoms are social withdrawal, lack of emotional expression, and apathy.
- Bipolar Disorder: During manic or depressive episodes of this mood disorder, people may experience psychosis with hallucinations or delusions.
- Major Depression: Psychosis can sometimes occur along with severe major depression.
- Schizoaffective Disorder: This involves symptoms of schizophrenia such as hallucinations or delusions, along with mood disorder symptoms.
- Drug-induced Psychosis: Intoxication with certain drugs like methamphetamine, cocaine, marijuana, LSD or alcohol can trigger temporary psychotic reactions.
- Medication reactions: Certain prescription drugs, like steroids or stimulants, can also provoke psychotic symptoms as side effects.
- Medical conditions: Serious illnesses like brain tumors, neurosyphilis, HIV, autoimmune disorders, seizures or stroke can produce psychosis.
Additionally, high fevers, extreme stress or sleep deprivation may result in brief reactive psychosis. But without an underlying condition, this usually resolves on its own within a month.
How does psychosis develop over time?
The progression of psychosis varies depending on the individual and cause. But it often follows some general stages:
1. Prodromal Stage
This initial phase can last weeks or even years. Subtle changes emerge as psychotic symptoms start brewing under the surface. People may start withdrawing socially, feeling uneasy, or struggling to concentrate or sleep. Thinking and behavior slowly become odder and more disorganized.
2. Active Psychosis Onset
Psychotic symptoms worsen and intensify until reaching a breaking point. Hallucinations and delusions interfere with functioning. Speech and behavior grow more erratic. People may thoroughly lose touch with outside reality in this crisis stage.
3. Residual Phase
After peaking, acute symptoms begin improving within a few weeks to months. But some signs of illness often persist at lower intensity. People may still have trouble concentrating, lack motivation, or isolate themselves during this stable phase.
4. Chronic Psychosis
Without treatment, psychosis may become an ongoing chronic condition. Active flare-ups are interspersed between residual periods. Long-term psychosis can seriously impair functioning and lead to other medical complications.
How is psychosis diagnosed?
Diagnosing psychosis involves:
- Psychiatric evaluation of symptoms
- Physical exam and lab tests to uncover any underlying illness
- Psychological testing to assess thinking, memory, concentration etc.
- Interviews with family about behavioral changes
- Ruling out other potential causes of symptoms
There are no blood tests or brain scans that can definitively diagnose psychosis. Trained mental health professionals rely on criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to make a clinical diagnosis based on symptoms.
What is the treatment for early psychosis?
Treating psychosis as early as possible leads to better outcomes. The main treatments include:
- Antipsychotic medication: These drugs help control delusions, hallucinations, disordered thinking and behavior. Second generation antipsychotics like olanzapine and risperidone are commonly used.
- Psychosocial therapy: Talk therapy helps people cope with and manage their symptoms. Cognitive behavioral therapy and social skills training can aid functioning.
- Coordinated specialty care: Programs provide team-based care including psychotherapy, medication management, family education, and work/school support.
- Self-care: Stress management, good sleep habits, substance avoidance, and healthy lifestyle changes support recovery.
Hospitalization may be needed during acute psychotic episodes if someone is a risk to themselves or others. But the long-term focus should be helping people function normally in the community.
What is the long-term outlook for early psychosis treatment?
Starting treatment early offers the best chance of full recovery. About 60-80% of individuals have significant improvement in symptoms and functioning after 1-2 years of coordinated specialty care. However, symptoms may come and go throughout life for many people.
Relapses are common within the first 5 years. Ongoing treatment lowers relapse risk. Stopping medication increases the chance of recurrence. Supportive services, structured schedules, and avoiding substance use help maintain stability.
With appropriate early treatment and healthy lifestyle habits, the long-term prognosis for psychosis can be good. Many people are able to finish school, maintain relationships and jobs, and lead productive lives.
When should someone seek help for potential psychosis?
It is important to seek help promptly when psychotic symptoms arise because early intervention improves outcomes. Contact a doctor, therapist or mental health center right away if you notice any of the following:
- Hearing or seeing things others can’t detect
- Feeling that people are plotting against or spying on you
- Believing ideas that are not based in reality
- Speech or thinking that is jumbled, illogical or disjointed
- Notable social withdrawal lasting weeks
- Rapid decline in self-care or functioning
- Strange behavior that is increasingly erratic
Don’t dismiss early symptoms or wait to get help. Starting treatment as soon as possible provides the greatest chance to minimize disruption and long-lasting disability.
Conclusion
The beginning stages of psychosis can be challenging to detect. Early symptoms often start with social withdrawal, unusual thoughts and behavior, and increasing difficulty with concentration and functioning. Hallucinations and delusions typically arise as psychosis worsens. While onset peaks in the late teens to 20s, psychosis can happen at any age.
Getting prompt treatment attention delivers the best opportunity for recovery. Coordinated specialty care programs dramatically improve outcomes, especially when started in the first 1-2 years. Ongoing treatment prevents recurrence and enables many people to manage psychotic disorders successfully long-term.