The word "psychosis" is used to describe conditions
that affect the mind, in which there has been some loss of
contact with reality. The terms "early psychosis" or "first
episode psychosis" mean that an individual is experiencing
psychosis for the first time. Hallucinations, delusions (false
beliefs), paranoia and disorganized thoughts and speech are
symptoms of psychosis. These symptoms can seem so real that
often the person does not realize that they are experiencing
psychosis. Psychosis also affects feelings and behaviour.
Psychotic episodes are periods of time when symptoms of psychosis
are strong and interfere with regular life. Although the lengths
of these episodes vary from person to person and may only last
a few hours or days, psychosis is most likely to continue for
weeks, months or even years unless the person is given proper
The experience of psychosis varies greatly from person to
person and individuals experiencing psychosis may have very
Approximately 3% of people will experience a psychotic episode
at some stage in their life, although a first episode usually
occurs in adolescence or early adult life. Psychosis occurs
across all cultures and levels of socioeconomic status and
affects males and females equally.
Being able to treat psychosis early is very important, since
it usually starts during a very critical stage of a young person's
life. Adolescents and young adults are just starting to develop
their own identity, form lasting relationships, and make serious
plans for their careers and future. A successful recovery leads
to a healthy, productive future.
Phases of a psychotic
There are three phases to psychosis; however, not all people
having a psychotic episode will experience clear symptoms of
all three phases. Each person's experience will differ.
The first phase is called the Prodromal Phase.
This is the period before the psychosis becomes more obvious.
There are often changes in feelings, thoughts, perceptions
and behaviours. Prodromal symptoms vary from person to person
and some people may not experience a prodrome. The duration
of this phase is quite variable, although it usually spans
The second phase is the Acute Phase.
This is the stage when the typical psychotic symptoms emerge.
It is also the stage that is easiest to recognize and diagnose.
Therefore the acute phase is when most people begin receiving
The third phase is Recovery.
Some of the symptoms that are apparent in the Acute Phase
may linger in Recovery. With appropriate treatments, the
great majority of people successfully recover from their
first episode of psychosis.
Early Signs (Prodromal Phase)
Prior to the onset of acute psychosis people may have symptoms
that are characterized as Prodromal symptoms. Some of the more
common Prodromal symptoms include:
- social withdrawal
- reduced concentration, attention
- depressed mood
- sleep disturbance
- skipping school or work
These symptoms are very general and could be signs of many
different things, including normal adolescent behaviour. It
is always important to be on the alert for such changes in
thoughts, feelings, perceptions and behaviour especially when
they are continuous over a period of time. The earlier the
treatment starts, the greater the chance of a successful recovery.
It is in the Acute Phase that typical psychotic symptoms emerge.
These are the symptoms that are hard to miss. They are intense,
active and continuous. They interfere with normal life functioning.
These symptoms are frequently separated into "positive"
and "negative" categories.
Positive symptoms are referred to as "positive"
because they are viewed as an excess or distortion of the person's
Some of the positive symptoms include:
Delusions (Fixed false beliefs)
- being followed or monitored
- being plotted against
- having special abilities or "powers"
- certain songs or comments are specifically directed toward
oneself or communicating a hidden message
- being controlled by forces or other individuals
- having one's thoughts broadcast so others can hear
Hallucinations involve seeing, hearing, feeling, smelling or
tasting something that is not actually there. The most common
type of hallucination involves hearing things - such
as voices or particular sounds. These hallucinations can
be so real that the individual may not realize that what
they are hearing is false. It is often the odd behaviour
that happens as a result of the hallucinations that gets
recognized as a problem.
Disorganized Speech or Behaviour
The speech of individuals with psychosis may be disorganized
in such a way that the person moves quickly from one topic
to the next, or to the point where the person's speech may
not be understandable.
The behaviour of individuals with psychosis also may be disorganized.
The person may have difficulties performing activities of daily
living (e.g., cooking, self-care) or display inappropriate
behaviours or responses (e.g., laughing while describing a
Negative symptoms reflect a decrease in, or loss
of, normal functions. These symptoms are often less evident
than positive symptoms and require careful assessment.
Some examples of negative symptoms include:
- little display of emotions
- not speaking very much
- difficulties in thinking or coming up with ideas
- decreased ability to initiate tasks
- lowered levels of motivation or drive
It is also common for other symptoms or problems to occur
along with the psychotic symptoms.
Some examples of other problems include:
- suicidal thoughts or behaviours
- substance abuse
- difficulties functioning
- sleep disturbance
In the recovery stage, the acute symptoms mentioned above
will lessen and start to fade; however, some symptoms may linger.
Even after the psychosis has responded to treatment, problems
such as depression, anxiety, decreased self esteem, social
problems and difficulties with work or school may occur.
Unfortunately, at this time there are many theories about
what causes psychosis, but no definite answers. Psychosis occurs
in a variety of mental and physical disorders; therefore, it
likely has multiple causes. Biology, stress and drug use are
three of the most common theories.
Neurotransmitters. There is strong evidence that
some psychoses involve a dysfunction in neurotransmitters in
the brain. Neurotransmitters are the "chemical messengers" of
the brain. They transmit impulses throughout the brain and
the central nervous system. Of particular importance is the
neurotransmitter dopamine. Most antipsychotic drugs that control
the positive symptoms of psychosis also block the transmission
Genetics. Individuals whose close relatives experience
psychosis are themselves at increased risk. For example, the
risk of developing psychosis associated with schizophrenia
in the general population is approximately 1%, yet the children
and siblings of those with schizophrenia have respective lifetime
risks of 13% and 9%.
Brain Changes. Changes have been found in the brains
of some individuals with schizophrenia, which appear to have
been present since birth or early childhood. Possible causes
of the changes include: genetic transmission, abnormal neurodevelopment
and pregnancy or birth complications (e.g. exposure of mother
to a virus during the second trimester of pregnancy).
Some psychoses appear to occur primarily in response to stress.
In most cases, it is believed that a vulnerability to psychosis
combined with stress will lead to psychosis.
Psychosis can be induced by drugs or can be drug assisted.
For example, it appears that amphetamines can cause a psychotic
episode, while other drugs, including marijuana, can increase
a person's natural vulnerability to psychosis resulting
in a psychotic episode.
Vulnerability to psychosis is acquired through a genetic predisposition,
or as a result of an environmental insult to the brain (brain
damage). Vulnerability can be measured by a family history
of psychotic disorders, birth complications (e.g. oxygen deprivation
of the baby) or brain injuries.
Stresses can be such things as significant life events (e.g.
death of a loved one, moving to a new city, etc.), abuse of
alcohol and drugs or stressful living conditions (e.g. high
levels of family conflict or financial problems).
The degree of vulnerability varies from person to person.
Likewise, the amount of stress that may trigger psychosis likely
differs for each individual. For example, a person with a low
vulnerability might withstand a large amount of stress without
experiencing psychosis, whereas, a person with a high vulnerability
might only withstand a minimal amount of stress without experiencing
a psychotic person dangerous?
Although some individuals with psychosis may experience mood
swings and increased feelings of agitation, they are more likely
to present emotional dampening and social withdrawal. While
strong delusions and hallucinations may cause a person to react
unpredictably or even aggressively, individuals with psychosis
are rarely violent and, in fact, they are at much greater risk
of causing harm to themselves than to others.