Early Psychosis Symptoms And How Psychosis Progresses

Reviewed by Whitney White, MS CMHC, NCC., LPC

Published 06/24/2022

Psychosis is a syndrome that can seem to come on quite suddenly. However, there are usually early warning signs. If you know what to watch for, you may be able to get help for yourself or someone else before their condition gets worse.

Psychosis Definition

Psychosis can be defined as a loss of contact with reality. Another way to think of it is that a psychotic person experiences the world in ways that are different from the way others do. They have sense experiences that don’t match what’s happening around them. They may also have strange or false thoughts and beliefs.

Who Might Have Psychosis?

Psychosis can happen to anyone. About 3 in 100 people will have psychosis at some time in their lives. Psychosis can occur because of a medical condition, like brain injury, Alzheimer’s, or stroke. It can happen as a part of a mental disorder like schizophrenia or bipolar disorder,  or, it can be a once-in-a-lifetime break with reality.

Some things can increase your risk of having psychosis or make your psychosis worse. They include:

  • Extreme stress
  • Homelessness
  • Drug or alcohol abuse
  • Grief or divorce
  • Childbirth
  • Being too tired
  • Genetic factors

Psychosis often happens for the first time when you’re an adolescent or young adult. But that doesn’t mean it can’t happen at any age. If a person has their first psychotic break after age 40, it’s called late-onset psychosis, and it may come very late in life if it’s a part of Alzheimer’s disease, Parkinson’s disease, dementia, or some other disorder that tends to affect older people. Although psychosis has mainly been studied in younger people, researchers in one study concluded that late-onset psychosis isn’t at all rare.

What Are the First Signs of Psychosis?

The sooner you can get treatment for psychosis, the better off you’ll be. So, what are the first signs you might notice? Here are some symptoms that can happen before the psychotic break happens.

  • Work or school performance gets worse
  • Trouble concentrating
  • Feeling suspicious of or uneasy around others
  • Not taking good care of personal hygiene
  • Isolating yourself from others
  • Strong emotions that don’t match what’s happening
  • Or feeling no emotions at all

What Are the Signs ofA Psychotic Break?

A psychotic break might be the first time you have psychotic symptoms. Or it can be when you suddenly have them after being in remission for a while. A psychotic break may come after the early warning signs mentioned above. However, the break itself is usually an event of sorts happening in a short time.

Signs of early psychosis include:

  • Hearing, seeing, tasting, touching, or smelling things that others don’t
  • Having strange beliefs that are persistent and not easy to set aside
  • Strong emotions not matching your circumstances or no emotions
  • Stopping self-care suddenly
  • Trouble thinking or concentrating gets rapidly worse

Later Symptoms of Psychosis

After the psychotic break happens, the primary symptoms are hallucinations and delusions. You might have had sense experiences that didn’t match what was in your environment. But once the psychosis gets worse, hallucinations get more vivid and overwhelming. You may have extraordinarily frightening or upsetting auditory or visual hallucinations.

Delusions are strong beliefs that don’t go along with the reality accepted by others. These are the kinds of thoughts that are likely untrue. Others find them irrational and hard to understand. Some types of delusions you might have in psychosis include:

  • Beliefs that someone or something outside yourself is controlling you
  • Beliefs that trivial words, objects, or events are important private messages just for you
  • Beliefs that you have been tasked with a special mission, have extraordinary powers, or that you are God

Do Psychotics Know They Are Psychotic?

Often people with psychosis don’t know they’re having symptoms of a mental condition. They really believe that their hallucinations are real. They believe their strange thoughts are truths that others simply don’t recognize.

However, some psychotic people know that what is happening isn’t real at all. For them, the terror might be in knowing that their mind isn’t working the way it’s supposed to. They might be afraid they’ll slip more deeply into psychosis or that their mental health will never be good again.

Whether they realize they’re psychotic or not, the experience is usually terrifying for them. For that and other reasons, it’s best to get help for them soon.

How to Know If It’s Time to Get Help

The symptoms of psychosis are usually fairly obvious. The question is, when do you need to get help? First, if someone has a psychotic episode, it’s almost always best to make sure they have some kind of help to get through it. Once you see any immediate concerns, it’s time to consider whether ongoing treatment is appropriate.

Screening for Psychosis

Mental health screenings can catch symptoms early or help you recognize later signs of a psychotic break. One way to screen yourself for psychosis is to take an easy online test. You answer a few short questions by clicking on the answer that fits with your beliefs and behaviors. The test is confidential, so no one ever needs to know you took it if you don’t want them to know.

After the psychosis screening test, you’ll get an instant visual display that shows how closely your condition matches psychosis. You can then get a report you can look over at your leisure and share with a doctor, psychiatrist, or counselor.

Emergency Care

Severe psychosis sometimes requires immediate emergency treatment. But that’s not always the case. So, how do you know whether to call in the EMTs, rush to an emergency room, or have an after-hours appointment?

The most important thing is that everyone is safe. Suppose there’s any danger in the way the psychotic person is speaking or behaving. In that case, you must get them to help right away. In most cases, it’s the person who is having the psychotic break is in danger. People with psychosis often harm themselves or even commit suicide.

If their words or behaviors indicate self-harm of any kind, it’s definitely time to seek immediate help. They might tell you about disturbing voices that tell them to commit suicide or injure themselves. They may be extremely confused and disoriented. They may not be able to take care of their most basic physical needs.

For those who are already in treatment for a mental disorder, their regular mental health provider may help. The best thing to do for them is to start by contacting their clinic or provider. If it’s after hours, try their number anyway. They probably have an after-hours psychiatrist on call. If not, their system may give you a message about where else to call.

Non-Emergency Care

For early or mild psychotic symptoms, non-emergency help is often appropriate. Treatment usually includes antipsychotic medications. Counseling is also helpful, especially if your psychotic break is a part of a mental disorder like schizophrenia, bipolar disorder, depression, or borderline personality disorder.

Make an appointment with a therapist or psychiatrist soon, though, because it may take a while to get on their calendar. Be sure you tell them why you want to see a mental health professional. This helps them prioritize your care and may help them get you in sooner.

Another option is to talk to a therapist online. With a large online counseling platform, you can usually start therapy within a very short time. You can discuss your symptoms with them in a live video conference, through text messages or live chat, or by phone. They can teach you ways to manage your symptoms. They can help you understand what’s happening to you better and learn more about psychosis. A counselor can also recognize signs that you need immediate help in your local community.

Benefits of Early Treatment

Recognizing psychosis early can be extremely helpful. In fact, one research study showed that people who received special care for early psychosis had better outcomes than those who didn’t. Some of the benefits they experienced were:

  • Better social functioning
  • Better functioning at work
  • Greater satisfaction with their treatment
  • Enhanced quality of life
  • More likely to continue with medications and therapy

Early treatment might not prevent psychosis, but it can ease the severity of the symptoms. With treatment, you may be able to avoid the most frightening outcomes of psychosis. And suppose another mental condition is causing those signs of psychosis? In that case, treatment can help you resolve underlying issues by meeting them head on. With the right mental health care, you can learn about and avoid behaviors that might increase your likelihood of having another psychotic episode.


Recognizing the early symptoms of psychosis has two clear advantages. First, you might be able to avoid the direst consequences of psychotic behavior. Second, you can get support as you deal with your symptoms. Finally, treatment may reduce the symptoms before they get worse. Whether you’re just noticing early warning signs of you’re in a full-blown psychotic episode, getting help is your best option. If you’re unsure, start with a screening test. Then, get whatever help you need. If someone close to you is having psychotic symptoms, encourage them to seek mental health help.