Information for Individuals and Families

To find a program near you providing early intervention in psychosis, please visit SAMHSA's treatment locator at https://www.samhsa.gov/esmi-treatment-locator

The Internal Experience of Psychosis

At first: People experiencing symptoms of psychosis often report that their minds are playing small tricks on them. They have difficulty screening out distracting information and sensations, and attending to what is important. However, people can stay focused with greater effort, and can usually dismiss or reject thoughts that they recognize are irrational.

Then: Visual experiences may become brighter or distorted in color, shape, or size. Soft or brief sounds may seem loud and irrelevant background noise distracting. The person experiences an increase in both quantity and quality of sensations. There is a sense of feeling overloaded with jumbled memories, thoughts, and stimulation from the environment.

As symptoms of psychosis progress: It becomes harder to concentrate on a book or conversation, or to carry on a conversation that would make sense to another person. It also becomes increasingly difficult to distinguish internal thoughts from external perceptions. For instance, upon hearing a noise outside while thinking about an event that occurred yesterday, the sound registers as something that happened yesterday. Irrational thoughts or beliefs may be accepted as reality, and may become fixed and resistant to logical evidence to the contrary. Many people begin to experience fear of being harmed or injured by other people, even friends and family.

Finally: A person experiencing full-blown psychosis loses control over his will, is disconnected from his own actions, and has an inability to follow through on a thought or action. A person experiencing psychosis might be very anxious, even panicky, and make serious errors in relating to the world. For instance, a person might see a stranger while walking down the street, but, in his confusion, think that he knows this person. He might begin to think that this person is almost everywhere and is following him. In an extreme state, this situation would become quite frightening. The person would miss more subtle cues that would correct his distortions; consequently, he would become completely out of touch with reality.

What Others May Observe

At First: Others, especially family members, may notice that their loved one starts to think and act differently without knowing just what is wrong.

Then: As the person’s level of functioning declines and symptoms become more obvious, it is harder to rationalize or explain away the unsettling realization that something is markedly wrong. The pre-psychotic or “prodromal” symptoms may persist for weeks or months unchanged but generally intensify as the person becomes overtly psychotic.

As prodromal symptoms progress: The person may have trouble expressing opinions or thoughts because she can’t concentrate for long. When talking to a professional, a young person may express stress, trouble with coping, or may feel different from her peers in some way. Her speech may be vague and she may have odd ideas. Initial complaints to professionals often focus on somatic (or physical) symptoms, particularly sleep disturbance and difficulties with memory and concentration. Others have vague physical symptoms that move around the body and that defy ordinary medical diagnoses.

With time: People experiencing early symptoms of psychosis tend to avoid social contact. They may also be less expressive or spontaneous. It is important to recognize that such behavior is part of an illness process, not rudeness or laziness. Insignificant critical comments or subtle looks can send these young people into extreme states of self-doubt, irritability, or paranoia. Other people may feel uncomfortable around them. As young people realize this, they may become demoralized and depressed. In addition, they may be guarded and try to conceal their difficulties, especially from professionals.

Finally: As symptoms become more serious, a person’s speech may seem fragmented or even incoherent. He may appear very suspicious and express bizarre ideas or even whole belief systems that are disconnected from reality. For example, he might be convinced that someone is reading his mind, that someone is controlling his thoughts with wires in his head, that others can hear his thoughts as if they were spoken out loud, or that someone is inserting thoughts into his head. The person is most likely desperately trying to make sense of his experience or thinking but is reaching distorted and inaccurate conclusions.

The Family’s Experience

Family members are often quite frightened or frustrated. They have seen an alarming change in their loved one’s behavior and may be unsure of what is going on. If they suspect a mental illness, they may be afraid to have their suspicions confirmed; their child or sibling may remind them of a family member with serious mental illness. They may feel ashamed or afraid that it is their fault. Some families may have religious or cultural beliefs that reject the possibility that the changes in their loved one are due to mental illness. In all situations, the professional needs to be encouraging and supportive. Most importantly, professionals need to listen to the family’s experience and concerns.

Often, families and friends ask how they should behave and talk to a person who is psychotic or showing early signs of a psychotic illness. There are no set rules, but some general guidelines are helpful:

1. Be yourself. Understand that this is not your fault.
2. Get information to help you understand the illness that is afflicting your loved one and how it affects his or her behavior.
3. Try not to take it personally if your loved one says hurtful things to you when he or she is unwell. Minimize arguments or long discussions. Stay as positive as possible.
4. Reduce stressors. Tone down emotions. Research shows that keeping the emotional atmosphere as calm as possible can speed recovery and help prevent relapse.
5. Communicate simply and clearly.
6. Solve problems step by step.
7. Ask for help from professionals if you have questions.
8. Don’t ignore violence or risk of suicide.
9. Hopefully, you are involved in your loved one’s treatment. Whether or not the provider working with your loved one has permission to speak with you, you can always offer information and observations.