Recognizing The Subtle Signs Of Mild Psychosis

Psychosis is a complex, multifaceted symptom characterized by disruptions to an individual's perception of reality, potentially creating challenges in recognizing what is and is not real. Identifying the early warning signs of mild psychosis and seeking treatment before symptoms escalate can often benefit longer-term health and well-being. Below, we'll provide an overview of the warning signs of mild psychosis, the symptoms of clinical psychosis that these could lead to, risk factors for developing psychosis, and treatment options.  

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About psychosis

Psychosis can affect a person’s thoughts, speech, and behaviors. Psychosis is a common symptom of several mental health disorders, including schizophrenia, bipolar disorder, and severe instances of depressive disorders, though the symptom can also be caused by some medical conditions or the use of certain substances.

Psychosis can present in varying intensities from mild to severe and often first emerges during adolescence or young adulthood. Psychosis can affect people of all races, genders, backgrounds, and cultures. The National Alliance on Mental Illness estimates that roughly three in 100 people will experience a psychotic episode at some point in their lives.

Possible signs of mild psychosis

Some mild psychotic symptoms may mirror those of depressive and anxiety disorders. However, these often are or will eventually be accompanied by core psychosis symptoms like delusion, disorganized speech, and disordered behaviors. Some warning signs that one may be experiencing mild psychosis include but aren't limited to:

• Low mood, feelings of hopelessness, and negativity
• Paranoia, mistrust, or suspicion without cause
• Disorganized thinking and speech patterns
• Unusual, random, or agitated behaviors
• Sleep disturbances
• Minimal expression of emotions, lack of empathy
• Loss of motivation
• Loss of the ability to experience pleasure
• Social withdrawal
• Cognitive impairments such as trouble with memory, concentration, and rational problem-solving 

Especially if left untreated, symptoms of mild psychosis could worsen. The timing and severity of the symptoms of moderate to severe psychosis can vary among individuals, but there is a set of core symptoms generally present in psychosis of all types. These are called "positive" symptoms because they involve new thoughts, beliefs, and behaviors that weren't present in the person's experiences before the disturbance. Positive symptoms of psychosis include:

• Hallucinations. Individuals might experience sensory hallucinations involving sight, sound, smell, touch, and/or taste. Auditory hallucinations, like hearing voices, are the most common type.
• Delusions. Individuals experiencing delusions often hold beliefs that aren't rooted in reality, even when presented with irrefutable evidence to the contrary. Some may have delusions of persecution or paranoia, where they believe that others are "out to get" them or external entities are controlling them. Delusions of grandeur are also possible, where an individual believes they are extraordinarily powerful or possess preternatural abilities. 
• Disordered thoughts and speech. People experiencing psychosis often have difficulty organizing and communicating their thoughts, resulting in speech patterns that seem disoriented and random. Colloquially, this is sometimes referred to as "word salad."
• Unusual behaviors. Disordered thinking can manifest as unusual behaviors as well. The individual may seem disoriented and agitated and move randomly or impulsively. Some people also experience catatonia, which means they stay still for extended periods and show no response to outside stimuli.

Phases of a psychotic episode

A psychotic episode usually does not occur suddenly. The onset of symptoms of psychosis can often be divided into three key stages: prodromal, active, and residual. These stages are outlined below:

The prodromal stage

Recognizing this first stage as the beginning of a psychotic episode may be challenging because early symptoms often resemble those of other mental health disorders like anxiety or depression. These are called secondary or "negative" symptoms—so labeled because they represent an absence of emotional or social engagement. For example, an individual may seem distant and lacking in emotion during this stage. They might lose interest in activities they once enjoyed and withdraw from social interaction. In some cases, an individual might begin to show signs of mild psychosis—as outlined above—in this stage.

Active stage

During this phase, negative emotional and social symptoms typically begin to subside and positive, core psychosis symptoms like delusions, hallucinations, and confused/disordered behaviors emerge. For example, people in this phase may become paranoid that others are trying to harm them, or they might have difficulty forming cohesive sentences. 

Residual stage

The residual stage signals a return of the same types of symptoms found in the prodromal phase. For instance, individuals may show signs of apathy, depression, and other mood-related symptoms. In addition, the symptoms experienced during the active stage can be so unnerving the individual might stop interacting with others entirely, even after they subside. 

Mental illnesses associated with psychosis

Psychosis is associated with several different mental health conditions. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) lists the following:

• Schizophrenia
• Bipolar disorder 
• Brief psychotic disorder
• Schizoaffective disorder
• Schizotypal personality disorder
• Substance-induced psychosis
• Delusional disorder
• Major depression 
• Postpartum psychosis

Potential causes and risk factors for psychosis

Aside from mental health conditions, other factors may put individuals at increased risk of developing psychosis, including the following.

Genetics

Multiple studies suggest that psychotic experiences are highly heritable and influenced by genetics, particularly in cases of early psychosis. However, just because an individual has a genetic predisposition doesn't guarantee that they'll experience psychosis and vice versa. That said, psychotic disorders like schizophrenia spectrum disorders feature a heritability rate of 80% or more.

Medical conditions

Neurological disorders like dementia, epilepsy, and Huntington's disease may cause psychosis. Brain tumors, stroke, and severe migraine may also cause psychosis symptoms.

Injury

Research suggests that, in rare cases, a traumatic brain injury (TBI) can cause psychosis. Traumatic brain injuries can damage brain tissue, create interruptions in blood flow, and interfere with brain functioning, putting some people with these injuries at greater risk of psychosis than others. Stroke, epilepsy, degenerative brain disease, multiple sclerosis, and dementia can also be associated with psychosis symptoms.

Substance use

The use or misuse of substances like marijuana, LSD, and amphetamines can raise the risk of psychosis in individuals who may already have a predisposition. Certain medications can also cause side effects associated with psychosis. 

Trauma

Major traumatic events like abuse, war, sexual assault, or the death of a loved one may trigger psychosis in individuals who may already be at risk. Multiple factors like the individual's age, environment, and the type of trauma they've experienced typically influence whether a traumatic event will result in psychosis. 

Scientists believe this effect may be due to the way that the mechanisms in the brain responsible for the release of stress hormones are activated during traumatic events. This process can negatively impact brain function and initiate or worsen psychotic symptoms, which might explain why individuals with post-traumatic stress disorder (PTSD) may present with psychotic symptoms. Additionally, research suggests a higher risk of psychosis in individuals who were exposed to extreme experiences of violence, danger, and hostility in childhood.

Environmental factors

Certain environmental factors like birth season, complications during pregnancy or birth, and living in migratory conditions have all been associated with psychosis risk according to a 2021 study.

Screening and diagnosis for psychosis

Diagnostic criteria for psychosis and psychosis-related disorders focus mainly on the timing, severity, and daily-life impact of symptoms. In general, a person must present at least two core symptoms for a significant portion of time during a one-month period, and signs must persist for no less than six months for a diagnosis of a psychotic disorder to be considered. The individual’s level of functioning at work, socially, and in terms of self-care must be significantly diminished compared to pre-symptom onset. Symptom criteria may vary somewhat between psychotic disorders.

Early detection can lead to more positive outcomes in treating psychosis, and people showing signs of mild psychosis should have a screening done by a qualified mental health professional as soon as possible. Several organizations offer resources for finding pre-screening services for young adults and others experiencing early signs of psychosis, including the following.

• The National Alliance on Mental Illness (NAMI) helpline is available to assist individuals in finding programs in their area from Monday through Friday, 10am to 10pm. Call 1-800-950-NAMI (6264) or text "helpline" to 62640. 
• The Substance Abuse and Mental Health Services Administration (SAMHSA) offers a mental illness treatment locator for local mental health programs and facilities.
• The Early Assessment and Support Alliance (EASA) offers a National Early Psychosis Directory to connect individuals with programs in their area that provide screening and other resources.  

Psychosis treatments

Treatment for psychotic symptoms is typically tailored to the individual's needs and any underlying conditions but usually involves a combination of methods such as:

• Medications. Antipsychotic medications are often the first-line treatment for psychotic disorders. A psychiatrist or a physician may prescribe mood stabilizers and/or antidepressants.
• Individual therapy. Cognitive behavioral therapy (CBT) is the most common form of psychotherapy, or talk therapy, for individuals with psychotic symptoms. CBT may help the individual learn to recognize and shift distorted thought patterns that may be contributing to symptoms and learn healthy coping mechanisms.
• Family therapy.Family therapy is often part of a psychosis treatment plan. In therapy, families can learn more about psychosis and how to better support a loved one who experiences the symptom. Sessions may focus on building communication, conflict resolution, and problem-solving skills.
• Group therapy. Some people with psychotic disorders find group therapy to be beneficial as well. They allow individuals with the same or similar diagnoses to share experiences and peer-to-peer support.
• Coordinated Specialty Care for First Episode of Psychosis (CSC-FEP). CSC-FEP is an early intervention program where individuals with psychosis work with a coordinated team of case workers, physicians, psychologists, and representatives from skills-training programs. CSC aims to support individuals and their families in learning to cope with psychosis, reduce symptoms, and improve quality of life. 

Finding mental health support 

That said, psychosis symptoms can be distressing and frightening for individuals and their loved ones, and caring for someone who experiences psychosis can be difficult as well. If you're caring for someone with a psychotic disorder, you may have trouble recognizing the signs that you may also need mental health support from a professional to address stress, anxiety, burnout, or other challenges. Examples of such signs can include:

• You feel overwhelmed, stressed, or exhausted
• You feel lonely or isolated
• You've lost interest in or no longer experience pleasure when doing activities you once enjoyed
• You're irritable or easily angered
• You're neglecting personal hygiene
• You’re experiencing sleep disruptions or changes in appetite
• You have chronic pain or headaches

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A mental health professional like a therapist can help you address these challenges and develop healthy coping mechanisms. Despite the potential benefits of mental health support, caregivers may experience barriers that deter them from getting help. For example, some have schedule constraints or a lack of nearby providers that create challenges in being able to regularly attend in-office sessions.

For many caregivers in these situations, virtual therapy can be an effective alternative. Online therapy platforms allow individuals to attend sessions from the comfort of home on a schedule that suits their needs. Research suggests that online therapy for informal caregivers may help reduce caregiver burden, stress, anxiety, and depression and improve quality of life.