Phases of Psychosis

Although a psychotic episode is viewed as occurring in three phases, not all people will experience clear symptoms of all three phases. Each person’s experience will differ.

Three Phases of a Psychotic Episode

The typical course of a psychotic episodes can be thought of as having three phases: Prodrome Phase, Acute Phase, and Recovery Phase.

The first phase is called the Prodrome Phase.

Psychotic episodes rarely occur out of the blue. Almost always, a psychotic episode is preceded by gradual non-specific changes in the person’s thoughts, perceptions, behaviours, and functioning. The first phase is referred to as the prodrome (or prodromal) phase. During this period the person starts to experience changes in themselves, but have not yet started experiencing clear-cut psychotic symptoms.

Types of changes in feelings, thoughts, perceptions and behaviours include:

• difficulty screening out distracting information and sensations.

• difficulty focusing or understanding what they are hearing

• changes in perceptual experiences – visual experiences may become brighter or sounds louder

• feeling overloaded

• finding t harder to keep track of what they are thinking and what others are saying.

• feeling disconnected

• desire or need to be alone

• sleep disturbances

• depressed mood

• irritability

• suspiciousness

• unexplained difficulty at/skipping school or work

Prodrome symptoms vary from person to person and some people may not experience any of the changes. This phase can last from several months to a year or more.

Just because somebody is experiencing all of these changes does not necessarily mean that they are likely to be in the prodrome phase of psychotic episode. The prodrome cannot be “diagnosed” until after psychosis has developed. Up until that point even professionals can only have a hunch that the changes may be the start of psychosis. Although the symptoms described above are typical of the prodrome phase of psychosis, they may also be due to other causes. If you are concerned about similar types of changes in yourself or someone else, it’s important to seek help.

The changes that have been observed in the prodromal phase are very general and could be signs of many different things, including ordinary adolescent behaviour. It is not possible to predict from these symptoms if a person is going on to develop psychosis. The “Warning Signs of Psychosis” section provides information on changes that are more characteristic of psychosis and suggest even greater concern and need for professional assessment.

The second phase is the Acute Phase.

This is the stage when characteristic psychotic symptoms – such as hallucinations, delusions and very odd or disorganized speech or behaviours – emerge and are most noticeable. The experiences are often very distressing for the person. It is during this phase when appropriate treatment for psychosis needs to be started as soon as possible.

The third phase is Recovery.

Within a few weeks or months of starting treatment, most people begin to recover. Many of the symptoms get less intense or disappear, and people are generally better able to cope with daily life. Some of the symptoms that emerged in the Acute Phase may linger in the Recovery Phase, but with appropriate treatments, the vast majority of people successfully recover from their first episode of psychosis.

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Warning Signs of PsychosisWhat is Psychosis?

Warning Signs of Psychosis

Too often people fail to seek professional help that would allow for early intervention because they either don’t recognize that something is going on or, if they do see something is wrong, they attribute it to drugs or normal teenage behaviours.

Each individual is unique and no two individuals will have exactly the same symptoms or warning signs, but one or more warning signs are likely to be evident. These signs are particularly important if they are new or have worsened in the last year.

A referral to an EPI service (or other qualified mental health professional) is highly recommended if some of these warning signs are present.

Take the “Reality Check” quiz on mindcheck.ca – this is a screening tool designed to help determine if further assessment by professional is needed. It does not provide a diagnosis and should not be relied on to rule out or confirm whether psychosis may be present.

The following signs may indicate that an individual is developing psychosis and a professional assessment should be sought.

Perception, Thinking and Speech Changes

• Things around them seem changed in some way

• Rapid speech that is difficult to interrupt

• Irrational statements

• Extreme preoccupation with religion or with the occult (usually this is a new change in the person)

• Peculiar use of words or odd language structures

• Unusual sensitivity to stimuli (noise, light, colours, textures)

• Memory problems

• Severe distractibility

• Reduced speech/talking

Social Changes

• Severe decline of social relationships

• Dropping out of activities – or out of life in general

• Social withdrawal, isolation, reclusiveness

• Unexpected aggression

• Extreme suspiciousness of other people

• Can’t seem to “read” social situations or interactions very well any longer

Emotional Changes

• Inappropriate laughter

• Inability to cry, or excessive crying

• Feelings of depression and anxiety

• Inability to express joy

• Euphoric (elated) mood

• Personality changes

Behavioural Changes

• Odd or bizarre behaviour

• Feeling refreshed after much less sleep than normal

• Excessive writing that is difficult to understand

• Cutting oneself; threats of self-mutilation

• Deterioration of personal hygiene

• Hyperactivity or inactivity, or alternating between the two

• Staring without blinking – or blinking incessantly

• Agitation

• Severe sleep disturbances

• Drug or alcohol use (This may be a coping mechanism)

• Reckless behaviours that are out of character

• Strange posturing or gesturing

• Significantly decreased activity

• Difficulties functioning at school or work

Do not hesitate to call an EPI service or other mental health professional if you are concerned that you or someone else may be experiencing psychosis.

What is Psychosis?

Symptoms of Psychosis

Psychosis includes a range of symptoms that affect an individual’s thoughts, feelings, and behaviours. Symptoms of psychosis are typically divided into two categories: “positive” and “negative” symptoms. “Positive’ symptoms are changes in thoughts and feelings that are “added on” to a person’s experiences (e.g., paranoia or hearing voices).  “Negative” symptoms are things that are “taken away” or reduced (e.g., reduced motivation or reduced intensity of emotion).

Positive Symptoms

Some of the positive symptoms include:

Delusions

Delusions are very  firmly held, false beliefs that are not consistent with one’s culture. These beliefs cannot be shaken despite reason or proof to the contrary.  They are often very unique to the person. It is often very difficult for other people to  understand why the person holds this belief.

Examples of delusions include:

I thought I had invented several things already. I thought people from the States stole my ideas when I was six years old. I thought they were paying my grandpa off for my inventions. I thought he was a millionaire from my inventions.

– Garnet, youth

• feeling they are being watched, followed or monitored in some way

• believing they are being plotted against

• believing they have special abilities or “powers”

• convinced that certain sights or sounds are specifically directed towards the young person or communicating a hidden message (e.g., the television announcer is personally criticizing them)

• believing  they are being controlled by forces or other individuals

• convinced that their thoughts are being broadcasted so others can hear them

• belief that they are responsible for a negative event e.g., earthquake, plane crash)

Hallucinations

Just then, surprisingly, there were voices bouncing off the wall, they were in different language that Ajax couldn’t understand. “Go away!” Ajax thought, but they didn’t go away, they just got louder and weirder.

– Ajax, youth

Hallucinations involve seeing, hearing, feeling, smelling or tasting something that is not actually there. These experiences appear entirely real to the person who is experiencing them. The most common type of hallucination involves hearing things – such as voices or particular sounds – such as music.

A person hearing voices may respond out loud to what they are hearing. The content of the voices can range from friendly to critical, cruel and upsetting and may even tell the person what to do.

It is often the person’s behaviour in response to the hallucination that gets noticed by others.  At times the person might be observed talking out loud when no one else is there or making gestures as if someone is in their presence.

Disorganized Speech or Behaviour

Examples of disorganized speech include:

• slipping off topic

• going off on tangent

• answering a question in a way that doesn’t make sense to the other person

• talking about things that seemed unrelated to the conversation

Disorganized behaviour refers to behaviours that don’t fit the situation;  difficulty in completing tasks or reaching goal; or catatonic behaviour (person becomes completely withdrawn).

Examples of disorganized behaviours includes:

• wearing clothing that doesn’t fit the weather

• displaying a inappropriate emotional response to the situation (e.g., laughing in response to hearing about a person’s tragedy)

• difficulty performing activities of daily living such as cooking or self-care

• not responding or reacting to their environment

Negative symptoms

Negative symptoms reflect a decrease in, or loss of, normal functions. These symptoms are often less evident than positive symptoms and require careful assessment.

Some examples of negative symptoms include:

• inexpressive faces; little display of emotions

• monotone and one syllable or general reduction in speech

• few gestures

• difficulties in thinking or coming up with ideas

• decreased ability to start  initiate tasks

• lowered levels of motivation or drive

• lack of interest in other people

• inability to feel pleasure

• lack of spontaneity

Other symptoms

It is also common for other symptoms or problems to occur along with the psychotic symptoms.

Some examples of other problems that may occur include:

• depression

• anxiety

• suicidal thoughts or behaviours

• alcohol and/or other drug use problems

• difficulties functioning

• sleep disturbance – for example staying up all night

• cognitive problems such as difficulties with memory, concentration, reasoning, etc.

Once treatment is initiated, acute, the psychotic symptoms should lessen and will usually fade away, often completely. However, some symptoms, especially negative symptoms may linger as they are less responsive to medication.  Even with a good response to treatment, problems such as depression, decreased self esteem, social problems and difficulties with work or school may require further support and treatment to help enable a full recovery.