Signs of Someone’s First Psychotic Episode: What You Need to Know

When you hear the term “psychotic break,” you might picture someone who’s out of control and experiencing delusions, hallucinations, illogical speech and more.

But the first signs of schizophrenia and other psychotic illnesses—which typically appear in people who are in their early to mid-20s—aren’t always so obvious. Because May is Mental Health Awareness Month, we wanted to take a closer look at psychotic episodes, and explain how parents play a crucial role in treatment.

“Generally, psychosis emerges fairly suddenly,” says Dr. Bryn Jessup, director of family services at Yellowbrick. “It can feel like a bolt from the blue.”

However, there are usually warning signs beforehand that a crisis may be imminent. Here are some things parents can look out for that may signal an oncoming psychotic episode:

• Distorted beliefs and perceptions, often including paranoia
• Noticeable changes in behavior that don’t have an obvious cause (such as the breakup of a relationship) and last longer than a week or two
• Withdrawal from family and friends (not answering the phone; avoiding favorite activities)
• Significant deterioration in self-care (sleeping all day; not showering)
• Increase in use of drugs or alcohol
• Agitation or hostility, sustained over days or weeks
• A comprehensive breakdown in self-regulation (such as a college student who unexpectedly fails all her classes)

If you think that your son or daughter may be heading down the path to having a psychotic episode, it’s important that you act quickly.

According to Jessup, people who receive treatment within three months of their first psychotic episode are twice as likely to show improvement compared to those who begin treatment later.

Unfortunately, young adults are especially sensitive to anything that might threaten or compromise their autonomy and self-worth. Keep this in mind when you raise concerns about their struggles with symptoms or behavior. Jessup says some young adults may get angry if you suggest they have difficulties that require professional attention beyond family support. “Parents can contribute to the feeling of being persecuted,” he says.

Here are the best ways parents can approach the subject of getting treatment to their son or daughter:

1. Bring it up, even if you’re afraid of their anger
   Yes, some young adults will get angry if you suggest that they need professional help, but not all will be hostile to offers of help. “Once you break through the bubble of isolation, some may be eager for that lifeline,” Jessup says.
2. Explain what you’ve seen
   Be prepared to describe specific changes in behavior. “You’re not trying to build a case,” he says. “You’re putting everything on the table so it can be acknowledged.”
3. Know this will take time
   Don’t expect everything to be resolved in one conversation. “The message from parents should be, ‘Let’s find out what’s going on, and we’ll figure it out from there,’” Jessup says. Focus on a first step, whether it’s seeing a doctor with you, making an appointment with a college health service, or moving home for a while.
4. Be empathetic
   Understand that your son or daughter is likely scared and confused. When offers of help are rejected and insults fly, try to empathize rather than becoming defensive.

While a psychotic diagnosis may be initially upsetting, Jessup wants patients and families to know that treatment options have been steadily improving over the years, leading to better outcomes. “Families play a really important role in supporting a stable recovery,” he says.