How to Spot and Treat Psychosis in the Pre-Illness Phase (It Never Has to Get Fully Symptomatic)

If you act quickly enough, you can sometimes stop psychosis before it even really grabs a toehold.

First episodes of psychotic mental illnesses, like bipolar disorder, major depression and schizophrenia often occur during adolescence or early adulthood.¹

When people initiate psychosis treatment before full onset, in the pre-illness or prodromal phase, the prognosis is much better. In some cases, early intervention can stop the progression of psychosis before it gets to the acute or full symptomatic phase.

Unfortunately, loved ones often misinterpret the early warning signs of psychosis as typical emotional and behavioral changes of adolescence and early adulthood and so miss a valuable opportunity to really help.

Read on to learn how to identify psychosis in the prodromal stage and to learn why early intervention is so important.

What Is Psychosis?

• Psychosis is a disruption in brain function that results in a loss of contact with reality.

• Psychosis can occur as a syndrome within mental illnesses such as schizophrenia, schizoaffective disorder, delusional disorder, brief psychotic disorder, bipolar disorder and major depression. Drugs and certain physical illnesses can also cause psychosis.

• The primary symptoms of psychosis are delusions, hallucinations and disorganized thoughts, speech or behaviors²

The Importance of Early Intervention and Treatment for Psychotic Mental Illness

• At some point in life, about three people in a hundred are going to experience a disorienting and scary first episode of psychosis.
• Unfortunately, few people initiate treatment soon enough – at the point where treatment can do the most preventative good.

Psychosis always requires professional treatment so there is no point in waiting to see if things get better on their own. Without treatment symptoms will likely worsen, and the earlier you initiate treatment the better the ultimate prognosis – in fact, in some cases, early intervention not only reduces the severity of a psychotic episode it stops symptoms entirely so that full psychosis never occurs. ³

Early psychosis intervention can help a person avoid or minimize many of the consequences of untreated psychosis, such as:

• An increased risk of depression and anxiety – psychotic symptoms can cause a great deal of worry, a loss of social support systems, increased drug and alcohol abuse, a loss of functioning and other behaviors that up a person’s risk for secondary mental illnesses
• A loss of self confidence and self esteem
• An increased risk to develop a substance abuse problem (from self-medication with drugs or alcohol)
• An increased risk of self harm and suicide
• Decreased ability to function on the job or at school
• Disrupted social relationships ⁴
  

How to Spot Psychosis in the Prodromal Stage

Most people will go through a prodromal stage prior to a first onset of psychosis. This prodromal stage can vary in length but typically lasts for several months. During the prodromal stage, a person will start to experience subtle and gradually worsening symptoms.

If you initiate treatment in the prodromal stage you can stop things before they reach the acute psychosis phase. Without intervention, a person in the prodromal phase will eventually progress to acute psychosis and experience symptoms that are severe enough to disrupt the ability to function on a day to day basis.

The trick is in distinguishing the signs of early psychosis from the normal developmental changes of late adolescence and early adulthood.

Here’s what to look for:

1. Feeling Off or Wrong in Some Way

In the prodromal phase people often start feeling as if something there is something wrong with the way their brain is working. They may:

• Start having trouble doing school work or on the job
• Start feeling unusually sensitive to sounds, smells, light and touch (not like being touched by others)
• Start feeling like they have special powers or abilities

2. Feeling Muddled or Confused

• Having trouble paying attention or thinking clearly
• Forgetting things or getting lost easily
• Having trouble reading longer sentences
• Having trouble understanding what others are saying
• Getting mixed up when speaking or writing

3. Social Withdrawal and a Reduction in Self Care

• Suddenly caring less about your appearance/personal hygiene
• Withdrawing from friends and family (spending a lot of time on your own in your room, for example)

4. Behavioral Changes

• Sleeping or eating a lot less or more than normal
• Feeling very tired all the time
• Not interested in activities or hobbies you used to find enjoyable

5. Fear and Anxiety

• General fear and anxiety without apparent cause
• Feelings of suspicion and paranoia – worrying that others are thinking badly about you or want to harm you in some way
• Feeling fearful around people - maintaining vigilance

6. Hallucinations

• Feeling like someone else is planting ideas in your head
• Seeing or hearing things that aren’t real
• Feeling like your brain is ‘tricking’ you in some way

7. Emotional Changes

• Feeling depressed
• Experiencing extreme mood swings⁵

After You Notice the Warning Signs… Then What?

Whether for yourself or for a loved one, once you spot warning signs of a problem the next step is to make an appointment for a mental health assessment from a doctor or mental health professional experienced in early psychosis identification.

Treatment for early psychosis typically consists of medication and counseling, and since the earlier you start the better the outcome, it’s important to take action as quickly as you can.