Early signs of psychosis

Psychosis refers to a group of symptoms that can impact an individual’s perceptions, thinking, well-being, and development. Learn more about what to look for and where to go to get help.

What is psychosis?

It is important to understand that psychosis is not a single diagnosis. Rather, psychosis refers to a collection of symptoms that affect the mind, where there has been some loss of contact with consensus reality (see Understanding Psychosis, NIMH).

Psychosis can occur as a part of many psychiatric, neurodevelopmental, and medical conditions and is an important target of evaluation and treatment (Arcienagas 2015).

When can it start?

Psychosis often begins in young adulthood when a person is in their late teens to mid-20s. However, people can experience psychosis at any point in their lifetime. Sometimes, and depending on the cultural context, psychotic or psychotic-like experiences may not indicate that a person has an underlying psychiatric illness requiring treatment. In other instances, these experiences may be disruptive to a person’s life and wellbeing, causing significant distress and decline in functioning.

Is it common?

According to the National Alliance on Mental Illness (NAMI) approximately 100,000 young people will experience psychosis each year, and as many as 3 in 100 people will experience psychosis in their lifetime.

For many people, psychosis may be temporary or episodic. For others, it may be a longer-term experience that, with the right supports, can still be managed. With early access to specialized treatment and the support of their loved ones and communities, people can and do lead fulfilling lives and define their own recovery.

Find a New Journeys team

If someone you know is experiencing symptoms, you can talk to your doctor, or request a referral for New Journeys, which is Washington State’s Coordinated Specialty Care for First Episode Psychosis. Anyone can make a referral by visiting the website and filling out the referral form.

Find a New Journeys team

New Journeys teams are trained to provide outreach, screening, assessment, specialized treatment, and referrals to other community-based supports for individuals experiencing symptoms and their families. New Journeys services are currently available in the following areas:

Psychosis signs and symptoms

The early signs of psychosis may be subtle, and each person’s experience will be unique. Early symptoms can be difficult to distinguish from developmental changes that occur in adolescence and early adulthood. The presence of one sign alone does not necessarily indicate psychosis; concern may increase when changes are new, persistent, occur together, or interfere with daily functioning.

Here are some common signs and symptoms to watch for:

Unusual or distressing thoughts, feelings, or beliefs

Believing that things in their environment hold special meaning or refer to them
Believing that others can read their mind or know what they’re thinking
Feeling suspicious or worried that others are trying to harm them
Harboring unusual, uncharacteristic, or distressing beliefs that cannot be explained by cultural or religious affiliation and do not change when presented with evidence that contradicts those beliefs

Sensory or perceptual changes

Hearing, seeing, feeling, or tasting things that others cannot
Feeling confused about whether something is real or not
Feeling their thoughts are so loud others can hear them

New and unexpected changes in behavior and functioning

Losing interest in participating in social activities and hobbies
Spending more time alone
Difficulties at school or work
New trouble with concentration or memory
Trouble organizing thoughts or difficulty expressing clear ideas
Decline in personal hygiene

Changes in mood

Changes in mood or emotions
Irritability, anxiety, or agitation
Changes in energy or activity levels

Causes of psychosis

Psychosis may have a variety of underlying causes, including:

Psychiatric causes

Schizophrenia Spectrum Disorders
Bipolar Disorder with psychotic features
- An estimated 50% of individuals that are diagnosed with bipolar disorder experience psychosis in their lifetime
Major Depression with psychotic features
Changes associated with the postpartum phase
Trauma

Medical causes

Use of certain prescription medications
Substance intoxication or withdrawal
Sleep deprivation
Endocrine disorders
Neurological conditions
Infections
Autoimmune diseases

Psychotic-Like Experiences (PLEs)

Many people have psychotic-like experiences (PLEs) at some point in their lives. PLEs can occur for a variety of reasons and as part of various conditions, but they also can occur in people who do not have mental health disorder.

Examples may include:

Vivid images or noises associated with trauma
Magical thinking associated with autism spectrum disorder
Strongly held beliefs related to obsessive compulsive disorder
Unusual personal experiences

PLEs typically:

Are brief in duration
Happen occasionally
Are common or expected in a person’s culture or religion
May be considered typical for a person’s age
Do not cause significant impairment or distress
Are more common than many people may realize

Additionally, some research indicates that individuals that experience PLEs may be at a heightened risk for experiencing psychosis.

Because PLEs can occur for many different reasons, talking with your healthcare provider can help determine whether additional screening or assessment may be helpful.

(Reference: Psychotic-Like Experiences: A Challenge in Definition and Assessment - PMC)

Recovery stories from New Journeys and resources

Recovery stories from New Journeys participants

New Journeys participants tell their own stories:

Resources

Find publications, resources, and information about early psychosis, New Journeys, and the First Episode Psychosis Initiative in Washington State.

Are you, or someone you know, in need of immediate help?

For life-threatening emergencies, call 911.
For 24-hour suicide prevention or a mental health crisis support, call or text 988.
You can also contact your local mobile crisis team for on-the-ground assistance.