Early Warning Signs of Psychosis and How to Recognize the Symptoms

Psychosis is a state of mind characterized by being out of touch with reality. It is also a word used to describe conditions that cause this state of mind. During a psychotic episode, a person has disturbed or disrupted perceptions and thoughts. This makes it difficult or impossible to distinguish between what is real and what isn’t. The main symptoms of psychosis include:

• Hallucinations
• Delusions
• Incoherent speech
• Behaviors and reactions inappropriate to a given situation

Someone with psychosis will also exhibit other signs as a result of these, like social isolation, difficulty functioning in normal situations, poor hygiene, depression, lack of motivation, anxiety, changes in sleeping patterns, and more.

Illnesses like Alzheimer’s disease and brain tumors, and also drugs and medications, can trigger psychosis. Mental illnesses that cause psychotic episodes include schizophrenia, delusional disorder, bipolar disorder, and schizoaffective disorder.

Psychosis is a serious health concern. It can lead to self-harm, suicide, substance abuse, and social isolation. Left untreated, psychotic conditions can lead to many more problems due to the inability to function normally: job loss, poverty, homelessness, and more.

When psychosis is caused by a medication, a drug, a tumor, or a medical condition, managing it is a matter of treating the underlying cause. When psychosis results from a mental illness, recovery and management are more complicated.

Living with a psychotic disorder means living with a chronic illness. It requires ongoing care, usually for the rest of the person’s life. There is no full recovery, but professional care can help reduce symptoms and psychotic episodes, and help a person function better and live more independently.

Early intervention makes a big difference. Studies have shown that when patients get treated during the early stages of psychosis, or even before a first full episode of psychosis, the outcomes are better. Patients have fewer, milder symptoms and are better able to function. Research also shows that early intervention reduces recurrence of psychotic episodes.

The evidence clearly shows that early management of psychotic conditions leads to better outcomes for individuals. The challenge is to detect and diagnose psychosis early. If you have a loved one with some of the warning signs that occur before an actual episode of psychosis, push for a psychiatric evaluation as soon as possible:

• Worrying changes. In a young person, this may be an unexpected decline in academic performance. Changes in work performance can also indicate early psychosis. At any age, a decline in hygiene and general self-care is also a sign. These troubling changes may be a result of difficulty concentrating, a common issue in early psychosis.
• Suspicion of others. Many people start to become wary of others before having a psychotic episode. They become suspicious with no reason and are uneasy around other people, even those they know and should trust.
• Isolation. Early psychosis can lead to isolation, often because of this wariness of others. You may see someone spend more time alone, even if they don’t become totally isolated.
• Unusual emotional reactions. Emotional reactions may seem out of line with the circumstances during this period. A person may overreact or underreact to situations, exhibiting strong emotions or acting flat and unemotional.
• Changes in mood. Mood disturbances alone do not indicate psychosis, but with other symptoms can be a warning sign. You may see signs of depression, anxiety, agitation, anger, and mood swings.

One study of young people all with risk factors and warning signs for psychotic disorders pinpointed the most predictive early symptoms. Those with significant decreases in normal functioning, depression, reduced ability to focus and pay attention, and a longer duration of early symptoms were most likely to develop actual psychosis later.

The early warning signs of psychosis often appear in adolescence and early adulthood. This can make it particularly difficult to recognize them as a mental health condition. It’s better to get an assessment from a doctor than to just write these signs off as typical teen behavior.

The early warning signs of psychosis are gradual. You won’t see someone you love become psychotic overnight. This makes identifying the first true episode difficult. If you’ve missed the warning signs, don’t hesitate to seek an evaluation for what seems like a psychotic episode. The sooner you can get help the better.

A first episode of psychosis may include the following symptoms:

• Delusions, or thinking and believing things other say are not true
• Seeing, tasting, or feeling things that others do not
• Strong, inappropriate emotions
• Lack of emotional response
• A rapid decline in personal hygiene
• Ongoing and worsening withdrawal from family and friends
• Difficulty thinking clearly

Psychosis includes hallucinations and delusions, but they may be less severe during the first episode. There is still time, at this point, to benefit from starting care right away as opposed to waiting for additional episodes.

A big challenge of detecting early psychosis is the fact that no one really expects to be psychotic or for a loved one to have a psychotic condition. It’s more common than most people realize but still not common enough to be on your radar.

More people could be screened and identified as having early warning signs of psychosis if more people understood the risk factors. The most important risk factor is family history. Anyone with immediate or even extended family members with psychosis has a significant risk of developing a psychotic condition.

Also important is trauma. Any type of trauma can contribute to or increase the risk of developing psychosis later, but those who experienced it in childhood and for longer may have a greater risk. Substance use can increase the risk of psychosis in people already vulnerable to it, such as those with family history.