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The teenage years are often the earliest onset for symptoms of psychosis, which is why these symptoms are rarely identified until later in life. Less than a fifth of adults with psychosis said their parents recognized the early warning signs. Early on, symptoms of psychosis are subtle and reminiscent of those experienced in other psychiatric disorders, such as mood disorders (depression and/or anxiety). Symptoms of psychosis are characterized by a loss of touch with reality in one way or another, usually in the form of:

  • Delusional thoughts.
  • Auditory or visual hallucinations.
  • Disorganized or irrational thinking.

Many symptoms of psychosis develop slowly over time and become more severe during adulthood. Sometimes, they can be mistaken for normal teen behavior – such as typical teenage mood swings and irritability – and are ignored. And because these symptoms can come and go, even the more alarming symptoms might not be treated with severe concern at first.

Recognizing the Early Signs of Psychosis

The early signs of psychosis can generally be divided into three categories. The severity of a teen’s symptoms and how and when they occur can be integral to determining a proper diagnosis and finding the right treatment plan. These three categories include:

1. Hallucinations

Hallucinations are the perception of stimuli that are not real. They can be visual, auditory, olfactory, or tactile. We all know that the world as we perceive it results from how our brain filters information, but that information may be interpreted falsely for individuals with hallucinations. Hallucinations can range from mild and recurrent to intense and long-term. For example, they might constitute something as simple as seeing the wrong colors, feeling the touch of a person who is not there, or hearing faint voices in the back of one’s mind.

2. Disordered Thinking

Disordered or disorganized thinking is usually exhibited through strange or nonsensical speech and behavior, often either in racing and uncontrolled/intrusive thought or a flight of ideas. You find yourself jumping between topics and making connections between ideas where none exist. While hallucinations can confuse speech and thinking, disorganized thoughts are sometimes recognized as a separate type of psychosis characterized by stumbling speech and nonsensical word salads.

3. Delusions

Delusions, unlike hallucinations, are false thoughts and ideas rather than false stimuli and experiences. A deception might be an idea not supported by reality, but one you still believe in very firmly, separate from any cultural or subcultural influence. A common type is a delusion of grandeur, where you firmly believe you are far more influential and powerful than you are and begin to attribute random events to your ability (such as changes in the stock market or weather). People with psychosis can sometimes recognize that they are experiencing delusional thinking and become extremely agitated or anxious. They begin to doubt what is and is not absolute and express signs of paranoia and distrust.

What Causes Psychosis in Teens?

Exact causes for psychosis have not been identified, but research does suggest that these symptoms are often hereditary. Individuals with direct relatives who have experienced psychosis are far more likely than the average person to experience psychosis as well. Environmental factors compound this risk, including childhood trauma and stress. Prenatal conditions are also linked to psychosis, including maternal infection, prenatal malnutrition, a disrupted supply of oxygen during fetal development, and advanced paternal age.

Medical “Mimics” and Differential Diagnosis of Psychotic Symptoms

Psychosis is a symptom of a more significant disorder or condition, from psychotic disorders to medical conditions such as head trauma and brain tumors. These conditions include:

  • SCHIZOPHRENIA: Schizophrenia is characterized by long-term and recurring psychosis absent of other causes, alongside a significant impairment to a person’s everyday functioning. Teen schizophrenia may include more auditory hallucinations and fewer incidences of delusional or disordered thinking.
  • SCHIZOTYPAL PERSONALITY DISORDER: One of ten personality disorders recognized by the DSM, schizotypal personality disorder is characterized less by hallucinations and more by delusional and magical thinking and severe social anxiety.
  • SCHIZOAFFECTIVE DISORDER: Schizoaffective disorder is a combination of schizophrenic symptoms and severe mood disorder symptoms (depression and/or mania). Teens with schizophrenia can also experience mood disorder symptoms, but these are not expected always to accompany their psychosis. Teens with schizoaffective disorder, on the other hand, experience depression and/or mania with psychosis that comes and goes.
  • SCHIZOPHRENIFORM DISORDER: This is a short-term psychotic disorder, lasting less than six months and at least one month.
  • DELUSIONAL DISORDER: Delusional disorder is characterized by delusional thinking without other types of psychosis, signs of a personality disorder, or mood disorder symptoms. The defining symptom of a delusional disorder is intense paranoia.
  • BRIEF PSYCHOTIC DISORDER: Brief psychotic disorder has a total duration of about a month, with at least one symptom of psychosis. In rare cases, a brief psychotic disorder may occur more than once. This condition usually occurs immediately after an extremely stressful event.
  • SUBSTANCE-INDUCED PSYCHOSIS: Certain drugs can induce short-term psychotic episodes past their immediate psychoactive effects. These include hallucinogens like DMT and psilocybin, as well as marijuana and synthetic cannabinoids. Depending on the drug and individual differences, these symptoms can come and go over months or years.
  • UNDERLYING MEDICAL CONDITIONS: Head trauma, brain tumors, certain viral infections, multiple sclerosis, and brain disorders like Alzheimer’s can induce symptoms of psychosis. These medical conditions are considered by a professional when making a differential diagnosis for a teen’s psychosis.

Treatment Resistance Challenges and Solutions

Teens experiencing symptoms of psychosis will be reluctant to reveal that anything is wrong and might feel embarrassed or worried about the onset of their symptoms, especially if they do not know how or why psychotic disorders can develop. Some teens with developing psychotic symptoms might not want or think they need treatment and can be challenging to talk to. Early signs of psychosis can be like symptoms of common mood disorders, so teens will often be erratic, cold, or distant, prone to mood changes, and low or exceptionally high energy.

Parents should take note of their children’s behavior and speech. In cases where psychotic disorders run in the family, it might help set aside some time to discuss these disorders with a teen and let them know how they occur and that they can be treated. It is sporadic for symptoms of psychosis to develop spontaneously – they usually take time to mature, and most cases of schizophrenia, for example, are generally only professionally identified and diagnosed months or years after the onset of the earliest symptoms.

Through early detection and professional help, a teen with symptoms of psychosis can learn to separate their symptoms from normal and healthy patterns of thinking and lead a better life. In cases where these symptoms reveal a more long-term or even lifelong disorder, early and comprehensive care and regular contact with professionals can be the key to developing effective lifelong coping mechanisms.