Early Signs of Psychosis

Although most people think of psychosis as appearing “out of the blue,” this is uncommon. Most often, there are warning signs, months or years beforehand. Of course, these are easiest to recognize when looking back, but we are learning how to recognize warning signs when they first appear. Early recognition provides the best opportunity for early intervention and prevention of psychosis.

People sometimes describe the earliest change as having more difficulty screening out distracting information and sensations. They may have difficulty focusing or understanding what they are hearing.  Visual experiences may become brighter or sounds louder. They may feel overloaded or find it harder to keep track of what they are thinking and what others are saying. They may feel more and more disconnected or just want to be alone.  Gradually, they may become confused about what is real and what is not real, mistrustful, even panicky. 

Other people may notice that someone is withdrawing, acting oddly, or just does not seem like him or herself. The person may become quieter, or begin struggling at school, work, or sports.  He or she may even stop going to school or work.

Some of these early changes are not specific to psychosis. In other words, many young people with these signs and symptoms may have mental health problems other than psychosis or be experiencing a temporary reaction to stress. For those in the very early stages of a psychotic illness, however, these provide important warning signs. When several signs or symptoms occur or become more intense over time, or they occur in the context of a family history of psychotic disorders, it is particularly important to seek help early.

Early warning signs and symptoms to keep in mind include:


Early, non-specific changes
  • Social withdrawal or isolation
  • Decline in functioning (at school or work, in self-care)
  • Depressed mood
  • Anxiety
  • Decreased motivation
  • Reduced concentration
  • Sleep disturbance
  • Reduced emotional expression
  • Problems with handling everyday stress
  • Impairment in personal hygiene

 

Other early warning signs are more like the positive symptoms of psychosis, but are milder or more subtle. We call these attenuated psychotic symptoms.

 

Attenuated (mild) psychotic symptoms
  • Suspiciousness
    (e.g., Feeling increasingly uneasy around friends, family, or teachers without knowing why)
  • Odd beliefs or magical thinking
    (e.g., Feeling confused about whether a dream actually happened; Wondering whether other people might be able to read your mind; Finding meaningful connections between unrelated events; Clear and frequent déjà vu experiences or experiences of unreality)
  • Unusual perceptual experiences
    (e.g., Sounds seeming louder than usual; Seeing shadows that look like people or vague figures out of the corner of the eye; Finding that everyday noises sound like words or have special meaning)
  • Tangential/circumstantial speech
    (e.g., Going off track while speaking; Using odd combinations of words)


When these symptoms have begun or become worse in the last year, research suggests that the person may be at higher risk for developing psychosis. [Also see What Does “At Risk” Mean]

Of note, some people experience attenuated psychotic symptoms that are longstanding and stable.  That is, the symptoms have been around for more than a year and have not been getting more frequent or intense over time.  These individuals do not tend to be at as high risk for developing psychosis.

 

Other people who may be at higher risk for psychosis
  • People who have a close relative (e.g., brother or sister, father or mother) who has experienced psychosis (e.g. schizophrenia, bipolar disorder or depression with psychosis) and who have had a decline in daily functioning (e.g., school or work functioning, social and family life, and self-care) over the past year.
  • People with full (rather than attenuated) symptoms of psychosis that began within the last three months but are brief and variable.  The symptoms may be intense but they come and go, last less than an hour, and appear no more than a few times each week. They are not frequent or sustained enough to meet criteria for a prominent psychotic disorder.  However, these symptoms should be taken seriously so they do not become more frequent or sustained over time.



Importantly, research suggests that early treatment of these symptoms, at a specialized program such as CEDAR, can help to prevent more serious problems from developing. Just like with early signs of medical illness, if early symptoms of mental health problems are left untreated, they are more likely to get worse.  If they are treated early, they often improve.

 

Early intervention has the potential to delay
or ultimately prevent the onset of psychosis,
and to improve the outcome of those who
do develop a disorder.

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