Indicators of a Psychotic Episode

Psychotic episodes can occur in the context of various mental, physical, and neurological conditions, and typically present with early warning signs. Noticing indicators of a psychotic episode can allow for early intervention and treatment, usually in the form of therapy or medication.

What is a psychotic episode?

Psychotic episodes are characterized by a change in cognition, behavior, and thoughts, linked to an inability to make a distinction between reality and fantasy ^[1].

A psychotic episode may occur in the context of a mental health condition, including psychotic disorders such as schizophrenia and schizoaffective disorder, mood disorders such as bipolar disorder, or personality disorders such as borderline personality disorder ^[2].

They may also occur due to a neurological disorder such as Lewy body dementia, substance use disorder, or a medical condition such as infection or fever. Sleep deprivation, stress, and childbirth can also sometimes cause a psychotic episode to occur ^[1][3].

First-episode psychosis typically first occurs in adolescence or early adulthood. Research suggests that around 1% of the population experience a psychotic disorder, with around 3% experiencing at least one psychotic episode in their life ^[4][5].

Psychosis typically presents as one or more of the following five symptoms ^[6]:

• Hallucinations: seeing, hearing, feeling, tasting, or smelling something that is not there, such as hearing voices talking to you or about you, or seeing figures and shapes.
• Delusions: holding a strong belief that is not based in truth or reality, such as believing that the CIA are following you or that people on the television are communicating with you.
• Disorganized thoughts: including an inability to follow a train of thought, jumbled or incoherent speech, unrelated answers to questions, and repetition of words or phrases.
• Disorganized behavior: including bizarre and unusual movements, inability to move or catatonia, and inappropriate verbal and emotional responses.
• Negative symptoms: including social withdrawal, flat or blunted emotions, lack of energy, inability to concentrate, and lack of speech.

Early warning signs of psychosis

Early warning signs may occur during the prodromal phase of psychosis, which will present as changes in thoughts, behavior, and emotions, but will not clearly be psychotic symptoms ^[4]. If untreated, the prodromal phase will become the active phase, in which psychotic symptoms will become clearer and more pervasive.

Early indicators of a psychotic episode may include ^[4][7][8]:

Thoughts and perceptions:

• Lack of energy or motivation
• Inability to concentrate or think clearly
• Speaking very fast without stopping
• Feeling unable to speak at all or very little
• Using language that seems odd or different
• Becoming suspicious of others
• Worrying or focusing on new or odd ideas
• Feeling strange or different compared to other people
• Loss of contact with reality
• Thinking about suicide

Behavioral

• Impaired functioning at school or work
• Decline in self-care and personal hygiene
• Withdrawing from social situations and becoming isolated
• Engaging in self-harming behaviors
• New or worsening insomnia and sleep disturbances
• Behaviors and actions that appear out of character to others

Emotional

• Becoming agitated or aggressive
• Feeling anxious or uneasy around others
• Unusual or inappropriate laughter
• Feeling elated or very high
• Feeling depressed or very low

The importance of detecting psychotic episodes early

By spotting the early warning signs of a psychotic episode, it is possible to receive early intervention from a professional, who can make an appropriate diagnosis and recommend or provide treatment to reduce symptoms of psychosis. Untreated psychosis can lead to the condition becoming worse, potentially bringing harm to the sufferer and others.

Receiving treatment early can ^[4][5]:

• Prevent worsening symptoms and potentially prevent an active phase of psychosis from occurring.
• Reduce or prevent harmful behaviors such as substance abuse and self-harm or suicide, which can become more likely to occur during a psychotic episode.
• Prevent serious impairments in academic or professional functioning.
• Reduce or prevent a decline in self-care and independent living skills.
• Reduce the impact on social and interpersonal relationships.
• Prevent the need for hospitalization and inpatient treatment.
• Provide an understanding and acceptance of the symptoms that are being experienced.
• Reduce the likelihood of further psychotic episodes occurring.
• Help in creating therapeutic relationships with mental health professionals who can be contacted if a psychotic episode reoccurs.

How to manage psychotic episodes

An episode of psychosis can be managed effectively with therapy, medications, and self-care.

Therapy

Cognitive behavioral therapy (CBT), interpersonal therapy, and family therapy can help by providing a better understanding and acceptance of psychosis, its symptoms, and the context in which it is occurring; understanding and managing underlying emotional causes; providing problem-solving and coping strategies; and increasing and improving support systems ^[1][7].

Medication

A doctor may prescribe medication to help manage and prevent further psychotic episodes. Typically, antipsychotic medications are used for psychosis, but medication may vary depending on the context in which a psychotic episode occurs ^[2]. For example, in the context of bipolar disorder, mood stabilizers may be prescribed.

Self-care

Looking after your physical and mental health can help to prevent a psychotic episode from occurring. This may include ^[4][5]:

• Avoiding alcohol and drugs
• Speaking with family and friends
• Creating a crisis plan or management plan
• Learning triggers to help avoid and manage challenging situations