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First Episode Psychosis

Essentials
painted image: woman seated with flowing arcs of color. Symbolizes first episode psychosis awareness and early intervention

Learn signs and symptoms of psychosis and what to know about early intervention services
for the best chance at a positive recovery outcome.

What are symptoms of a psychotic break? 

A person in psychosis is not fully grounded in the real world. A psychotic break can include hallucinations, delusions, or behaviors that indicate a disconnect from reality. This may indicate that the person is developing a severe mental illness—but not always. A medical evaluation is critical for figuring out what may be happening and how to help. 

Psychosis may include a symptom called anosognosia, which impairs a person’s ability to understand or perceive their illness. This symptom is the single largest reason why people with schizophrenia spectrum disorders refuse medication and do not seek treatment. Without awareness of the illness, refusing treatment appears rational, no matter how obvious the symptoms are to others.

Prior to a psychotic break, symptoms of psychosis may be “prodromal.” The person may still be able to differentiate between reality and what they are experiencing, but family members may notice that their loved one seems different or is behaving and speaking in ways that seem atypical or out of character. Primary features of prodromal psychosis might look like anxiety, stress, uncertainty, inattention, poor concentration, or expressions of feeling left out. The prodromal phase is sometimes only identifiable in hindsight. 

Signs of a psychotic break: 

  • Delusions: persistent beliefs that are clearly implausible 
  • Hallucinations: sensory experiences that don’t match reality  
  • Disorganized thinking: speech so disorganized that it impairs basic communication
  • Disorganized or abnormal motor behavior: decreased reactivity, unpredictable agitation, bizarre and rigid posturing
  • Negative symptoms: disengagement with people and activities

What should I do?

If you see one or more of these symptoms in your loved one, seek evaluation and treatment from a professional. You might start with your family doctor. Explain what you see in your own words, and don’t worry if you don’t understand all these terms. You are not responsible for diagnosing your loved one. Your primary care doctor is likely to refer your loved one to a psychiatrist or another professional to assess the symptoms and consider a diagnosis. 

How important is early intervention?

Early signs that a young person may be shifting into psychosis can be alarming. Be reassured that early treatment does improve outcomes. Early intervention treatment is often referred to as Coordinated Specialty Care (CSC) and includes a person-centered, team approach with case management, family support and education, medication management, individual and group psychotherapy, peer support, and supported education and employment. 

The National Institutes of Mental Health in 2008 studied the benefits of CSC for schizophrenia. The project was called Recovery After an Initial Schizophrenia Episode (RAISE). RAISE showed improved outcomes when treatment provides more than typical outpatient care.

Since the typical age of onset for severe mental illness (SMI) straddles the line between late adolescence and adulthood, challenges to getting early intervention are significant. TAC provides additional information to help families navigate school-age onset of SMI.

Can cannabis be the cause? 

A diagnosis of cannabis-induced psychosis is becoming increasingly common. Professional care is necessary to determine whether psychosis related to cannabis use is temporary or if there is onset of a chronic mental illness. Some research shows a link between cannabis usage and the onset of schizophrenia.

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