What to look for...
Remember the FACTS
Any of the following new or worsening signs in an adolescent or young adult should trigger assessment for psychosis:
Functional decline
Because psychotic experiences are not observable by others, the following observable changes should prompt careful inquiry into a young person’s internal experience:
- Decline in self-care
- Decline in attendance or performance at school/work
- Withdrawal from family, friends, and usual activities
- Reduced emotional expression
- Reduced interest in activities previously enjoyed
- Decreased ability to handle everyday stress
- Insomnia or altered sleep
- Decline in the amount or content of speech
Often the initial signs of a psychotic disorder include shifts in a person’s emotions or behavior:
- Increased dysphoria, irritability, agitation, hopelessness, anxiety
- Preoccupation with new ideas or causes (ex. religion, politics, philosophy)
- Behavioral such as pacing, staring, talking to self, or seeming disconnected and disengaged
The Look, Feel, & Importance of Early Signs
The earliest changes in psychosis-spectrum illnesses can be subtle. These early changes are often not specific to psychosis or psychotic disorders; the majority of young people with these symptoms will have mental health problems other than psychosis. For those in the very early stages of a psychotic illness, however, these changes are important warning signs.
Some people may begin to:
- Have difficulty screening out distracting information and sensations
- Have difficulty focusing or understanding what they are hearing
- Experience visual sensations as brighter or sounds as louder
- Feel overloaded, or find it harder to keep track of what they are thinking & what others are saying
- Feel more and more disconnected from others and even from a sense of "self," and just want to be alone
Others may notice that someone is:
- Withdrawing, acting oddly, or just does not seem like themselves
- Struggling with school, work, or extracurricular activities
- Unable to sleep, or sleeping during the day rather than the night
When several signs or symptoms occur together, become more intense over time, cannot be clearly explained by other factors, or occur alongside a family history of psychosis, it is particularly important that the person be assessed by a skilled mental health provider who has some knowledge about early psychosis.
Other early warning signs are more obviously "psychotic-like," albeit milder or more easily dismissed; for example, rather than hearing a clear voice they believe is real, a person may initially hear mumbling or whispers. We call these "attenuated" psychotic symptoms. When these symptoms are new or increasing in frequency or intensity, the risk for acute psychosis may be imminent. However, a surprising number of adolescents and even some young adults will report attenuated psychotic symptoms that are longstanding and stable. Depending on the nature of their symptoms, these individuals may not be at imminent risk for a psychotic disorder, but they are at higher long-term risk for psychosis and other serious mental health challenges. Early intervention is particularly warranted for youth with recurrent or impairing, even if attenuated, psychotic symptoms.
Adapted from psychosisscreening.org.