An Overview of Psychosis in Teens

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.

What Exactly Is Psychosis?

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.

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. 

Symptoms of Psychosis in Teens

Unfortunately, most adults with psychosis say their parents didn’t recognize the warning signs when they were younger. According to a survey 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.

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.

Early Warning Signs

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 Teens With Psychosis Face

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.

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.

What Causes Psychosis in Teens?

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.

Psychosis Can Be 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.

Are There Any 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.

Teen Psychosis Can Be Linked to Marijuana Use

Studies have also demonstrated a link between teens who smoke marijuana and psychosis. One systematic review and meta-analysis found that teens who use cannabis have a higher risk of developing psychosis. Using marijuana at an early age is associated with a higher risk of later developing psychosis.

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.

How Is Psychosis in Teens Diagnosed?

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. 

Questionnaires and Personal Interviews

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-TR).

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 they began, how long they have been happening, and whether they are constant or come and go. 

Direct Observations

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. 

Daily Functioning

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. 

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.

Determining a Diagnosis

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, and 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.

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.

How to Treat Psychosis in Teens

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.

Family-focused interventions 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.

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:

• Haldol (haloperidol)
• Trilafon (perphenazine)
• Thorazine (chlorpromazine)

Examples of atypical antipsychotic medications include:

• Abilify (aripiprazole)
• Zyprexa (olanzapine)
• Seroquel (quetiapine)
• Risperdal (risperidone)

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:

• Group therapy
• Animal-assisted therapy (AAT)
• Electroconvulsive therapy (ECT)
• Deep brain stimulation therapy (DBS)

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.

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

Tips for Coping With Psychosis in Teens

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.

• Lean on your social support system: 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. 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.
• Work with your child's care team: 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. 
• Join a support group: 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. 
• Talk to your child's teacher: 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, including counseling that you and your family could take part in. 
• Check for community support resources: 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.
• Consider seeing a therapist: You may decide that you would like to see a therapist on your own. Working with a mental health professional can give you the time and space to express your concerns and frustrations without judgment.

How to Get Help

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.

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.