August 15, 2022

What are the Early Warning Signs of Psychosis? 

Episodes of psychosis are often misunderstood. Research shows that approximately 3% of the US population experiences psychosis at some point during their lives.

However, psychosis can be more of a gradual process. Most people exhibit various behavioral and psychological changes before experiencing an acute episode. Some of these changes are subtle, and others are more apparent. Regardless, it’s important for individuals and their loved ones to be aware of these warning signs. 

Understanding Psychosis

The onset of psychosis can occur slowly. At first, the individual experiences various changes in their thoughts and patterns. However, they might not have insight into what’s happening. In addition, loved ones can’t always separate problematic symptoms from typical development.

During a psychotic episode, the person briefly loses a sense of contact with reality. Psychotic symptoms can vary, but an episode often includes:

  • Hearing, sensing, seeing, or believing things that aren’t real (hallucinations)
  • Having persistent beliefs that don’t align with reality (delusions) 
  • Experiencing intense and inappropriate emotions (or complete detachment from emotions)
  • Withdrawing from relationships
  • Limited or no personal hygiene
  • Difficulty with concentration and focus
  • Incoherent speech 

Researchers aren’t exactly sure what causes psychosis. Instead of a single culprit, numerous variables likely increase one’s susceptibility to symptoms. Some of the following variables include:

Trauma: People who experience psychosis are more likely to experience trauma, particularly in early childhood.

Genetics: Psychotic disorders can run in families. However, just because someone has a family history of psychosis doesn’t mean they will experience an episode.

Substance use: Certain drugs like amphetamines, marijuana, and alcohol may trigger psychosis, particularly in people who may already be vulnerable to mental health issues.

Neurological conditions: Traumatic brain injury, brain tumors, stroke, and Alzheimer’s may trigger psychosis.

Psychosis is a significant health concern. In severe cases, it may lead to violence, self-harm, and suicide. Unfortunately, many people facing homelessness or extreme economic despair have had histories of psychosis. 

Despite its inherent risks, stigmatization also remains a serious problem. For example, some people believe psychosis is always a sign of danger- or that people who have psychosis are “crazy” or “broken.” Unfortunately, these untrue assumptions and harmful stigmas prevent people from seeking the treatment they need. 

Early Warning Signs of Psychosis 

While the average onset for psychosis is 24 years old, warning signs may begin as early as childhood or adolescence. Close family members are often the first to notice unusual or concerning behavior. 

Early intervention can be essential for securing appropriate treatment. The right resources can help you or your loved one manage their symptoms and avoid future distress. Here are some of the key signs to consider.  

Increased Paranoia 

Many people start becoming suspicious of others before having a psychotic episode. They may become seemingly obsessed with threats, conspiracies, or betrayal. Therefore, they constantly scan their environment for potential threats.  

To an outsider, the worries seem excessive and unfounded. They may even try to reason with their loved one. However, their attempts often seem futile. The paranoia can become so severe that the individual assumes anyone questioning them is also out to hurt them. 

Social Withdrawal

Social withdrawal is a precursor to numerous mental health conditions, and it’s common in psychotic disorders. Social withdrawal often coincides with paranoia. Individuals feel mistrust toward others, so they distance themselves.

Even if someone can’t completely disconnect from others, they may be guarded in conversations. They may worry about the effects of people getting too close. 

Mood Changes 

Mood disturbances may accompany other symptoms before psychosis occurs. These mood disturbances may include any combination of depression, anxiety, restlessness, anger, and sadness. At this point, some people are wrongfully diagnosed with other mental health conditions like depression or bipolar disorder. 

Some people also experience a sense of exaggerated elation or child-like joy. This form of restless excitement can be disproportionate or even inappropriate to the current situation (i.e. smiling incessantly at a job interview or laughing at a funeral). 

Changes in Academic or Work Performance 

Sudden changes in school or work may indicate mental health problems. Because psychosis affects concentration, it is hard to focus on certain tasks. 

Shame or fear may prevent people from reaching and seeking assistance. Instead, they may act out in these settings, presenting as defiant, withdrawn, or socially inappropriate. It is not uncommon for adolescents to get suspended or expelled from school. Furthermore, adults may find it challenging to hold down a job.

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Flat Affect 

We all exhibit emotions differently, but a complete lack of emotions may be a precursor to psychosis. When a person has a flat affect, they present as unfazed by their circumstances. It’s challenging to distinguish whether they’re happy, upset, or anxious- it often looks the same.

Sometimes, other people may notice that the individual appears to be “spacing out” during conversations. For example, they may feel like they’re talking, but “nobody’s home.” 

Declining Self-Care 

After early childhood, most people are independent enough to practice appropriate grooming and hygiene. Failure to shower, get dressed, or take care of oneself may signify mental health problems. 

Declining self-care often coincides with concentration problems. It can also go hand-in-hand with paranoia (i.e., worrying that the laundromat is dangerous). Similarly, many people with psychotic disorders struggle to maintain a daily routine and complete everyday tasks. 

Excessive Sensitivity to Sensation

Extreme discomfort around certain textures, noises, or lights may indicate psychosis. This is particularly true if the changes are sudden and seemingly come out of nowhere. 

Sudden Aggression 

Psychosis can trigger aggressive thoughts and behavior. The aggression is often a result of paranoia. 

They are worried about being harmed, causing them to feel jumpy and suspicious of others. Even if they don’t present as outwardly aggressive, it may seem like your loved one can’t relate well to other people. You may feel like you’re often walking on eggshells when you’re around them.

Alternating Hyperactivity and Inactivity 

Drastic changes in energy can occur with psychosis. This can happen because the individual struggles with emotional regulation. Likewise, they may be sleeping or eating less than usual or using drugs, affecting their overall emotional well-being. 

Substance Use 

There is a strong overlap between substance use and psychosis. Many people use drugs or alcohol to self-medicate their symptoms. Furthermore, confounding variables, such as homelessness or legal trouble, may increase one’s propensity for substance use

With that said, substance use can also intensify psychosis. It’s challenging, therefore, to know which issue came first.


Delusions can start to unfold during the early phase. Delusions fall into several subtypes. It’s common for people to experience 1-2 of these subtypes intensely.

Persecutory delusion: This type of delusion refers to extreme fears of being conspired against, spied upon, or otherwise tampered with. People may become extremely wary of everyday people along with government officials.

Delusion of love: This delusion leads people to believe that someone else is in love with them. This intense thought results in stalking, excessive jealousy, and even aggression. Sometimes, the person thinks a celebrity is in love with them- even if they have never met.

Somatic delusion: Somatic delusions persuade people that something is deeply wrong with them. Over time, this often results in excessive doctor visits, lab tests, and surgeries. In extreme forms, people develop tactile hallucinations where they experience certain bodily sensations.

Delusion of grandeur: This delusion leads people to believe they have significantly more influence than they actually do. For example, they might assume they have a rare and extraordinary talent or immense wealth.


Even if they aren’t fully developed during the early phase, many individuals start experiencing such disturbances during this time. For example, they may claim to see their dead loved one in the next room. Or, they might tell you that they can hear God speaking to them. 

Keep in mind that hallucinations can occur with any of the five senses. They may ebb and flow over time, based on the individual’s current mental health.

Lack of Sleep

Many people with psychotic disorders also struggle with sleep issues. Unfortunately, the two problems often aggravate one another. 

Poor sleep can make someone more prone to symptoms like hallucinations. But psychotic symptoms can also make it challenging to sleep, thus reinforcing a challenging cycle. 

Phases of Psychosis 

There are typically three phases in a psychotic episode: prodrome, acute, and recovery. Understanding these phases can help you better understand the situation and support your loved one appropriately.

Prodrome phase: The prodrome phase is characterized by early psychotic symptoms. The individual may recognize their changes, but the psychosis is not fully developed. People often describe this time as feeling disconnected, overwhelmed, or depressed. This phase can persist for several months or years, and it’s usually quite gradual.

Acute phase: The acute phase refers to the presence of active psychotic episodes. This is when symptoms like hallucinations and delusions are most apparent. The experience tends to be distressing for the individual. It can last a few hours to a couple of days, though some people may experience the acute phase for over a month.

Recovery phase: The recovery phase refers to an absence or maintenance of psychotic symptoms. Treatment can provide the stabilization needed to achieve this phase.

Types of Psychotic Disorders

Psychotic disorders can affect people of all ages and demographics. Professionals diagnose these conditions based on psychotic symptoms- along with a full assessment of other physical and mental health factors.

Schizophrenia: Schizophrenia is the most common type of psychotic disorder. This condition entails significant behavioral changes and positive symptoms like hallucinations or delusions. Symptoms last longer than six months. 

Schizoaffective disorder: Schizoaffective disorder refers to having both schizophrenia symptoms and mood disorder symptoms. The individual will also meet the diagnostic criteria for disorders like depression or bipolar disorder

Schizophreniform disorder: Schizophreniform disorder has the same symptoms as schizophrenia, but the symptoms have lasted fewer than six months. Approximately two-thirds of people with this condition develop schizophrenia. 

Brief psychotic disorder: Brief psychotic disorder refers to short, sudden episodes of psychosis. The episodes are in response to specific, stressful situations and generally last less than a month. The recovery from these psychotic episodes tends to be quick. 

Delusional disorder: Delusional disorder is characterized by persistent delusions lasting for at least one month. Delusions are the main symptom- the individual does not have any other symptoms of psychosis. 

Substance-induced psychotic disorder: Substance-induced psychotic disorder refers to having psychotic symptoms associated with drug use or withdrawal. Symptoms disappear once the drugs are no longer in someone’s system. 

Psychotic disorder due to a medical condition: This disorder refers to experiencing psychotic symptoms due to specific medical conditions like brain tumors, head injuries, or dementia.

Paraphrenia: This disorder refers to schizophrenia symptoms occurring later in life when people are in their elderly years. Paranoid delusions are one of the most common symptoms of this disorder. 

Psychosis Treatment 

Proper treatment can reduce or even eliminate psychotic symptoms. If you suspect you or a loved one is struggling (even if only one episode has occurred), seek support. 

Antipsychotic medication: Antipsychotic medication is typically the first recommendation for psychosis. Antipsychotics block dopamine, a neurotransmitter associated with thoughts, perceptions, and pleasure. It is theorized that people with psychosis have higher levels of dopamine. Balancing this neurotransmitter, therefore, reduces symptoms.

Cognitive-behavioral therapy (CBT): CBT is a well-known therapy that helps people understand the intersection between their thoughts, feelings, and behaviors. A CBT therapist will work with clients to challenge certain thoughts and replace maladaptive responses with more appropriate, healthy ones. 

Family support: Family interventions can be beneficial for people experiencing psychosis. Family therapy may include discussing treatment options, creating appropriate care plans, and reviewing healthy boundaries.

Hospitalization: In more serious cases, psychiatric hospitalization may be required to stabilize distressing symptoms. This is a short-term treatment if the individual is at grave risk of harming themselves or others. 

Final Thoughts

Psychosis can be frightening, but it is manageable. The right treatment can significantly improve one’s quality of life. If you suspect your loved one may be struggling, reach out for help. Even if you don’t know exactly what’s going on, it’s worth consulting with a professional. 

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Disclaimer: This information is not specific medical advice and does not replace information you receive from your healthcare provider. This is only a brief summary of general information. It does NOT include all information about conditions, illnesses, injuries, tests, procedures, treatments, therapies, discharge instructions or lifestyle choices that may apply to you. You must talk with your health care provider for complete information about your health and treatment options. This information should not be used to decide whether or not to accept your health care provider’s advice, instructions or recommendations. Only your health care provider has the knowledge and training to provide advice that is right for you.

You must talk with your health care provider for complete information about your health and treatment options. This information should not be used to decide whether or not to accept your health care provider’s advice, instructions or recommendations. Only your health care provider has the knowledge and training to provide advice that is right for you.

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