Early Onset Psychosis
Psychosis can be a frightening term. It includes some of the most challenging symptoms that people with a variety of psychiatric diagnoses may experience. Most commonly associated with schizophrenia, symptoms of psychosis can also occur in severe mood disorders, severe depression, bipolar disorders, and at times in severe stress reactions.
Because these symptoms, which can include hallucinations, delusions, or extremely disorganized thought patterns, can be very disturbing to the people experiencing them and those around them, it’s critically important to obtain an accurate diagnosis – and patients and their families should know that with early diagnosis and treatment, a person with psychosis can learn to manage their symptoms and live a full, productive life.
Treatment for Early Onset Psychosis: Accurate, Timely Diagnosis and Evidence-Based Intervention
The diagnostic assessment must ensure that medical, neurological, and substance use-related causes are excluded. Whatever the diagnosis, evidence shows early intervention and consistent treatment significantly improve prognosis for patients diagnosed with a mental health disorder that include symptoms of psychosis.
What is Psychosis?
The National Alliance on Mental Illness (NAMI) offers this definition of psychosis:
“…disruptions to thoughts and perceptions that make it difficult for an individual recognize what’s real and what isn’t. These disruptions are often experienced as seeing, hearing, and believing things that aren’t real or having strange, persistent thoughts, behaviors, and emotions.”
Fundamentally, psychosis represents a disturbance in a person’s grasp of reality, whether that is in their perceptions (hallucinations), beliefs (delusions, including paranoia), or their ability to think or express themselves coherently (thought disorder).
Mental health disorders that may include early onset psychosis and/or symptoms include:
Schizophrenic disorders
- Schizophrenia
- Schizoaffective disorder
- Schizophreniform disorder
These disorders, including related symptoms of psychosis, most often emerge between ages 17-25, but the first episodes can occur well into adulthood, as late as age 40.
Brief psychotic disorder
Also known as acute and transient psychotic disorder, associated symptoms of psychosis commonly appear by age 18, but may appear as late as age 35.
Mood disorders
- Major depressive disorder (MDD)
- Bipolar disorder I & II
The average age of onset of symptoms of psychosis in mood and related disorders is around 18-20 years old, but may appear during later adulthood, as well. It’s extremely rare for symptoms of psychosis to appear in children or early adolescents.
Symptoms of Psychosis and Age: Important Facts for Families
In rare cases, patients may develop the symptoms of psychosis we describe below in childhood or early adolescence. When symptoms appear early, there’s typically a clear family history of psychosis, but not always. At BACA, we have the knowledge and experience to treat these early cases in the context of whichever mental health or behavioral disorder they appear.
Early Onset Psychosis: What are Hallucinations and Delusions?
The National Alliance on Mental Illness
“Things a person sees, hears, or feels – i.e. sensory perceptions – when there is no real or identifiable source that causes those perceptions.”
Early Onset Psychosis: Hallucinations
Hallucinations most often associated with psychosis and early onset psychosis include:
Auditory
Auditory hallucinations occur when a person hears sounds that aren’t there. They’re the most common type of hallucination, and most often involve hearing voices.
Visual
Visual hallucinations occur when a person sees things that aren’t there. Visual hallucinations aren’t always sinister or disturbing, but more often simply unusual or confusing.
Olfactory
Olfactory hallucinations occur when a person smells things that aren’t there. They may be pleasant or unpleasant. Olfactory hallucinations may occur in short episodes, or they may be present constantly.
Touch
Touch, or tactile hallucinations, occur when a person experiences physical sensations that have no real external cause, such as tingling on the skin, or the sensation of being tapped on the arm or shoulder when no one is there.
Early Onset Psychosis: Delusions
The National Alliance on Mental Illness (NAMI) defines delusions as:
“Thoughts or beliefs held by a person that are objectively and demonstrably false or untrue.”
Delusions most often associated with psychosis/early onset psychosis include:
Grandeur/Over-Inflated Sense of Self
A person with these types of delusions often believes – with absolute certainty – they possess powers, knowledge, secret talents, or special skills no one else has.
Persecution
A person with this type of delusion becomes certain that some type of external force exerts power over them and actively seeks to cause them harm when there’s no tangible evidence to support the belief
Thoughts/Thought-Related
For some people, delusions take the form of errant beliefs about the thoughts inside their head. They may arrive at the conclusion – with no concrete external evidence – that their thoughts are/have been:
- Under the direct control of external factors, including other people, entities, or forces
- Planted in their brains by external entities, forces, or other people
- Stolen directly out of their minds by external entities, forces, or other people
- Read, made audible, or made accessible/known to others, by some external force, entity, or person
Relationship/Relationship-related
These types of delusions involve real and/or fictitious relationships. In real relationships, a person may develop the delusion – with no real evidence – that their partner is unfaithful/cheating on them. In addition, a person with relationship-related delusions may believe they’re in a serious romantic relationship or a deep friendship with someone they’ve never met and don’t know, such as a celebrity or famous person.
Treatment for Early Onset Psychosis and Psychosis at BACA:
Coordinated Specialty Care (CSC)
The National Institute on Mental Health (NIMH), the Substance Use and Mental Health Services Administration (SAMHSA), and the American Psychiatric Association (APA) identify Coordinated Specialty Care (CSC) as first-line approach to treating psychosis in children, teenagers, and young adults.
The APA identifies the following components of CSC:
Coordinated Specialty Care: Core Components
Collaborative Decision-Making
Evidence indicates collaboration between providers, patients, and families using a team-based approach improves outcomes and reduces stigma. This approach stresses combining provider expertise with the lived experience of the patient and family.
Psychotherapy
Cognitive behavioral therapy for psychosis (CBTp): CBT for psychosis may occur in individual , family, or group settings. Evidence shows that CBTp can reduce distress caused by symptoms pf psychosis, and improve psychosocial function.
Medication
Medication is the standard the first-line treatment for psychosis, but recent research suggests that using medication for early psychosis/first episode psychosis in adolescents can extend the Duration of Untreated Psychosis (DUR), and lead to negative outcomes, as compared to following the CSC model. When an assessment indicates the need for medication, a person with early onset psychosis may receive a prescription for:
- Typical antipsychotics
- Atypical antipsychotics
Case Management
Evidence suggests treatment outcomes improve when a case manager coordinates care in collaboration with patient, family, and provider.
Family Participation: Education, Support
Families play a crucial role in the treatment of early onset psychosis. When the family learns about the symptoms of psychosis and the facts about mental health disorders involving psychosis, outcomes improve because family members understand how they can support their loved one as they learn to manage symptoms of psychosis.
Peer and Community Support
Community and peer support groups help people with emerging symptoms of psychosis understand they don’t have to go through everything by themselves. Learning from peers others who’ve learned to manage hallucinations and delusions associated with early onset psychosis can make a big difference: patients will often listen to people who have been there and done that over people who have neither been there nor done that.
Vocation, Education, and Lifestyle
The CSC approach is multidisciplinary. It’s specifically constructed to help a person with early onset psychosis thrive in all life domains. This means the treatment process involves creating opportunities for education and vocational training appropriate for people who experience the symptoms of psychosis.
It also means teaching patients how to maximize their healing potential with lifestyle changes and educational workshops that improve overall health and wellness, including:
- Exercise and activity
- Healthy eating
- Mindfulness and distress tolerance
- Sleep hygiene
- Social/relationship skill building
- Eliminating/reducing alcohol and substance use
It implies that a full and productive life is possible.
Coordinated Specialty Care at BACA: Evidence-Based Treatment, Experienced Clinical Team
We adapt all treatment modalities to meet the principles and guidelines or trauma-informed care presented above. Therapeutic modalities for early onset psychosis and mental health disorders with symptoms of psychosis include, but are not limited to:
Psychotherapy:
- Cognitive behavioral therapy (CBT)
Medication:
- Typical antipsychotics
- Atypical antipsychotics
At BACA, a treatment plan for a person – child, adolescent, or young adult – with early onset psychosis or a mental health disorder with symptoms of psychosis will include most of the following:
- Education about psychosis and mental health disorders with symptoms such as hallucinations and delusions
- Education about treatment for symptoms of psychosis
- Psychotherapy, such as CBT
- Prescription medication, if indicated
- Group counseling
- Family counseling
- Complementary/expressive therapies
At BACA, we take the time to learn about our patient and their families in order to understand their unique needs and design a treatment plan. We design a treatment plan focuses on strengths, addresses areas with the greatest need for change and growth, and gives each patient – and their family – the best chance of rediscovering balance, managing the disruptive symptoms of psychosis, and achieving stable, sustainable, long-term recovery.
