What Is First-Episode Psychosis? Delusions, Hallucinations, And Other Symptoms

Psychosis is generally seen as a mental health emergency, significantly impacting daily functioning and causing a disconnect with reality. When occurring for the first time, psychosis can be disorienting and scary for the person impacted and those around them. Because early intervention can be key to treating psychosis, understanding the signs of a first episode as early as possible can be helpful in seeking effective and compassionate treatment, which usually involves a combination of medication and therapy.

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What is psychosis? 

According to the National Institute of Mental Health (NIMH), psychosis involves a collection of symptoms that indicate a loss of contact with reality. People with psychosis may struggle to determine whether their thoughts, perceptions, and sensory reactions are accurate or based on legitimate external stimuli in their environment. Depending on the cause, a psychotic episode can involve several symptoms.

Symptoms of psychosis

Hallucinations

Hallucinations usually involve sensory perceptions that are not truly occurring, such as hearing, feeling, smelling, seeing, or tasting sensory stimuli that are not truly there. Some people may hear voices, whereas others may see shadows or feel bugs on their skin. 

Delusions

Delusional beliefs can be thought of as firmly held concepts that do not sway, even when a person is presented with evidence against them. They can be bizarre (not realistically possible) or non-bizarre (realistically possible, but not occurring). 

Disorganized speech or confused thinking

Psychosis can cause unusual, uncharacteristic, and disjointed actions, thoughts, and speech that may not make sense to others. In some cases, people with psychosis may not interact with or notice their environment. 

Lack of certain behaviors and emotional disruption

Psychosis can also cause “negative symptoms,” which generally refer to a lack of certain behaviors and emotions. Numbness, social withdrawal, difficulty falling asleep, and changes in behavior are a few of these symptoms. 

What is first-episode psychosis? 

First-episode psychosis (FEP) is the first episode of psychosis in a person’s lifetime. In some cases, this label is used when an individual experiences a psychotic episode but has not yet determined the cause or diagnosis behind the episode. Using the FEP label can help providers treat psychosis when the condition occurs and provide diagnostic support after an individual has been stabilized. 

Intervention efforts for psychosis are often more impactful for people who are experiencing their first episode, as early signs of psychosis can lead to quick treatment and support. The first episode of psychosis may be less severe than the following episodes, and, in some cases, there may not be another psychotic episode, depending on the cause of the first. The World Health Organization (WHO) reports that treatment for FEP should generally occur within 12 weeks of symptom onset for best results. 

What can cause first-episode psychosis? 

First-episode psychosis can have various causes and often occurs in young adults. In some cases, FEP is incited by external factors, such as traumatic events or substance use. In others, the condition may occur due to the onset of a mental illness, such as schizophrenia or schizoaffective disorder. 

Some people previously diagnosed with a mental illness like major depressive disorder (MDD) or bipolar disorder may experience psychotic features later in their illness. People with a family history of psychosis may also be at risk of the early warning signs of psychosis. Medical conditions like stroke, brain tumors, aneurysms, and other nervous system conditions can also cause psychosis. 

When a person is experiencing psychosis for the first time, the focus is often on treating and managing the symptoms so they can regain their connection to reality and return to normal function. After symptoms have been managed, a psychiatrist, doctor, or therapist may provide diagnostic testing, interviews, and support to learn more about what might have been the cause of the episode and whether there is a risk for future episodes. 

The value of early intervention in psychosis treatment

Although updated research may be needed, a study published in the World Psychiatry Journal notes that early intervention typically offers better flexibility and more systematic delivery of support. Crisis intervention support options, quick triage and screening, and other psychosis identification methods in healthcare settings can help offer this support instead of waiting for symptoms to worsen before giving care. 

Early signs of psychosis

Before the first episode of psychosis, someone may experience early warning signs, which may include symptoms like those listed below: 

• Suspiciousness and paranoia
• Social withdrawal
• Depression
• Anxiety
• Inappropriate emotions or mood swings 
• Changes in sleep habits
• Changes in eating habits
• Changes in core personality traits
• Irritability and aggression 
• Rapid, disjointed speech
• Difficulty trusting others
• Noticing “signs” in everyday items or events
• Talking obsessively about one subject or idea 

When these early signs appear, seek support by talking to a mental health or medical professional. 

How to find support for first-episode psychosis

If you or someone you love is experiencing first-episode psychosis, you’re not alone. Support options are available, and you can reach out at the first sign of potential psychotic symptoms.

Crisis intervention services

Crisis intervention services and coordinated specialty care can target a crisis while it is occurring. They can offer short-term medical support, inpatient care, and intensive therapy for clients who are unable to care for themselves due to psychosis. Emergency room staff are normally trained to triage patients who may be experiencing a mental health crisis. Clients may be connected to inpatient or outpatient psychiatric care from the emergency room to address their immediate needs. You may also consider checking out the 211 website to find more services in your area. 

Medication

Antipsychotic medications are often the first recommended treatment for psychosis, as they may halt severe symptoms like hallucinations and delusions, allowing individuals to reconnect with reality and participate more actively in treatment. During early-episode psychosis, providers may also prescribe anti-anxiety or antidepressant medications to treat comorbid conditions or symptoms. If the individual is living with a condition like bipolar disorder or schizoaffective disorder, they might be prescribed a mood stabilizer to reduce symptoms like mania that can worsen psychosis. 

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 groups

Support groups for schizophrenia and psychosis may also be helpful, allowing individuals to connect with others who can relate to their symptoms and experiences. Because social support can be beneficial mental wellness, these groups may meet a basic need for those who don’t have much social support outside of their treatment team. The Schizophrenia & Psychosis Action Alliance (S&PAA) offers internet-based secular self-help support groups for people with schizophrenia, psychosis, and psychotic disorders, as well as their loved ones.

Family education

Often, family members play a key role in providing care and support to people with psychosis. Psychoeducation can help loved ones better understand psychotic symptoms and their impacts. Family education programs also equip participants with new techniques for providing support. Research shows that psychoeducation is an effective treatment method, reducing relapses in people with psychosis while also alleviating stress for family members. 

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Talk to a mental health professional about the emotional effects of first-episode psychosis

If you recently experienced first-episode psychosis or would like to learn more about mental health conditions linked to psychosis, talking to a therapist may be helpful. Mental health professionals can help you draft a safety plan and develop a personal treatment plan to support you in daily life. They can help you implement new coping mechanisms and improve relationships. 

However, some individuals may avoid in-person resources due to symptom severity or barriers like those involving finances, transportation, and scheduling. In these cases, online therapy through a platform like BetterHelp may be more convenient. Clients may connect with providers from home via phone, video, or live chat sessions. In addition, online therapy can be flexible, allowing clients to choose different time slots each week, including outside of standard business hours. 

Studies generally support the effectiveness of online therapy for individuals with schizophrenia and psychosis. One study, published in 2015 in HHS Public Access, found that individuals with schizophrenia who tried an online intervention group with their family members usually had lower levels of perceived stress and a higher perceived level of social support after three months of treatment.