Early Psychosis and Psychosis
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. Don’t wait to take the first step and prepare yourself with information by reviewing these tip sheets:
What is Early and First-Episode Psychosis?
Early Psychosis: What’s Going on and What Can You Do?
Encourgaging People to Seek Help for Early Psychosis
Early Intervention: Tips for School Staff and Coaches
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 Or First-Episode Psychosis
Early treatment of psychosis, especially during the first episode, leads to the best outcomes.
Research has shown significant success using a treatment approach called Coordinated Specialty Care (CSC). CSC uses a team of health professionals and specialists who work with a person to create a personal treatment plan based on life goals while involving family members as much as possible.
CSC has the following key components:
- Case management
- Family support and education
- Medication management
- Supported education and employment
- Peer support
Traditional treatment for psychosis involves psychotherapy and medication. Several types of therapy have successfully helped individuals learn to manage their condition. In addition, medication targets symptoms and helps reduce their impact.
Psychosis can be related to several mental health conditions:
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.
There are a growing number of first-episode psychosis or CSC programs around the country. Early Assessment and Support Alliance (EASA) and Strong 365 (a project of the One Mind Institute) collect and update information about existing CSC programs and offer helpful resources and information for youth, young adults and families. In communities without CSC or early psychosis programs, university medical schools will also have access to the most recent research on CSC and first-episode psychosis treatment, as will most psychiatrists that have related experience.
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.
Coping with psychosis isn’t easy. Because psychosis often begins during the teen years and young adulthood, many people lean on their families for support. If you or a family member is struggling, NAMI can help. NAMI and NAMI Affiliates provide support and information about programs and community resources for you and your family. The NAMI HelpLine, 800-950-NAMI (6264) or firstname.lastname@example.org, has information about psychosis, treatment and finding support and resources.
If you find yourself in an emergency, NAMI has information about what to do in a crisis.
When you are living with a mental health condition, learning about managing your mental health and finding the support you need will help you reach your recovery goals. You can do many things to improve your ability to manage symptoms and cope with psychosis.
- Get help early. Reach out for help to locate the best treatment possible. If you’re a teenager or young adult, the most effective treatment for early or first-episode psychosis is Coordinated Specialty Care (CSC). These programs are available in a growing number of areas. CSC focuses on you and your unique needs using a team-based approach that works.
- Manage stress. Stress is a natural reaction for most people when they experience psychosis. The first episode of psychosis, when you’re learning about the initial evaluation, diagnosis and treatment choices, can be a stressful, overwhelming and confusing time. Managing or reducing stress can greatly improve your symptoms and well-being. Here are some tips for reducing stress:
- Learn about psychosis. Ask questions and learn about what you’re experiencing. The more you know about psychosis, the less worried or anxious you may be.
- Adjust your expectations. Know your limits, at home, work or school. Don’t take on more than you can handle and take time to yourself if you’re feeling overwhelmed.
- Find balance. Don’t push yourself too hard. If you’ve recently experienced an episode of psychosis, you may need to adjust your schedule or lifestyle. Working or going to school part-time keeps you engaged in your own life but allows time for you to focus on recovery and take time for yourself.
- Make time for fun. Make time for hobbies, recreation and regular exercise.
- Avoid alcohol and drugs. Substance abuse affects the benefits of medication and worsens symptoms. If you have a substance abuse problem, seek help.
- Maintain connections. Having friends and family involved in your treatment plan can go a long way toward recovery. People experiencing psychosis often have a difficult time in social situations, so surround yourself with people who understand. NAMI Peer-To-Peer and NAMI Connection support groups are great ways to meet caring, supportive people who are focused on recovery.
Helping a Family Member or Friend
Families and friends can play a major role in helping their loved ones manage and recover from psychosis. Family members may need to provide emotional support, arrange for treatment and find new ways to cope with the signs and symptoms of psychosis. Learning about early psychosis and psychosis will help you understand what your friend or family member is experiencing and trying to cope with. It is challenging. Here are some ways you can offer support:
- Coordinated Specialty Care for first-episode psychosis. Teens and young adults experiencing early psychosis benefit from early identification and treatment. The most effective treatment for early psychosis is Coordinated Specialty Care (CSC). CSC includes family involvement and gives families the information and skills to support a loved one’s treatment and recovery.
- Helping to manage stress. The stress can become overwhelming when a loved one is experiencing psychosis, but here are some things you can do to manage stress.
- Learn about psychosis. Ask questions and learn about what your loved one is experiencing. The more you know, the less worried or anxious you may be and the better prepared you’ll be to help.
- Be positive. Thinking and speaking positively whenever possible can help reduce stress and negativity in the entire family. Instead of thinking “I can’t do it,” switch to “It’s a challenge, but we can handle it.”
- Take care of yourself. Don’t overlook your own needs when caring for a loved one with psychosis. To be effective you must be physically and mentally healthy. Make time for exercise, a healthy diet, fun activities and fulfilling relationships.
- Connect with others. Faith communities and spiritual beliefs help many people cope with difficult situations. Prayer and other religious activities may greatly reduce stress and provide social support to reduce isolation.
- Respond calmly. To your loved one, the hallucinations seem real, so it doesn’t help to say they are imaginary. Calmly explain that you see things differently. Be respectful without tolerating dangerous or inappropriate behavior.
- Pay attention to triggers. You can help your family member or friend understand, and try to avoid, the situations that trigger symptoms, cause a relapse or disrupt normal activities.
- Help ensure medications are taken as prescribed. Many people question whether they still need the medication when they’re feeling better or they don’t like the side effects. Encourage your loved one to take medications regularly to prevent symptoms from returning or worsening. Encourage communication with the prescribing psychiatrist about concerns over side effects. Everyone is different, and it may take several trials before the best medication or combination of medications is found.
- Understanding lack of awareness (Anosognosia). Your family member or friend may be unable to see that he or she is experiencing psychosis. Rather than trying to convince them, show support by helping your loved one be safe, get therapy and take the prescribed medications.
- Help avoid drugs or alcohol. These substances are known to trigger psychosis. If your loved one develops a substance abuse disorder, getting help is essential.
No one wants to worry about the possibility of a crisis, but they do happen. If a situation escalates suddenly, you may need to call 911 or another emergency phone number. Be prepared with information to keep the situation calm and everyone safe. Preparing for a crisis can reduce its impact and shorten the time it takes for your loved one to get back on track.
NAMI offers information to learn more about caring for a family member, friend or yourself. NAMI also offers peer-led education and support programs in many communities. NAMI Family-To-Family helps the family and friends of people living with a mental health condition. NAMI Family Support Groups help people find support, encouragement and insight from the challenges and successes of others facing similar circumstances. Your local NAMI will have program information and local resources.