An Overview of Psychosis in Teens

How to Spot the Signs of Psychosis in Adolescents

Teens with psychosis often show early warning signs.
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In This Article

Teens can experience all forms of mental illness, including psychosis. However, as with the signs of depression and other forms of mental illness in adolescence, the key indicators seen in adults may be missed or simply attributed to the normal stress of teenage development.

Psychosis involves a disruption to a person’s thoughts and perceptions that make it difficult for them to distinguish between what is real and what isn’t. However, it's important to know upfront that psychosis is a symptom rather than a diagnosis.

Overview

The severity of psychosis varies. One person may have mild impairment while another struggles with activities of daily living due to their symptoms.

Psychosis generally stems from various psychiatric disorders, although it may also appear in the course of certain medical and neurological conditions. Doctors need to rule out these causes before a psychiatric diagnosis is made. 

Early recognition and treatment can slow, stop, or in some cases even reverse the effects of psychosis. Parents need to be informed about what to look for as well as where to turn for help.

Symptoms

Unfortunately, most adults with psychosis say their parents didn’t recognize the warning signs when they were younger. According to a survey conducted by the National Alliance on Mental Illness (NAMI), only 18.2% of people with psychosis said their parents saw symptoms of mental illness and intervened.

Many parents may rely on their child's doctor to identify signs of mental illness or psychosis. However, according to NAMI, only 4.5% of people with psychosis report that medical professionals recognized their symptoms.

Teens with psychosis start to lose touch with certain aspects of reality.

Symptoms may appear for a while and then disappear. Parents, caregivers, and other adults in a teen's life (such as teachers and coaches) may dismiss the behaviors as a phase or typical teenage mood swings. When symptoms come and go, they may assume a teen is doing fine during periods when symptoms are not present.

The early warning signs of psychosis may be similar to the signs of depression or another mental illness, including:

  • Mood swings
  • Unusual movements
  • Cold, detached demeanor
  • Inability to express emotions
  • Loss of interest in usual activities
  • Difficulty maintaining relationships
  • Not keeping up with personal hygiene
  • Problems at school (social and/or academic)

Challenges

It’s not uncommon for teens to attempt to hide or disguise their symptoms for as long as possible. A teen who is experiencing psychosis is likely to feel confused, embarrassed, and even afraid.

Signs of psychosis vary from person to person. It's important to get a gauge of your teen's well-being and closely monitor for changes in their mood or behavior that go beyond the normal ups and downs of adolescence.

Parents should also know that sudden psychosis, as in the case of a brief psychotic disorder, is relatively unusual. By contrast, most people with schizophrenia, for example, exhibit signs of psychosis for months, if not years, before they are diagnosed.

Hallucinations

Hallucinations are a common symptom of psychosis and can affect any of the senses including sight, hearing, touch, smell, and taste.

Auditory hallucinations are the most common type of hallucination. A teen may hear voices that tell them what to do or warn them of danger. Some teens report the voice seems to come from inside their brain, while others feel as though they’re hearing voices around them from people who do not exist. For some, the voices simply sound like background noise.

Visual hallucinations involve seeing things that aren’t really there. A teen may see people or objects that no one else sees. These hallucinations can run the gamut in terms of content and intensity. Some hallucinations are simply confusing (a wall seems to change color, or an object appears in an unexpected place), but they can also be intensely distressing (such as seeing blood on the floor or the face of a stranger in the mirror).

Olfactory hallucinations involve smells. A person may detect odors that aren’t really present, such as perfume, rotten eggs, or garbage. Some olfactory hallucinations come and go, while others may be present all the time.

Teens with psychosis may also experience "phantom" physical sensations. People with tactile hallucinations can feel like something is crawling on or under their skin or may turn around thinking that someone has tapped them on the shoulder when no one is there.

Delusions

Teens who experience delusions have fixed false beliefs that are inconsistent with their culture. For example, a teen may believe that the government is controlling their behavior through the TV or become convinced someone is poisoning them.

Even when there is no evidence in support of these beliefs, teens experiencing psychosis will maintain their delusions. While it can be frustrating, you can't talk to someone who is experiencing delusions into thinking differently or giving up a delusion simply by stating that it is untrue.

Disordered Thinking

At times, teens with psychosis may exhibit disorganized speech. They may become easily confused during a conversation. Their sentences may not make sense and their speech may contain meaningless words.

The disordered thinking that results from psychosis can affect focus, concentration, and make teens feel uneasy relating to others.

Causes and Risk Factors

The exact cause of psychosis is not known, but researchers suspect there are several contributing factors, such as genetics. For example, a teen who has a sibling with schizophrenia may carry a genetic predisposition for psychosis.

Teens who have a close relative (like a parent or sibling) who has experienced psychosis are at a higher risk for developing it themselves.

Psychosis as a Symptom of Psychiatric Disorder

Certain psychiatric disorders may present with psychosis including:

  • Schizophrenia: Teens with schizophrenia exhibit behavioral changes that may be intense. They may have hallucinations or delusions. Symptoms often affect their education and their relationships.
  • Schizoaffective disorder: A person with schizoaffective disorder has a combination of prominent mood symptoms typical in bipolar disorder or depression along with psychotic features of schizophrenia.
  • Schizophreniform disorder: In schizophreniform disorder, symptoms of schizophrenia are of limited duration—typically between one to six months.
  • Brief psychotic disorder: A person may experience a sudden bout of psychosis, typically in relation to a stressful life event, such as the loss of a loved one. In these cases, symptoms usually disappear in less than a month.
  • Substance-induced psychotic disorder: Teens with serious substance use problems may experience hallucinations or delusions as a result of their substance use.
  • Mood disorders: Sometimes psychosis occurs in certain presentations of major depression and bipolar disorder.
  • Psychotic disorder due to medical condition: In some cases, psychosis may be caused by an underlying condition such as a brain tumor or head injury.

Risk Factors

Researchers have also investigated potential environmental risk factors that may interact with and "trigger" a genetic vulnerability for psychosis, such as:

  • Fetal hypoxia: Fetal hypoxia occurs when the oxygen supply to a developing fetus is disrupted. It's been proposed that the resulting changes to the fetal brain may affect later predisposition for schizophrenia. Fetal hypoxia may be caused by a variety of factors, such as bleeding during pregnancy or an emergency cesarean section.
  • Maternal infection: The child of a mother who experienced an infection during pregnancy may be at a higher risk of schizophrenia.
  • Paternal age: Several studies have linked a father’s age to an increased risk of schizophrenia. For each decade of a father's life, the risk of schizophrenia in offspring increases 1.5 times.
  • Prenatal malnutrition. Historically, during periods of famine the rates of schizophrenia increase. A lack of key vitamins, such as B and D, has also been associated with higher rates of schizophrenia.
  • Trauma: Adults with schizophrenia report higher rates of childhood trauma. 
  • Stressful family environment: Certain stressors that create an unhealthy childhood environment have also been linked to the later development of psychosis.

Psychosis and Marijuana Use

Studies have also demonstrated a link between teens who smoke marijuana and psychosis. In 2011, a team of researchers led by Rebecca Kuepper published the findings of their study in the British Journal of Medicine.

After following nearly 2,000 teenagers over 10 years, the researchers found that teens who had smoked marijuana at least five times were twice as likely to develop psychosis compared to those who had never smoked pot.

Another study found that smoking marijuana may cause symptoms of psychosis to appear earlier. Researchers found that marijuana smokers were likely to experience psychosis two years sooner than their non-marijuana smoking counterparts.

Although there is not enough evidence to definitively conclude that marijuana causes psychosis, the studies thus far have indicated teens may be particularly vulnerable to the effects of marijuana.

One reason for this is that researchers suspect marijuana could interfere with normal brain development. During adolescence, the emotional and reasoning centers of the brain are not yet fully formed and need to continue to make new connections. Research has suggested that when teens use marijuana, it may increase their vulnerability to psychosis through this mechanism.

Diagnosis

Psychosis is a symptom of a diagnosable condition rather than being one in and of itself. However, doctors and mental health professionals can evaluate a person’s feelings and behaviors to see if they are experiencing psychosis. 

Establishing whether or not someone is experiencing psychosis, as well as figuring out what has caused the symptom, can help providers arrive at a diagnosis. 

The screening tools used for psychosis are usually questionnaires. The guidelines and criteria for diagnosing specific conditions and disorders that cause psychosis are found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

A doctor or mental health professional (such as a psychiatrist) will usually begin by asking questions related to a person’s symptoms. Their questions might be about the content of the person’s thoughts, when the thoughts began, how long they have been happening, and whether they are constant or come and go. 

A person experiencing psychosis may not be aware of a specific trigger, but if there was an event or incident that precipitated the symptom, it can help a provider reach an accurate diagnosis.

While they are asking questions, as well as at other times throughout the evaluation, a provider will also observe a person’s behavior, demeanor, and appearance for any clues that could indicate a particular diagnosis. 

Providers will also want to know what a person’s day-to-day life is like and in what ways it has been affected by their symptoms. For example, a provider will want to know if the person is having trouble with self-care such as taking a shower, cleaning the house, doing laundry, going to the store for groceries, and making sure bills get paid on time. 

If a person is unable to answer these questions, providers may turn to family members who can provide insight and information. 

Knowing about a person’s social activities and whether they can go to school or work is helpful for making a diagnosis. It can also help to know whether a person has been able to maintain close relationships with family and friends.

Once a provider has gathered information about a person’s psychosis, they can compare it to the various diagnostic criteria for disorders that cause the symptom, as well as look for other potential explanations. 

For example, psychosis may be brought on by certain medications or substances but will go away as soon as the drug is stopped.

In some cases, a doctor might want to order other tests to determine a cause for psychosis. For example, a blood or urine test to check for illicit drugs or an MRI of the brain to look for lesions or tumors. 

If they are unsure of a diagnosis, a provider may refer a person with psychosis to a specialist for a more thorough evaluation or recommend admission to an inpatient psychiatric facility.

Treatment 

There isn’t a cure for psychosis, but there are treatments. Parents, educators, and medical professionals should know that the sooner a teen with psychosis gets help, the better the outcome is likely to be.

Family Intervention

Family intervention is key for teens with psychosis. Studies show that parental participation can be highly protective against relapse.

Interventions that are family-focused may include psychoeducation, communication skills training, and problem-solving therapy. A supportive home environment and learning how to assist a teen’s efforts are instrumental to recovery.

It's also helpful for parents to learn how to adjust rules and expectations at home. For example, teens with psychosis may not be able to babysit younger siblings or stay home alone for long periods of time.

Parents of teens with psychosis often experience guilt and anxiety. Siblings will also have their own unique reactions to the situation, which may range from anger to confusion and fear. Family-based therapy is essential for ensuring everyone's emotional needs are addressed.

Medication

Some teens with psychosis may benefit from medication. Antipsychotic medication can help balance certain brain chemicals that contribute to hallucinations, delusions, and disordered thinking.

Antipsychotics come in two classes: typical and atypical, the former representing an older class of medications that are less frequently prescribed. While they are not without side effects, atypical antipsychotics are generally less likely to cause serious side effects (such as tardive dyskinesia) that are associated with typical antipsychotics.

Examples of typical antipsychotic medications include:

Examples of atypical antipsychotic medications include:

Therapy

Individual therapy is an important part of a teen’s treatment for psychosis. There are many different options for psychotherapy, which may be used in conjunction with medications.

One example is cognitive-behavioral therapy (CBT). Together with a trained mental health professional, CBT can help teens learn to handle stress in a healthy way as well as cope with the unique and the challenges that stem from psychosis.

Other forms of therapy that may be used include:

Education

Teens with psychosis, as well as their families, need to be educated about their illness. A person with psychosis who understands their symptoms will be better equipped to cope with them.

Life skills training is also a crucial component of treatment.

Teens learning to live with a mental illness often benefit from social skills training, which helps them learn to interact with peers in a socially appropriate manner.

They can also develop the life skills they need to effectively carry out their daily activities, such as bathing and preparing meals.

Coping

If you’re caring for a teen who is experiencing psychosis, you may feel confused, frightened, and overwhelmed. You may even experience a sense of grief. These emotions are normal and common in caregivers but can be especially intense for those caring for someone with psychosis.

Caregiving can be incredibly stressful, but you should know that you don't have to go through it alone. There are resources, support, and coping strategies that can help.

As you support and reassure your teen (as well as keep them safe), you need a wide network you can reach out to for comfort, advice, and resources.

You will likely work closely with the medical and mental health providers overseeing your teen’s care, but they can also be excellent sources of information and support for you and your family. 

There are also support groups specifically for caregivers, both in-person and online, which you may find helpful. Sometimes, just being around others who understand what you’re going through is enough to validate your feelings and empower you. 

If your teen is still attending school, you may find it useful to reach out to teachers, principals, and administrators. There may be programs in place to support teens who need extra help or supervision in school, which may include counseling that you and your family could take part in. 

You may decide that you would like to see a therapist on your own. Working with a mental health professional can provide you with the time and space to express your concerns and frustrations without judgment.

You can learn valuable coping skills and techniques for managing stress that will prepare you to care and advocate for your own needs as well as your teen’s.

If your family needs more help, look to your community, religious or spiritual center, and local social work offices. Services such as respite care may be available to you.

Even something as simple as having a friend or neighbor assist with groceries, laundry, or transporting your kids to school can be a big help.

A Word From Verywell

If your teen is showing signs of psychosis, you'll need to seek professional help. You can start by bringing up your concerns with your teen's doctor, though they will need to be referred to a mental health professional (such as a psychiatrist) who can give your teen a proper evaluation.

If your teen is in immediate danger, such as threatening to harm themselves or someone else, call 911 or go to the emergency room.

Talk to your teen’s doctor about your concerns. They can refer your teen to a mental health professional, such as a psychiatrist, who can perform an evaluation and begin to make a plan for treatment.

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Article Sources
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