Five Stages Of Psychosis: A Detailed Overview And How To Find Support

Psychosis, or a break with reality, is a common term in psychology typically used to describe a group of symptoms that can be common in several mental illnesses and physical conditions. A psychotic episode can cause significant challenges in daily functioning, so being able to identify when an episode is occurring and at what stage may enable an individual to seek help and move forward safely. The “five-stage model” of psychosis offers a theory of what psychosis progression might look like in people experiencing an episode. Therapy can be helpful for gaining a deeper understanding of psychosis, developing healthy coping skills, and forming a safety plan for future episodes.

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Understanding symptoms of psychosis

Other symptoms of psychosis may include difficulty thinking clearly, challenges with memory, feelings of paranoia and suspicion, neglect of self-care, poor performance at work and school, and personality changes. 

Anyone can develop psychosis at any time, and first-episode psychosis can be one of the most helpful to treat. Psychosis is not a psychiatric disorder in and of itself, but mental illness can be one of several risk factors for its development. 

Psychosis can be thought of as a group of symptoms that may be caused by various mental illnesses, physical conditions, and life experiences. Some of the most common causes of psychosis include the following: 

• Psychotic disorders like schizoaffective disorder 
• Schizophrenia spectrum disorders like schizophrenia 
• Delusional disorder 
• Brief psychotic disorder 
• Postpartum depression and postpartum psychosis
• Mood disorders like depression and bipolar I disorder 
• Types of dementia, such as Alzheimer’s disease 
• Stroke
• Traumatic brain injuries (TBIs) 
• Severe sleep deprivation
• Severe stress 
• Prescription medication use
• Substance misuse 

Psychotic episodes can vary in length depending on their cause and whether the individual has sought treatment. Detecting psychosis symptoms early may improve one’s chances of recovery. 

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

What are the five stages of psychosis? 

Psychologists have theorized that there may be five stages of psychosis. Currently, many clinical providers view psychosis with a three-stage lens, including the prodrome phase, acute phase, and recovery phase. However, these categories may not fully encompass people's experiences in an episode. Others might identify more with the following five stages. 

Stage one: Early-stage psychosis

Signs of early-stage psychosis or a cue that psychosis is beginning may be when an individual shows subtle changes in personality, behavior, and mood. For example, they may display a prolonged low mood or have slight sensory perceptions that others aren’t experiencing. They may miss appointments more often, struggle to reach out to others, and neglect self-care. 

Studies show that treatment for psychosis is often most effective in the early stages. Successfully targeting symptoms and treating them with interventions like medication or acute care can make a difference and reduce the potential harm that could come with later symptoms.  

Stage two: Being overwhelmed by the psychosis  

In the second stage of psychosis, an individual may become overwhelmed by their symptoms, which may progress into a psychotic episode. In this phase, they might experience increasing symptom severity, potentially involving the following:

• Extreme mood swings
• Paranoia and fear
• Full hallucinations 
• Delusional beliefs, such as the belief that the government is chasing them 
• Confusing or disorganized thought and speech patterns 

During this stage, a person may be completely disconnected from reality and struggle to respond to external stimuli. They may be untrusting of their friends and family members and reject offers for support. During this stage, acute emergency treatment is sometimes required to ensure an individual’s safety. 

Stage three: Psychosis vulnerability

After the overwhelming episode has passed, a person may enter a vulnerable state, which may involve emotions like shame and embarrassment. They may realize that the episode was not rooted in reality and start to question some of their beliefs from those moments. Social relationships may struggle, as previous symptoms may have scared or pushed others away. In this stage, repairing relationships with others and seeking treatment may be beneficial. 

Stage four: Living with psychosis vulnerability

After acknowledging the impact the psychotic episode had on their life, an individual may learn to live with this vulnerability, seeking support and finding new coping strategies. In this stage, creating a safety plan may be helpful to start to track which symptoms are common in the early stage of psychosis. Knowing the signs ahead of time can help individuals seek support as soon as possible.

Stage five: Life beyond psychosis 

Life beyond psychosis can be considered the official name for the recovery stage. This stage might occur when one has learned about psychosis, understands the warning signs, and has a support network in place to ensure further episodes can be effectively managed. People in this stage may actively attend treatment and receive guidance from others. They may have more control over self-care, mood, and daily life. 

Support options for psychosis 

Regardless of the cause of your psychosis, you’re not alone, and your symptoms are treatable. Below are a few treatment options people might consider for psychosis. 

Acute crisis care during a psychotic episode

During an active episode of psychosis, a person may completely lose touch with reality, and they may engage in dangerous behaviors toward themselves or others. In these cases, acute crisis care at an inpatient hospital unit or mental health facility might be recommended by a doctor. 

When an individual is hospitalized, a care team of nurses, doctors, therapists, and other professionals can attend to them to ensure high-quality, comprehensive care. Acute care is often short-term and may end once the psychotic episode has passed and the individual’s symptoms are stabilized. 

Long-term inpatient or outpatient care

In mental health conditions like schizophrenia, psychotic episodes can sometimes last weeks, months, or years, depending on the severity of the condition. A person who is experiencing frequent psychotic episodes might benefit from long-term inpatient care in a mental health facility or frequent outpatient care with specific mental health programs designed to offer case management, medication management, and mental health support. 

Medication management for symptoms of psychosis

People experiencing a psychotic episode may benefit from a class of medications called antipsychotic medications. These can be classified as typical or atypical and may provide relief from more severe symptoms like hallucinations and delusions. Antipsychotics tend to be the most commonly prescribed medications for mental illnesses that cause psychosis. 

A medication management program may also be helpful. Some mental health organizations can pre-package and deliver medications to clients to ensure they take their medication on time each day. Because approximately 50% of people with conditions like schizophrenia struggle to adhere to a medication schedule, medication management can be a step up from only attending psychiatric or doctor’s appointments once monthly. 

Consult a medical doctor before starting, changing, or stopping a medication for any condition. The information in this article is not a replacement for medical advice or diagnosis.

Support systems to help navigate mental illness

Support systems can also be helpful in guiding people with mental health challenges. Having others around may increase the chances of noticing personality changes and detecting psychosis early. In addition, studies show that social support can improve mental and physical health, reducing the risk of illnesses that may worsen psychosis and other symptoms of mental health disorders. 

Self-care to improve mental health

Although self-care on its own may not be a cure for psychosis, this can serve as a prevention method. In general, ensuring you’re managing stress and getting plenty of sleep can be helpful. Sleep deprivation can be a significant risk factor for many mental and physical health conditions, so practicing sleep hygiene can be one step toward reducing your risk. 

In addition, eating nutritious foods, participating in hobbies, exercising, and spending time with those you love may improve your mood and physical health. Using these strategies alongside professional support options like medication and psychotherapy may increase the chances of full remission from psychotic symptoms. 

Therapy

Therapy can be an effective prevention technique for psychotic symptoms and may also be helpful after an episode. A therapist can help individuals draft safety plans, develop coping strategies, and find support systems. 

If you struggle to attend in-person therapy due to symptoms or other barriers, you might benefit from online therapy through a platform like BetterHelp. On an online platform, clients can attend therapy from any location with an internet connection and choose between phone, video, or live chat sessions, giving them flexibility. In addition, online platforms often offer worksheets and additional resources, which may be valuable to those working through challenging thought patterns. 

Studies frequently support the effectiveness of online therapy for individuals with psychosis. One study published in 2015 found that individuals with schizophrenia who tried an online intervention group with their family members usually experienced lower perceived stress and an increased perceived level of social support after three months of treatment.