Treating Early Psychosis In Young Adults

First Break, Early Psychosis In Young People

Est. reading time: 5 mins
Posted Under: For Families, Interviews

Clinically Reviewed by: Amanda Fialk, PhD, LCSW, LICSW


Early psychosis and first-episode psychotic events can be frightening, confusing and stressful for the person experiencing it and for their family and community of loved ones. An episode can occur out of nowhere and to seemingly healthy individuals living ‘normal’ lives.

This mental health awareness month, Amanda Fialk, PhD, LCSW, LICSW, Partner and Chief Clinical Officer at The Dorm, shares some essential information on early psychosis, how it manifests as a trauma to a young person and their community, and how The Dorm helps treat psychotic disorders in young people through a holistic and integrative care process.

First, What Is A Psychotic Break?

Amanda Fialk: Psychosis affects roughly 3 in 100 people in their lifetime. A psychotic break refers to an episode of psychosis and typically the first onset of psychotic symptoms for an individual. These symptoms may include delusional thoughts and beliefs, auditory and visual hallucinations, disorganized speech and paranoia, and difficulties recognizing what is a reality and what is not reality.

Early psychosis or a first-episode psychosis is frightening, confusing and stressful for the person experiencing it and for their family and loved ones. A psychotic break can come seemingly out of nowhere; impacting individuals who prior to the first episode were living productive and fulfilling lives. In this way, first-episode psychosis can be viewed as a trauma, not only for the individual experiencing the symptoms but for the entire family system.

During early psychosis or a first episode of psychosis, it is vital to connect with the right treatment quickly. Doing so can be life-changing and radically alter a person’s prognosis. While it can be difficult to tell the difference between the early warning signs of psychosis and typical teen or young adult problematic behavior, getting a professional assessment is key.

When Do Psychotic Breaks First Present?

Amanda: For many (though not all) individuals experiencing psychosis, the late teens and early 20’s – both for men and women – is when psychosis first presents.

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Why during the early 20s? Psychosis can start at any age, but young adults are at an increased risk due to continuing brain development and pubescent hormonal changes.

While we once thought that the brain didn’t change much after early childhood, findings indicate that the brain continues to undergo profound changes up to and into the early 20s. This malleability means that being exposed to different influences in your social environment through your teenage years can have a profound impact on the way that the brain continues to develop. Research also indicates that shifting hormones may play a role, especially in symptom progression for adolescents who are already experiencing adjustment problems.

What Are The Warning Signs of Psychosis Or A ‘First Psychotic Break’?

Amanda: The first sign of psychosis is usually withdrawal. A teenager or young adult, often someone who has had no prior emotional or behavioral issues, will begin to be less engaged with what’s going on around him. Instead of school, work, friends, family and fun, they become preoccupied with what’s going on internally, increasingly fixated on disturbing ideas that are bubbling up.

Specific warning signs might include:

  • Hearing, seeing, tasting or believing things that others don’t 
  • Suspiciousness or extreme uneasiness with others
  • Persistent, unusual thoughts or beliefs
  • Strong and inappropriate emotions or no emotions at all
  • Withdrawal from family or friends
  • A sudden decline in self-care
  • Trouble thinking clearly or concentrating
  • Delusions or hallucinations
  • Agitation, anxiety, hypochondria, insomnia, intellectual impairment, and physical immobility

Can A First Psychotic Episode Lead To Schizoaffective Disorder Or Schizophrenia?

Amanda: Both schizoaffective disorders and schizophrenia are classified as psychotic disorders according to the latest Diagnostic and Statistical Manual of Mental Disorders (DSM V) therefore a first psychotic break can mark the onset of either diagnosis.

It’s important to clarify, however, that both schizoaffective disorders and schizophrenia are different disorders with their own diagnostic criteria and treatment.

Any person with schizoaffective disorder will exhibit the same symptoms of schizophrenia (with psychotic symptoms like delusions and hallucinations), but they will also exhibit symptoms of mania (bipolar type schizoaffective disorder) or depression (depressive type schizoaffective disorder) in order for it to be classified as schizoaffective.

How Is A Psychotic Disorder Different Than A Nervous Breakdown?

Amanda: The term nervous breakdown (or “mental breakdown”) refers to a perceived crisis in someone’s mental or emotional health. This is not a diagnosis, but rather a signal that someone is overwhelmed with stress and pressure, limiting their ability to effectively utilize coping skills. Nervous or mental breakdowns typically build over time and likewise healing will be gradual and require professional help. While a nervous or mental breakdown does not exclude the possibility of psychosis, a psychotic break refers specifically to an episode of psychosis.

What Are The Risk Factors For Psychosis And What Might Be A Trigger?

Amanda: We are still learning about how and why psychosis develops, though it is thought to be triggered by a mix of genetics (family history) and life stressors during critical stages of brain development including through adolescence and the early 20s.The most common cause of psychosis, however, is a psychiatric disorder: schizophrenia or, less often, bipolar disorder or severe depression. Psychosis can recur episodically with these illnesses.

Risk factors that may contribute to the development of psychosis include stressors such as physical illness, substance use (marijuana, hallucinogens and stimulants) as well as psychological or physical trauma.

If psychosis is related to schizophrenia and/or bipolar disorder, these conditions have a much higher rate of inheritance, so if someone has a first degree relative like a parent or sibling who has one of those disorders, they are at a much greater risk of developing it themselves.

What Advice Do You Have For Someone Experiencing Early Psychosis Or A Loved One Trying To Help?

Amanda: Acting quickly to connect a person with the right treatment during early psychosis can be life-changing and radically alter that young person’s future.

Evidence shows that treatment after the initial episode can dramatically reduce the number and intensity of future recurrences by as much as 50 percent and prevent much of the disability associated with a psychotic illness.

How Does The Dorm Treat Young People With Early Psychosis?

Amanda: The most successful treatment plans respect the complexity of symptoms that come with psychosis. That is why we see the greatest outcomes when there is a holistic and intensive evaluation period and when treatment plans are comprehensively customized to the individual.

At The Dorm, our integrated approach to treating individuals diagnosed with psychotic disorders includes:

Psychoeducation (at the group and individual level): Education serves to support, validate and empower clients.

– Socialization: People struggling with psychotic symptoms often feel isolated and marginalized. They can disengage socially and stop participating in meaningful life and leisure activities. We recognize the healing power of being part of a supportive community but are also empathetic to the challenges of doing so for someone with a psychotic disorder. We help our young adult clients develop social skills (individually and in a group setting) and learn to re-engage in daily community socialization through groups at The Dorm Clubhouse.

-Cognitive and Dialectical Behavioral Therapy: We offer individual and group CBT and DBT to help individuals who are diagnosed with psychotic disorders modify negative thoughts, behaviors, and emotional responses associated with psychological distress and symptoms of their illness. Clients who participate can learn to communicate through words instead of behavior, to develop emotional regulation skills enabling them to tolerate previously overwhelming feelings, to learn adaptive functioning and develop an enhanced understanding of themselves and their motivations.

-Family Therapy/Parent Therapy: Familial-based psychological counseling can help family members process the emotional impact of having a loved one diagnosed with a psychotic disorder. Education is provided around the benefits and risks of medication, symptoms and the meaning of symptoms, and how to communicate and lay effective and loving boundaries with a family member diagnosed with a psychotic disorder.

-Life Skills Therapy: Individuals who are diagnosed with psychotic disorders often struggle to maintain basic activities of daily living (ADL’s). Cooking, cleaning, sleep/wake cycles, medication compliance, personal hygiene, and budgeting are often compromised. Our therapists provide comprehensive individual and group-based life skills training both in the home and at the Clubhouse to individuals diagnosed with psychotic disorders.

-Holistic Services: At The Dorm, we believe in the power of alternative and holistic approaches to the treatment of psychotic disorders. Yoga, meditation, mindfulness, and various forms of exercise are offered at both the individual and group level to help with symptom management and stress relief.

-Medication: Medication often plays a key role in the treatment of psychotic disorders which is why we always offer to consult psychiatric services to our clients if it’s required. Consulting psychiatrists can attend carefully to a patient’s preferences and concerns and educate patients about the benefits and risks of medications. We also work closely with outside treating psychiatrists to help ensure medication is being utilized effectively and optimally.

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