Understanding The Stages Of Psychosis

Psychosis generally refers to a disconnect from reality. Psychosis is a mental state that often comes with symptoms like delusions, hallucinations, and disorganized thinking and speech. Often, a psychotic episode involves three stages: the prodromal stage, the acute stage, and the recovery stage. Seek professional help if you believe you could be experiencing symptoms of psychosis. Treatment usually involves a combination of therapy and medication to manage symptoms and help individuals succeed in their daily lives.

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Early warning signs of psychosis

A few key indicators may signal that a person could develop psychosis in the near future. Some potential early signs of psychosis can include the following:

• Changes in behavior: Unexplained changes in behavior, such as suspiciousness, social withdrawal, a decline in hygiene, or other behaviors that seem out of the ordinary, could be early signs of psychosis. These behaviors may happen suddenly and can impact how a person acts at home, school, or work. 
• Cognitive changes: In some cases, a person may experience cognitive changes during the prodromal phase. A person’s thoughts may become unclear, potentially creating challenges in decision making.
• Emotional changes: A person in the early stages of psychosis may begin to experience strong emotions, such as being easily agitated, or their emotions may seem to be dulled. 
• Perceptual changes: Sudden changes in perception, or how a person sees the world, may occur before the full-blown hallucinations and delusions that typically arise during the acute phase of psychosis. 

While these warning signs can give clues to friends and family members that a person may be experiencing early psychosis, they are not a guarantee that the person will experience psychosis. Early psychosis symptoms can be challenging to identify as they often overlap with symptoms of other mental health conditions. 

Prodromal stage

During the prodromal phase of psychosis, a person may exhibit some subclinical symptoms of psychosis that do not rise to the level of acute psychosis. The length of the prodromal period can depend on the individual and may last anywhere from a few weeks to several years, although updated research may be needed.

During this time, a person may experience a variety of symptoms and behavioral changes, such as mood swings, depression, anxiety, sleep disturbances, anger, irritability, and suicidal thoughts or ideations. The symptoms of psychosis during the prodromal stage can be challenging to identify due to their subclinical nature. Individuals with psychotic symptoms may also experience other comorbid conditions, which can add to the difficulty of identifying symptoms during this stage. 

Even though symptoms can be difficult to diagnose during the prodromal stage, getting appropriate treatment from a mental health professional during this period may be possible. A therapist or psychiatrist can help you identify symptoms and their causes, as well as help you monitor symptom progression. A professional may also change your treatment plan as symptoms progress, which may reduce their impact and potentially prevent them from reaching the acute stage.

Acute stage

Symptoms of the acute phase can include those discussed below:

• Hallucinations: During the acute stage, individuals may experience hallucinations, which typically involve seeing, hearing, smelling, tasting, or feeling something that is not there. For example, a person may hear voices or see loved ones that are not present. Hallucinations usually seem real and can be unnerving for those experiencing them. 
• Delusions: Delusions can be defined as thoughts a person believes to be true, even though they are not based in reality. A common type of delusion is generally referred to as persecutory and can involve the belief that a person or group of people are attempting to harm you in some way. These false beliefs can contribute to paranoia and social withdrawal in some individuals. 
• Disorganized or confused thinking: A person experiencing psychosis may have a hard time forming organized thoughts. This may be due, in part, to the challenge of determining what is real and what is not. 
• Incoherent speech: Psychosis can cause incoherent or disorganized speech in some individuals, which can create challenges in communicating with friends and family or in the workplace.  

Individuals who experience psychotic episodes (sometimes called acute psychosis) may not always be able to tell what is real and what is not. Treating this break from reality may involve inpatient treatment. During the acute phase, attending school, going to work, and maintaining interpersonal relationships may be challenging. Getting treatment, which usually involves antipsychotic medication and therapy, can be highly effective and often shifts psychosis into the recovery stage.

Recovery and remission stages

After a psychotic episode, an individual may undergo treatment and start the recovery phase. The recovery phase generally marks a period of stabilization and symptom improvement following the acute phase. The recovery phase can be characterized by a gradual return to baseline function and a reduction in the intensity and frequency of psychotic symptoms. While recovery can be different for each individual and may vary in duration, this phase generally involves symptom remission, functional improvement, and overall stabilization. During this time, a person may be able to reflect on their psychotic episode and build a plan to prevent or better manage one in the future.

After recovery, a person may not experience symptoms of psychosis at all. This period can be referred to as remission. During remission, the individual may function relatively normally. Remission can be partial or complete, as well as temporary or long-lasting. In partial remission, some symptoms may still be present, but they usually are not as severe or frequent as they were during the acute phase, while complete remission typically indicates the absence of all symptoms.

Individuals who have experienced a psychotic episode may benefit from continuing treatment throughout their lives. A relapse can be possible, even in cases where a person has not experienced symptoms for a while, and a mental health professional may address any symptom changes that could indicate impending psychosis.

Treating psychosis 

Treating psychosis is typically a multifaceted process involving a team of mental health professionals that could include doctors, therapists, and psychiatrists. In many cases, individuals will receive both antipsychotic medication and cognitive behavioral therapy to manage symptoms and attempt to prevent additional psychotic episodes. 

Antipsychotics must be prescribed and monitored by a doctor. Always consult your prescribing provider before starting, stopping, or changing the way you take medication.

Online cognitive behavioral therapy can be an effective way to treat the prodromal and recovery phases of psychosis. While online therapy may not be appropriate for acute psychosis, this format can be effective at helping a person identify early warning signs and change thought patterns after an acute event. An online therapist can work with a person over time to make lifestyle changes, discuss the side effects of medication, and implement strategies to reduce the impact of psychosis.

For individuals experiencing psychosis or a related mental health condition, finding an experienced therapist in their area can be challenging. Online therapy platforms typically have a much larger pool of therapists with whom clients can connect. In addition, online therapy can offer more flexibility than in-person therapy because you can attend sessions via video conference, phone call, or online chat from anywhere with an internet connection.