Psychosis in Teens: Symptoms & Treatments

Mental health disorders are common in teens, with a prevalence rate of 31% among adolescents[1]. Psychosis alone has a prevalence rate of 5%-8% among teens and can cause significant distress, disruption, and disability[2]. This blog will discuss psychosis in teens, its symptoms, causes, diagnosis, and treatment options.

What is Psychosis in Teens?

Psychosis is a mental illness in which a person has delusions (false beliefs such as thinking people are talking about them or believing they can control the weather) and hallucinations (seeing, hearing, feeling, tasting, or smelling something that is not actually there).

Psychosis is often a symptom of schizophrenia, a psychotic disorder that can cause long-term disruption in a person's ability to think, act, behave, and relate to others [3]. However, not all adolescents who experience psychosis have schizophrenia—it can also be a symptom of bipolar disorder, major depression, dissociative states, or other psychiatric disorders[2].

Helpful tip

Psychosis alone has a prevalence rate of 5%-8% among teens and can cause significant distress, disruption, and disability[2].

Signs and Symptoms of Psychosis in Teens

According to NIH, psychosis symptoms in teens are as follows. [2]

Prodromal Symptoms (Early Symptoms that are often misdiagnosed with depression)

• Social withdrawal
• Behavior that is tired, strange, or suspicious
• irregular or unusual cognitive development

Active Psychotic Symptoms of Teens (Acute Psychotic Episode)

• Delusions
• Hallucinations- auditory hallucinations (hearing voices that are not real) are the most common form.
• Perseveration- keep saying the same thing over and over.
• Not knowing their own identity
• Not having much to say
• Illogical thinking- not making sense of their thoughts
• Talking a lot about details that are not important.
• Changes in eye movement

Non-Common Signs of Psychosis in Teens

These psychosis symptoms are usually not seen in teens.

• Waxy flexibility- feeling stiff and can't move
• Become catatonic- cannot move or respond.

Causes of Psychosis in Teens

Psychotic Disorders

The most common cause of psychosis is a mental disorder. [2] A few conditions that can cause psychosis are schizophrenia, bipolar disorder, mood disorders, schizophreniform disorder, and schizoaffective disorder. However, a person experiencing psychosis may have psychotic symptoms without having any other psychotic illness [4].

Genetic Risk Factors

If the parents or siblings of adolescents have a family history of childhood-onset schizophrenia, it is more likely that the adolescent will develop a psychotic disorder [2].

Stress and Trauma

Childhood trauma, environmental factors such as neglect, physical and emotional abuse can also act as a trigger for the onset of psychosis in adolescents. Stressful incidents, such as the death of a parent or other family member, can also increase the risk [2].

Did you know?

Teens with PTSD are more likely to experience psychosis, as trauma can significantly impact their mental health and perception of reality.

Drug Use

The use of certain illicit drugs, such as marijuana, cocaine, and LSD, increases adolescents' risk of developing psychotic symptoms [2].

Medical Illness

While not common in teens, certain medical conditions can also cause early psychosis often, such as brain tumors or cysts, stroke, HIV, and epilepsy[5]. Teens with these conditions are more likely to experience psychotic symptoms than those without them.

The Brain's Landscape: Understanding Its Structure and Function

Before diving into the specifics of psychosis, it's crucial to have a basic understanding of the brain's key regions and their roles:

• Prefrontal Cortex: This region is responsible for high-level cognitive functions, including decision-making, planning, and social behavior.
• Hippocampus: It plays a significant role in memory formation and learning.
• Amygdala: This almond-shaped structure is involved in emotion processing, particularly fear and anxiety.
• Thalamus: It acts as a relay station, transmitting sensory information to the appropriate areas of the brain. [9]

Neuroscience Behind Psychosis: What Happens During a Psychotic Episode?

During a psychotic episode, several changes occur in the brain:

• Altered Dopamine Functioning: Dopamine, a neurotransmitter associated with reward and pleasure, plays a significant role in psychosis. Research suggests that overactivity in the brain's dopamine system, particularly in the striatum, contributes to the hallucinations and delusions characteristic of psychosis.
• Abnormalities in Brain Structure: Studies have found certain structural abnormalities in the brains of individuals with psychosis, including reduced volume in the prefrontal cortex and hippocampus. These abnormalities may contribute to the cognitive difficulties often seen in psychosis.
• Disrupted Connectivity: Psychosis is also associated with disrupted connectivity between different brain regions. For example, decreased connectivity between the prefrontal cortex and other areas might contribute to impaired reality testing, leading to symptoms like delusions. [10]

Interpreting the Changes: Why Do These Alterations Cause Symptoms?

The changes that occur in the brain during a psychotic episode can help explain the diverse symptoms of psychosis:

• Hallucinations: Overactivity in the dopamine system could lead to heightened significance being attached to irrelevant stimuli, potentially leading to hallucinations.
• Delusions: Impaired functioning in the prefrontal cortex could disrupt reality testing, leading to false beliefs or delusions.
• Cognitive Difficulties: Structural abnormalities and disrupted connectivity might interfere with various cognitive functions, such as memory, attention, and executive functioning.

Understanding the neuroscience of psychosis provides critical insights into the complex interplay of brain regions and neurotransmitters in this condition. It also underscores the importance of continued research in this field, as a deeper understanding of these processes could pave the way for more effective treatments in the future. [11]

Diagnosis of Psychosis in Teens

The diagnosis should be made by a mental health professional. Your healthcare provider will perform a mental health screening to assess your teen's symptoms and mental state. They may make psychiatric diagnosis and also recommend a physical exam, lab tests, and imaging tests to rule out any medical conditions that could be causing psychosis symptoms[6].

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) requires the onset presence of certain conditions for more than six months for each psychotic illness[2]. For example, schizophrenia requires at least two of the following symptoms, such symptoms as delusions, hallucinations, grossly disorganized or catatonic behavior, disorganized speech, and negative symptoms (such as flat affect).

Mental health screening can help diagnose early signs of these mental health concerns, which can be used to provide effective treatment strategies.

Treatment for Psychosis in Teens

• Family Intervention

The parents and other family members can monitor the teens' behavior and provide support to them. They should also create a safe and stress-free environment for the patient. For example, the patient must not be responsible for family responsibilities such as babysitting the siblings or taking care of the household chores.

• Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) can be an effective tool in altering dysfunctional behaviors. It helps the patient to understand their thought patterns and beliefs system in order to help them identify and change their faulty ways of thinking[2].

Helpful tip

Therapy can be a lifeline for teens with psychosis. It helps manage symptoms, provides coping strategies, and enhances their quality of life. Never underestimate the benefits of therapy!

• Antipsychotic medication

Antipsychotics can be used efficiently to treat prodromal psychotic symptoms. Many typical and atypical antipsychotics can reduce the visual hallucinations and delusions associated with psychotic episodes and improve functioning. However, they may have some side effects, such as weight gain, extrapyramidal symptoms, and metabolic abnormalities[2].

Unraveling Misconceptions: The Truth About Psychosis

Psychosis, like many mental health disorders, is often misunderstood. Misconceptions about psychosis can create barriers to understanding, compassion, and appropriate treatment. Let's debunk some common myths and shine a light on the realities of this condition.

Common Misconceptions About Psychosis

• Misconception 1: Psychosis is Always Violent The belief that individuals experiencing psychosis are violent is both inaccurate and damaging. The majority of people with psychosis are more likely to be victims of violence rather than perpetrators.
• Misconception 2: Psychosis Equates to Schizophrenia While psychosis is a symptom of schizophrenia, it can also occur in other disorders such as bipolar disorder, severe depression, and certain medical conditions. Psychosis is not a diagnosis but a symptom.
• Misconception 3: People with Psychosis Can't Recover Contrary to this misconception, with appropriate treatment and support, many individuals with psychosis can lead fulfilling lives. Early intervention significantly improves long-term outcomes. [12]

The Stigma of Mental Health Disorders

Stigma surrounding mental health conditions can have severe repercussions, particularly for adolescents. Teens already navigate a challenging phase of life, and the added burden of stigma can exacerbate their struggles.

• Impact on Self-Image: Stigma can make adolescents internalize negative beliefs about themselves, leading to decreased self-esteem and self-worth.
• Hinders Treatment: The fear of being judged or treated differently may discourage teens from seeking help, hindering early detection and intervention.
• Isolation: Stigma can lead to social isolation, as teens may feel misunderstood or rejected by their peers, further worsening their mental health. [13]

The Prevalence of Psychosis and Its Impact

To fully grasp the significance of these misconceptions and stigmas, let's consider some statistics:

• For males, the peak age of onset is in their teens to mid-20s, whereas for females, it typically occurs in their teens to late 20s.
• An initial psychotic episode occurs in about 50 out of every 100,000 persons.
• Children rarely experience psychosis.
• While it's estimated that between 1.5 and 3.5 percent of people will have a psychotic condition and match the diagnostic criteria for it, a much larger percentage of people will likely experience at least one psychotic symptom throughout their lifetime.[14]

Adolescence, Brain Development, and Mental Health

Adolescence is often regarded as a tumultuous period, a storm before the calm of adulthood. It's a time of exploration, self-discovery, and growth, but it also carries its unique set of challenges. To truly understand these challenges and their impact on mental health, we must delve into the fascinating world of adolescent brain development.

The Enigma of Adolescence: A Time of Change and Challenge

The adolescent years are marked by significant physical, emotional, and social changes. Teens navigate the precarious path towards independence, grapple with identity issues, and experience the rollercoaster of puberty.

During this period, they face unique challenges:

• Peer pressure and the desire for acceptance: As teens start to place more value on their peer relationships, the pressure to fit in can be intense. This can lead to stress, anxiety, and even risky behaviors.
• Academic expectations: High school years bring an increased academic workload and the pressure to make crucial decisions about higher education and career paths.
• The quest for identity: Adolescence is often a time of self-discovery and exploration, which can lead to confusion and inner turmoil.

Helpful tip: Caring for a mentally ill parent can be tough. Remember, it's okay to seek help. Support groups for teens can offer coping strategies and understanding.

The Teen Brain: A Work in Progress

The human brain undergoes significant development during adolescence. The brain's 'grey matter', responsible for processing information, peaks just before puberty and then starts to decrease, while the 'white matter', responsible for transmitting information, continues to increase.

Two key areas of the brain undergo significant changes:

• Prefrontal Cortex: This is the brain's decision-making center, responsible for abilities such as planning, impulse control, and emotional regulation. During adolescence, this area is still maturing, which may contribute to the impulsivity and emotional turbulence many teens experience.
• Limbic System: This area, responsible for emotional responses and reward processing, develops earlier. This discrepancy in development could explain why teens might rely more on emotion rather than logic when making decisions.

Adolescence and Vulnerability to Mental Health Issues

The changes happening in the brain during adolescence can contribute to increased vulnerability to mental health issues.

• Increased risk-taking behavior: Due to the ongoing development of the prefrontal cortex, teens may engage in riskier behaviors, which can lead to issues such as substance abuse.
• Heightened emotional sensitivity: The still-developing brain can make adolescents more susceptible to emotional disorders like anxiety and depression.
• Emergence of serious mental health disorders: Conditions like psychosis often first appear during adolescence, when the brain is undergoing rapid change. [15]

The Historical Context and Current Trends of Teen Psychosis

In order to gain a broader understanding of psychosis in teens, it's essential to explore the evolution of its perception and treatment throughout history, as well as to examine current trends and statistics.

The Historical Backdrop of Psychosis in Adolescence

Understanding psychosis, particularly among adolescents, has been a journey spanning centuries.

• Ancient and Medieval times: Mental health disorders, including psychosis, were often misunderstood and feared. They were largely believed to be caused by possession or divine punishment. Treatment, if any, was rudimentary and often harmful.
• 18th and 19th centuries: As scientific understanding grew, the perspective shifted from divine causation to medical explanations. However, treatments remained primitive, and asylums were common. [16]
• 20th century onwards: The advent of psychoanalysis and the development of antipsychotic medication in the mid-20th century revolutionized the treatment of psychosis. The shift towards community care and deinstitutionalization in the late 20th century further improved the quality of life for individuals with psychosis.[17]

Despite these advancements, the stigma surrounding psychosis and mental health disorders persisted, often leading to delayed diagnosis and treatment, particularly in adolescents.

Teen Psychosis Today: A Statistical Perspective

Understanding the prevalence and impact of teen psychosis is crucial in shaping effective prevention and intervention strategies. Here are some key statistics:

• 5 out of every 100 kids and teenagers might experience symptoms like hearing voices or seeing things that aren't there.
• 1 out of 100 people will actually have a mental health condition called schizophrenia in their lifetime. This condition is slightly more common in boys than in girls, with about 1.4 boys having it for every 1 girl.
• If someone in your close family has schizophrenia, your chances of getting it are five to 20 times higher than someone else your age.
• If you have an identical twin with schizophrenia, there's a 40% to 60% chance you'll get it too. If you have a fraternal twin or another brother or sister with it, there's a 5% to 15% chance you might get it. [19]

The Current Landscape and Future Trends

Today, the focus is on early detection and intervention, which have been shown to significantly improve outcomes. There is also increasing emphasis on personalized treatment plans that consider the unique needs of adolescents.

Research continues to explore the genetic and environmental factors contributing to psychosis in teens, and there is optimism that these advancements will lead to better prevention strategies and treatments.

Psychosis and Performance at School: An Intertwined Reality

Psychosis in adolescents can present significant challenges in a school environment. Understanding these challenges and finding effective ways to navigate them is crucial for educators and school counselors.

The Impact of Psychosis on Academic Performance

Psychosis can profoundly impact a teen's performance at school. The implications range from cognitive to social aspects.

1. Cognitive Challenges: Teens experiencing psychosis may struggle with concentration, memory, and problem-solving skills. This can lead to difficulties in keeping up with classwork and maintaining academic performance.
2. Social Difficulties: Psychotic symptoms such as delusions and hallucinations can cause significant social distress. Teens might withdraw from their peers or struggle to participate in group activities.
3. Attendance Issues: Frequent absences can become a problem if a teen is dealing with acute psychotic episodes or if they avoid school due to anxiety or fear of stigma. [19]

Did you know? Teens with psychosis who have a secure attachment style often show greater resilience and improved treatment outcomes.

Supporting Students with Psychosis: A Guide for Teachers and School Counselors

Given these challenges, the role of teachers and school counselors becomes pivotal. Here are some tips on how they can support students with psychosis:

• Promote a Supportive Environment: Foster an environment of understanding and acceptance in the classroom. This can help reduce the fear of stigma and encourage students to seek help when needed.
• Early Detection: Teachers often spend more time with students than any other adults, making them well-positioned to identify early signs of psychosis. These might include changes in academic performance, social withdrawal, or unusual behaviors.
• Facilitate Accommodations: Depending on the student's needs, certain academic accommodations may be necessary. These could include additional time for tests, modified assignments, or breaks during the day.
• Encourage Communication: Regularly communicate with the student's parents and healthcare providers (with appropriate permissions) to ensure consistency in supporting the student.
• Educate and Advocate: Increase awareness of mental health issues among students, staff, and the larger school community. Advocate for policies that support students with mental health disorders.[20]

Family Dynamics and Teen Psychosis: Understanding the Interplay

A teen's psychosis doesn't just affect the individual, it can also dramatically impact the dynamics within their family. Understanding these effects and knowing how to navigate them is crucial for families on this journey.

Psychosis in Teens: Its Effect on Family Dynamics

1. Increased Stress: Dealing with psychosis can increase stress levels in a family. Parents may be emotionally drained, siblings may feel neglected, and the teen themselves may feel guilty for the changes in the family dynamic.
2. Changed Roles: Family roles may shift as the focus turns to caring for the teen. Parents may need to take on a more intensive caretaker role, while siblings may feel the need to 'step up' in other areas.
3. Strained Relationships: The strain of dealing with a mental health crisis can put pressure on relationships within the family. This can result in increased arguments or feelings of resentment.

Navigating Family Dynamics: Tips for Families

Despite these challenges, there are several strategies families can employ to cope and provide support:

• Open Communication: Ensure everyone in the family has a clear understanding of the diagnosis and what it means. Openly discuss the challenges, feelings, and concerns that arise.
• Family Therapy: Family therapy can provide a safe space for everyone to express their feelings, learn coping strategies, and work on strengthening relationships.
• Self-Care: It's important for each family member to also take care of their own physical and mental health. This can involve engaging in hobbies, exercise, or simply taking time to relax and recharge.
• Support Networks: Reach out to extended family, friends, or support groups. These networks can provide emotional support, practical advice, and a sense of community.
• Education: Learn about psychosis and its treatments. The more a family understands, the better equipped they'll be to support their teen.

Personal Stories: The Struggles and Triumphs of People with Psychosis

Imogen

Imogen, a 27-year-old London resident, began experiencing symptoms of psychosis during her early teenage years. Unaware of the terminology surrounding her condition, she found herself unable to express what was happening to her. Her first major breakdown at the age of 15 led to hospitalization, but the severity of her condition was initially dismissed as bad behavior. However, following a second breakdown at 16, a thorough assessment from a psychiatrist led to a diagnosis of a psychotic episode.

Imogen was eventually diagnosed with bipolar type 1 disorder and autism. She experiences psychotic episodes, depression, and mania, all symptoms associated with her bipolar disorder. Through a combination of anti-psychotic medication, therapy, social work assistance, and self-education, Imogen has learned to manage her conditions. Now a part-time student at Birkbeck University, she is committed to advocating for mental health awareness, driven by her own experiences with psychosis.

Read Imogen's Story.

Chris Crutchley

Chris Crutchley, a 37-year-old individual diagnosed with Bipolar Disorder during his college years, has chosen to share his story publicly for the first time. Despite fears of societal stigma and potential professional setbacks, Chris feels compelled to contribute to efforts to end the stigma around mental health. The recent birth of his first child, an event that seemed uncertain for Chris due to his mental health struggles, has further motivated him to share his story, hoping it can aid others who suffer from mental illness and foster understanding of the obstacles faced when seeking care.

Chris was a two-sport athlete on an academic scholarship in college, with no prior history of mental illness. In 2001, he experienced his First Episode Psychosis (FEP), characterized by a gradual decline into psychosis over several days. Despite his mental state fluctuating between moments of clarity and delusion, his family was quick to seek medical help, contributing significantly to his recovery. The average time for a US citizen to receive care after their first psychotic episode is 74 weeks, starkly contrasting with Chris's early intervention.

The years following were filled with challenges, including readjustments to daily routines, emotional struggles, medication side effects, and even hospitalization due to a lapse in medication. Chris has since learned to own his story, sharing his experiences with trusted individuals and educating himself about mental illness. He now cherishes the opportunity to be a father and aspires to help others who face similar struggles.

Read Chris Crutchley's Story.

Managing Psychosis in Daily Life

Caring for a kid with psychosis can be demanding and stressful. Therefore they need a lot of support from their family, friends, and community.

Early education on coping strategies and stress management can help a lot in managing their stress[7]. Further, caregivers can also opt for community mental health services such as family therapy and support groups.

You may also receive help from an online therapist that protects confidentiality to help cope with the stress.

Final Words

Prolonged periods of untreated psychosis can worsen the symptoms and interfere with one's daily activities. Therefore, early intervention is vital for faster recovery. With proper treatment, there is a 25% chance of recovering completely, and about 50% of patients will be able to live a normal life, although they suffer from continued episodes[8]. So, look for early warning signs of psychosis and ask for help from a mental health professional when needed.

FAQ

References

1. Common mental disorders prevalence in adolescents
2. Psychotic Disorders in Children and Adolescents
3. Schizophrenia: An Overview
4. Understanding Psychosis
5. Psychosis
6. Mental Health Screening
7. Caring for Patients With Psychosis
8. What is Psychosis
9. Phoenix-Talent School District: Psychology – Brain Structure/Anatomy and Function
10. Pubmed: Neurobiology of Schizophrenia
11. John Wiley & Sons: Brain morphologic changes in early stages of psychosis
12. The Recovery Village: 12 Common Myths About Psychosis
13. Pubmed: Understanding the impact of stigma on people with mental illness
14. Pubmed: Psychosis
15. Texas State University: Adolescent Brain Development
16. Encyclopedia: Mental Illness During The Middle Ages
17. Research Gate: Mental Illness and Psychiatry: The 20th and Early 21st Centuries
18. Pubmed: A Review of Childhood-Onset Schizophrenia
19. The British Journal of Psychiatry: Psychosis and academic performance
20. The National Association of State Mental Health Program Directors: Supporting Students Experiencing Early Psychosis
21. Rethink: From psychosis to: Imogen's story
22. Nami: From My First Episode To My First Child