Early Warning Signs of Psychosis in Teens and Young Adults

When people picture psychosis, they often imagine dramatic symptoms: hearing voices or holding beliefs that are clearly out of touch with reality. In many cases, though, psychosis does not arrive suddenly. It can build slowly over weeks or months, with changes that are easy to mistake for stress, moodiness or ordinary teenage behavior.

Knowing what those early changes can look like helps families and young people ask questions sooner. This article is not a diagnostic tool. Only a qualified clinician can assess what is going on. But noticing patterns is a reasonable place to start.

What psychosis means

Psychosis describes a set of experiences in which a person has trouble telling what is real. It can include hallucinations, such as hearing or seeing things others do not, and delusions, which are firmly held beliefs that do not match reality. Thinking and speech may also become disorganized.

Psychosis is a symptom, not a single diagnosis. It can occur with schizophrenia and related conditions, but also with severe depression, bipolar disorder, substance use, certain medical conditions, extreme sleep loss and other causes. That is one reason a thorough evaluation matters.

Psychosis often first appears in the late teens and twenties, though it can occur at other ages.

Early changes people sometimes notice

Before clear psychotic symptoms appear, some people go through a period of subtler changes. These might include:

• Pulling away from friends, family or activities they used to enjoy
• A drop in school or work performance that is hard to explain
• Trouble concentrating or following conversations
• Changes in sleep, such as staying up all night or sleeping at odd times
• Less attention to hygiene or appearance
• Unusual suspiciousness or a sense that others are talking about them
• Heightened sensitivity to sounds, lights or colors
• Odd or unusual ideas, or a feeling that things have special meaning
• Flat or out-of-place emotions, such as little reaction to big news
• Saying that things feel strange or unreal, or that their thoughts feel different

Any one of these on its own can have many explanations. Teenagers withdraw, sleep oddly and struggle in school for all kinds of reasons. What tends to stand out is a cluster of changes, a clear shift from how the person used to be, and changes that persist or grow over time.

Telling the difference from typical stress

There is no simple checklist that separates early psychosis from other problems. Still, some questions can help you decide whether to seek an evaluation:

• Is this a noticeable change from the person's usual self?
• Has it lasted more than a few weeks?
• Is it affecting school, work, relationships or daily care?
• Does the person describe experiences that seem confusing or frightening to them?
• Are friends, teachers or other family members noticing the same things?

If the answer to several of these is yes, it is reasonable to talk with a mental health professional. You do not need to be certain something is wrong to ask for an assessment.

The role of substances

Cannabis, stimulants, hallucinogens and other substances can trigger psychotic symptoms in some people, and substance use can make early signs harder to interpret. If a young person is using substances, it is helpful to share that with the evaluating clinician. Honest information helps the clinician understand the full picture; it is not about getting anyone in trouble.

Why earlier evaluation matters

Getting help earlier can make it easier for a person to stay connected to school, work and relationships while symptoms are addressed. Early care also gives families support and information at a time when they may feel confused and frightened.

An evaluation typically includes a conversation about symptoms, history, sleep, substance use, family history and how daily life has changed. A clinician may also recommend a medical check to rule out physical causes. Treatment, when needed, may include therapy, family support, practical help with school or work, and medication prescribed and monitored by a psychiatric provider.

How to bring it up

Raising the subject with a teen or young adult can be delicate. Some approaches that may help:

• Lead with what you have noticed, not a label. "You seem really tired and you haven't been seeing your friends. I'm worried about you."
• Stay calm and curious. Ask how they have been feeling and listen without arguing about whether their experiences are real.
• Focus on their goals. A young person may be more open to help that is framed around sleeping better, feeling less stressed or getting back on track at school.
• Offer to go with them. Help finding and attending an appointment can lower the barrier.

If the person refuses help and is not in danger, keep the door open. Continue to check in, stay connected and seek guidance for yourself as a family member.

When it is urgent

Some situations need immediate help. If a person is talking about suicide, has harmed themselves, is a danger to others, or cannot take care of basic needs like eating or staying safe, act right away. Call or text 988 to reach the 988 Suicide & Crisis Lifeline, which also supports people who are worried about someone else. If there is immediate danger, call 911 or go to the nearest emergency room.

Support in Ohio

At SOS Wellness, our child and adolescent psychiatry team and adult psychiatry team evaluate and care for people experiencing psychosis and related conditions, including schizophrenia and schizoaffective disorder. Care can include psychiatric evaluation, therapy, medication management and case management to help coordinate support. Visits are available at our Middletown and Norwood offices, and by telehealth for people located in Ohio when clinically appropriate.

If you have noticed changes in yourself or someone you love and want to talk them through, you can request an appointment or contact us with questions. Asking early is a reasonable and caring step.