How to Spot the Signs of Psychosis in Teens

Teens with psychosis often show early warning signs.
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Although no parent wants to imagine their teen could have a mental illness, psychosis can occur during adolescence. Knowing how to spot the signs of psychosis in teens is key to early intervention.

Unfortunately, most adults with psychosis say their parents didn’t recognize the warning signs. According to a 2011 survey by the National Alliance on Mental Illness, only 18.2 percent of individuals with psychosis say their parents saw symptoms of a mental illness and intervened.

Many parents rely on medical providers to identify signs of mental illness or psychosis. But, only 4.5 percent of individuals with psychosis say healthcare professionals recognized their symptoms.

Early treatment can slow, stop or even reverse the effects of psychosis. So it’s important for parents to be informed about what to look for and how to get help.

Overview

Psychosis involves a disruption to a person’s thoughts and perceptions that make it difficult for them to distinguish what is real and what isn’t. Psychosis is a symptom, however, and not a diagnosis.

Psychosis comes in varying degrees. While some people may only experience mild impairments, others struggle with activities of daily living due to their symptoms.

Psychosis generally stems from various psychiatric disorders, although there are certain medical and neurological conditions that can present with psychosis as well. These often need to be evaluated for and ruled out before a psychiatric diagnosis is made.

 

Some types of psychiatric diagnoses in which psychosis may occur include:

  • SchizophreniaTeens with schizophrenia exhibit changes in their behavior. They may have hallucinations or delusions and their symptoms are likely to affect their education and their relationships.
  • Schizoaffective disorderSchizoaffective disorder occurs when a person has prominent mood symptoms of bipolar disorder or depression along with the types of psychotic symptoms that may be present in schizophrenia.
  • Schizophreniform disorder – Schizophreniform disorder includes symptoms of schizophrenia but the duration is limited. Symptoms have only been present between one and six months.
  • Brief psychotic disorder – Sometimes, people experience sudden periods of psychosis. It’s often related to a stressful life event, such as the loss of a loved one. The symptoms usually disappear in less than a month.
  • Substance-induced psychotic disorder –Teens with serious substance abuse problems may experience hallucinations or delusions in the context of their substance use.
  • Psychotic disorder due to another medical condition – Psychosis can sometimes stem from physical health conditions, like a brain tumor or head injury.
  • Mood disorder - Pyschosis can be present in certain presentations of major depression and bipolar disorders.

Early Warning Signs 

Sudden psychosis, like in the case of a brief psychotic disorder, is relatively unusual. Most people with schizophrenia, for example, exhibit signs of psychosis for months or years before ever getting diagnosed.

Teens with psychosis start to lose touch with certain aspects of reality. But symptoms may appear for a while, and then disappear.  So parents may dismiss symptoms as a phase or assume their teen is better when symptoms go away.

But, just because a teen doesn’t actively show symptoms, doesn’t mean there isn’t a problem.

Early warning signs of psychosis may be similar to the signs of depression or other mental illness. Signs to look out for include:

  • Loss of interest in personal hygiene
  • Loss of interest in usual activities
  • Mood swings
  • Unusual movements
  • Cold, detached demeanor
  • Inability to express emotions
  • Problems at school and difficulty maintaining relationships

A teen who is experiencing psychosis may feel afraid, embarrassed, or confused. It’s common for teens to try to hide their symptoms or to disguise some of the warning signs for as long as possible.

Signs of psychosis vary from person to person. So it’s important to closely monitor changes in a teen’s mood or behavior.

Hallucinations

Psychosis may involve hallucinations. Auditory hallucinations are the most common type of hallucination.

A teen may hear voices that tell him what to do, warn him of danger, or the voices may simply sound like background noise. Some teens report this voice seems to come from his brain, but others feel as though they’re hearing voices around them from people who don’t exist.

Visual hallucinations involve seeing things that aren’t really there. A teen may see people or objects that no one else sees.

Olfactory hallucinations involve smells. A teen may think she detects odors that aren’t really present, like perfume, rotten eggs, or garbage. Some olfactory hallucinations come and go, while others may be present all the time.

Teens with hallucinations may also report feeling physical sensations that aren’t really there. A teen with tactile hallucinations may say she feels spiders crawling on her or that someone keeps tapping her on the shoulder.

Delusions

Teens who experience delusions have fixed false beliefs that are inconsistent with their culture. A teen may believe that the government is controlling his behavior through the TV or he may think someone is trying to poison him.

Even when there is no evidence that a belief is not true, teens maintain their delusions. You won’t be able to talk your teen into thinking differently or giving up a delusion by telling him it’s not true.

Disordered Thinking

Sometimes teens with psychosis may exhibit disorganized or confused speech. They may be confused at times or may make up meaningless words. Their sentences may not make sense at times.

Psychosis is likely to cause trouble thinking clearly, difficulty concentrating and uneasiness relating to others. 

Risk Factors 

Little is known about the exact cause of psychosis. Researchers suspect there are many factors that play a role.

Teens who have a close relative, like a parent or sibling who has experienced psychosis, are at a higher risk. Having a brother with schizophrenia or a mother with bipolar disorder with psychosis, for example, means a teen may be at a higher risk of developing psychosis.

Studies have also found a link between marijuana and psychosis. When researchers followed nearly 2,000 teenagers over 10 years, they discovered that young people who smoked marijuana at least five times were twice as likely to develop psychosis, compared to those who never smoked pot.

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

It’s too early for researchers to conclude whether marijuana causes psychosis. But, some researchers suspect marijuana interferes with normal brain development. During adolescence, when the emotional and reasoning centers of the brain are still making new connections, some researchers think marijuana increases a young person’s vulnerability to psychosis.

Researchers have also looked for the environmental factors that may act on genetic vulnerability leading to the development of psychosis Some possible links include: 

  • Fetal hypoxia – Fetal hypoxia occurs when a fetus’ oxygen is disrupted. It may be caused by a variety of events, such as bleeding during pregnancy or an emergency cesarean section.
  • Maternal infectionA child whose mother 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. Each decade of life in fathers increases the risk of schizophrenia in offspring by 1.5 times.  
  • Prenatal malnutrition – During times of famine, rates of schizophrenia increase. A lack of certain vitamins, such as vitamin B and D have also been associated with higher rates of schizophrenia.
  • Trauma – Adults with schizophrenia report higher rates of childhood trauma. 
  • Stressful family environment – Certain aspects of an unhealthy childhood environment have been linked to the later development of psychosis.

Treatment 

There isn’t a cure for psychosis. But, treatment is available to manage the symptoms. And the sooner a teen gets help, the better the outcome is likely to be.

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

Family interventions may include psychoeducation, communication skills training, and problem-solving. Creating a supportive home environment and learning how to assist a teen’s efforts can be instrumental in recovery.

Parents also benefit from learning how to adjust expectations in the home. A teen with psychosis may not be able to babysit younger siblings or may not be able to stay home alone for long periods of time, despite being 17, for example.

Parents often experience a fair amount of guilt and anxiety when a teen develops psychosis. Treatment with a mental health professional may help parents address those emotions in a healthy way.

Teens may also benefit from medication as well. Antipsychotic medication can help balance certain brain chemicals that contribute to hallucinations, delusions, and disordered thinking.

Individual therapy can also be an important part of a teen’s treatment for psychosis. Cognitive behavioral therapy with a trained mental health professional can help a teen learn how to deal with stress and the challenges that stem from psychosis.

It’s important for teens with psychosis to be given education about their illness. A teen who understands his symptoms will be better equipped to cope with the issues he faces.

Life skills training may also be part of treatment. A teen may need social skills training to help her interact with peers in a socially appropriate manner, or she may need help carrying out daily activities like bathing and preparing meals.

How to Get Help for Your Teen

If you see any signs of psychosis in your teen, seek professional help right away. Talk to your teen’s doctor about your concerns. Your teen may be referred to a mental health professional, like a psychiatrist or a psychologist, for a further evaluation.

If your teen appears to be in immediate danger, call 911 or go to your local emergency room. A teen who threatens violence or self-harm needs immediate intervention.

Sources

Kuepper R, van Os J, Lieb R, Wittchen H, Hofler M, Henquet C. Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort study. BMJ. 2011;342(mar01 1):d738-d738. doi:10.1136/bmj.d738.

Mack A. Cannabis Use and Earlier Onset of Psychosis: A Systematic Meta-analysis. Yearbook of Psychiatry and Applied Mental Health. 2011;2012:5-6.

Results from the 2011 NAMI Survey. First Episode: Psychosis.

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