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Psychosis and Early Psychosis

Psychosis and Early Psychosis

Psychosis is characterized by the temporary inability to distinguish what is real from what isn’t real. Losing touch with reality in this way is called a psychotic episode. During a psychotic episode, a person may see or hear things that don’t exist. They may believe things that aren’t true. For example, people experiencing psychosis often believe they are an important figure. Psychotic episodes can be frightening and confusing and can lead to attempts to self-harm.

Early psychosis, also referred to as first-episode psychosis (FEP), is when an individual first begins to experience a break with reality. Seeking help for psychosis, especially for early psychosis, is critical because the earlier treatment begins, the better the outcome.

It is important to understand that psychosis is not a psychiatric condition, rather it is a symptom of serious mental illness or it can be related to a physical condition.

There are many misconceptions about psychosis. For example, most people think psychosis is rare, but it occurs more frequently than you might imagine. It is estimated that 3 out of 100 people will have a psychotic episode during their lifetime. And each year, approximately 100,000 American adolescents and young adults experience their first psychotic episode.

People also mistakenly believe that people who are psychotic are also dangerous. In reality, they are no more likely to be violent than the general population, however, they may be more inclined to injure themselves.


Psychosis and early psychosis can come on suddenly or may develop gradually over time. Considering that psychosis often occurs in young people, it can be hard for family members to know if it’s just normal teen behavior or if it’s a sign of something more serious. Knowing the early warning signs, which mental health professionals call “prodromal” symptoms, can help.

Warning signs of early psychosis include:

  • Spending an unusual amount of time alone
  • Being suspicious of others
  • A concerning decline in grades at school or in work performance
  • Difficulty concentrating
  • Neglecting self-care (for example, not brushing teeth or taking a shower)
  • Changes in emotional responses (intense and inappropriate emotions or emotional flatness)
  • Trouble sleeping

The hallmarks of psychosis include:

  • Hallucinations: Hearing voices (auditory hallucinations), seeing things that aren’t real, have strange sensory experiences
  • Delusions: Recurring and unshakable beliefs that aren’t true, such as thinking you are an important person or have special powers, believing outside forces are controlling you, thinking casual remarks have significant meaning
  • Disordered thinking: Disjointed thoughts, illogical thinking, random utterances, or incoherence
  • Disorganization: Unpredictable, agitated behaviors
  • Trouble concentrating: Inability to maintain focus
  • Catatonia: Decreased responsiveness

During a psychotic episode, a person may have difficulty with everyday functioning. They may feel anxious, depressed, and unmotivated. And they may have trouble sleeping and isolate themselves from friends and family.

If you have a loved one or child who is experiencing psychosis or early psychosis, encouraging them to get help is critical. Early treatment offers the greatest hope of recovery. Be aware, however, that the delusions, disordered thinking, and other aspects of psychosis may make an individual hesitant to seek help. In this case, be calm, kind, supportive, and encouraging when you suggest getting help.


Mental health conditions in which psychosis is a primary symptom are known as psychotic disorders. These conditions include:

  • Schizophrenia: Schizophrenia affects a person’s ability to distinguish reality from fantasy.
  • Schizoaffective Disorder: A condition involving symptoms of both schizophrenia and affective disorders (also called mood disorders).
  • Schizotypal Disorder: Characterized by strange, superstitious, or unusual beliefs and behaviors.
  • Delusional Disorder (formerly called paranoid disorder): Delusions are the main symptom of this condition.
  • Brief Psychotic Disorder: A sudden, temporary psychotic episode, sometimes triggered by a stressful event.

Psychosis may also be present in other disorders, including:

  • Bipolar Disorder: A condition characterized by intense and unstable emotions.
  • Psychotic Depression: A type of major depressive disorder in which psychosis is present.
  • Postpartum Psychosis: The most severe form of postpartum mental illness.
  • Substance Use Disorders / Dual Diagnosis: Psychosis can be induced by substance use or may be present in addition to addiction and another mental health disorder.


The medical community is still uncovering the exact causes of psychosis, but we have discovered several factors that likely contribute to it. We do know that teenagers and young adults are at increased risk of experiencing an episode of psychosis because of hormonal changes in their brain during puberty.

Contributing factors include:

  • Genetics: Having a close relative increases the risk of psychosis.
  • Trauma: Exposure to a traumatic event can trigger a psychotic episode.
  • Drugs and alcohol: Addictions to drugs and alcohol are strongly linked to psychosis. In one study, 74% of people with first episode had a substance use disorder at some point during their lifetime. Cannabis, LSD, alcohol, amphetamines, and other substances are associated with increased risk of psychosis in people who have an underlying predisposition.
  • Head injuries: Traumatic brain injuries increase the risk of psychosis in the months and years following the head injury.
  • Brain disorders: Alzheimer’s disease and other dementias, as well as strokes, brain tumors, and Parkinson’s disease may lead to psychosis.
  • Mental health conditions: Psychosis is often seen as a symptom of mental health disorders.
  • Infections: Chronic infections, such as Lyme disease, have been associated with psychotic episodes.
  • Hormonal changes: The hormonal changes that occur during puberty put adolescents and young adults at greater risk of developing psychosis.
  • Sleep deprivation: Chronic insomnia can lead to symptoms of psychosis.
  • Medication use: Certain medications—including some common antibiotics, muscle relaxants, pain relievers, and others—have been found to induce psychosis in some people.


Psychosis and psychotic disorders are complex and involve several brain areas. Research in a 2018 issue of JAMA Psychiatry found that people with an initial psychotic episode and later psychosis showed abnormal connections in the brain. Specifically, reduced integration and increased segregation of brain regions disrupts the way the neurons communicate with each other.

Abnormalities in the neurotransmitters dopamine, glutamate, and possibly others cause decreased activity in the prefrontal cortex, the area of the brain involved in decision-making, judgment, forethought, attention, impulse control, and more. Brain SPECT imaging studies on people with psychotic disorders show why incoming information is distorted.


Because there are so many possible contributing factors of psychosis, it is very important to find the root cause (or multiple causes) of your symptoms. For the most accurate diagnosis, visit a mental health specialist who performs brain imaging to identify head injuries or other brain abnormalities, as well as extensive lab tests to detect any infections or other conditions that might be involved.

Brain SPECT imaging, a state-of-the-art brain mapping tool, can be helpful to people with psychosis in many ways. It can:

  • Help patients understand that they actually do have a real condition
  • Identify brain patterns associated with brain disorders and mental health conditions
  • Determine which medications (if needed) will be most effective for patients
  • Increase compliance with a treatment plan
  • Show progress or show if treatment needs to be adjusted

Psychosis is not a simple or single symptom. Each person’s experience with psychosis is unique. For this reason, giving everyone with psychosis the same treatment will never work.


At Amen Clinics, we use brain SPECT imaging as part of a comprehensive assessment to diagnose and treat our patients. We also perform lab testing and assess other factors—biological, psychological, social, and spiritual—that can contribute to psychosis. Based on all of this information, we are able to personalize treatment using the least toxic, most effective solutions, including helpful forms of psychotherapy, simple tools to kill the ANTs (automatic negative thoughts), natural supplements, nutrition, exercise, and medication (when necessary).

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