Psychosis

Many young people will go through times when they feel worried, stressed, confused or very upset. This often isn’t a sign of mental illness. Psychosis is when your thoughts and emotions are so disturbed that you lose touch with reality. This can be distressing and scary, but there is help available.

Psychosis is often used as an umbrella term to refer to the group of psychotic disorders that includes schizophrenia, schizoaffective disorder and delusional disorder. You can find out more about schizophrenia in our leaflet on the topic.

This resource looks at psychotic episodes, which are specific times when someone experiences psychosis. It is important to remember that some people who experience psychosis will only have one psychotic episode in their lifetime.

Psychosis affects people of all ages, but is very rare in younger children. Psychosis usually begins when someone is in their late teens.

There are lots of reasons why someone might experience psychosis:

• Life events - A psychotic episode can sometimes happen after a stressful event like a close friend or relative dying.
• Childbirth - Psychosis can happen after someone has given birth, which is called post-partum psychosis.
• Drugs - Psychosis can also happen as a result of using illegal drugs (like cannabis, LSD, ecstasy or speed).
• Serious mental illness - Psychosis can also happen when someone has a serious mental illness like severe depression or bipolar disorder.

Sometimes it’s difficult to know exactly what caused psychosis, and it can be a combination of lots of different things.

When you have psychosis, you will usually have very unusual and sometimes unpleasant and frightening thoughts and feelings. They might appear suddenly, or they might start gradually so that only people like your close family and friends notice you’re behaving strangely.

You might experience one or more of the symptoms below:

• Delusions - You might experience strong, unusual beliefs, called delusions. For example, you might think that you are being spied on by the TV or that you have special powers. These beliefs will be obviously untrue to the people around you, but not to you.
• Disordered thinking – You might experience disordered thoughts and be unable to think clearly. Your ideas might seem extremely jumbled or confused, and other people might find it very difficult to follow what you say.
• Hallucinations – You might see, hear, smell or feel things that aren’t really there. These experiences are called hallucinations. The most common hallucination that people have is hearing voices. Hallucinations can feel very real and frightening to the person having them.
  

Other symptoms

Psychosis can make your school and home life challenging. It can affect your sleep and appetite, and your ability to concentrate and enjoy things.

You might find yourself becoming frustrated and angry with your friends or family. Some people try to smoke or drink alcohol to feel better, but this tends to make things worse.

Some people find the symptoms of psychosis so distressing that they feel like harming themselves. If this happens, or if you are experiencing any of the symptoms of psychosis, speak to your doctor or someone you trust straight away.

It is important to get help as early as possible. The earlier you receive treatment, the more likely you are to recover well.

Speak to someone you trust if you feel like you might be experiencing the symptoms of psychosis. This could be a parent, carer, friend or teacher.

First, you could talk to your family, school nurse or GP. They may get you specialist help from a Child and Adolescent Mental Health Service (CAMHS) team or an Early Intervention Team or Service (EIS) - a specialist team for young people with psychosis. If you become very unwell, you could need some time in hospital until you are better.

Medications called ‘antipsychotics’ are an important part of treatment. You might need to take them for a long time in order to stay well. As with medication of any kind, there can be side-effects, and the doctor you see will be able to tell you about these and what can be done to help.

Talking treatments can be helpful as well, but will probably need to be in addition to medication.

If the psychosis is related to drug use or an underlying physical illness, you might need specific help and treatment to manage this.

You and your family might need help to understand more about your illness, how to manage it, and how to help prevent it coming back. You may need support to rebuild your confidence to continue with school, college or work.

With early help and treatment, most young people will recover from their psychotic episode.

If the psychosis was brought on by an underlying physical illness or taking drugs, you might avoid having another episode by following the advice of your doctor, taking the right medications and avoiding using drugs.

It’s often difficult to know what the long-term effects of a psychotic episode will be, and a definite diagnosis might not be possible straight away. However, your doctor and people involved in your care will be available to support you throughout.

It’s important to continue with any treatment advised by your doctor and keep a balanced, healthy lifestyle.

Talking to others when you feel stressed can help identify problems early and help get you the right treatment.

“I was about 14 when it happened. I had a good family, did well at school and had a group of good friends. Life had been good to me although my mum said I could not handle stress. I would be a bag of nerves before exams, was scared of failing and could not face it if someone was unwell.

“Uncle Rob’s death a year back in the accident was just too much. I knew I would feel upset for a long time. But then I didn’t feel upset. It was strange. I thought people were doing strange things to me like controlling me through radio signals. I felt I had lost control of myself and even felt my body was changing in a strange sort of way… not just the puberty.

“And then I could not face school, I was swearing, felt muddled in my head. My learning mentor got worried and spoke to my mum, who had noticed my strange behaviour.

“I couldn’t sleep, couldn’t be bothered about going out. I didn’t like the idea of seeing a psychiatrist from the Child and Adolescent Mental Health Service and I thought they would judge me. But it was very different. She seemed to know and understand how I felt, what I thought. I felt relieved. She even said I was not going to be locked away in a hospital. It was just an illness for which I needed to take medication for a few months or years.

“She then introduced me to Kay, a worker from the Early Intervention Psychosis team. Kay explained to me and my family all about psychosis, and what we could do to keep me well. She was there when I felt I was losing it before my exams. It’s nearly a year now. I am like any other 16-year-old, going to school, with friends. I take my meds and stay away from drugs and alcohol.”

• Changing Minds: The Go-to Guide to Mental Health for Family - Available as a book, ebook, audiobook, and as an MP3. This guide about mental health for 13–17-year olds talks about addiction, stress, eating disorders, depression, schizophrenia and self-harm.
• Young Minds, information on psychosis - Young Minds is the UK’s leading charity fighting for children and young people’s mental health. Read their information for young people on psychosis.
• Rethink Mental Illness, information on psychosis - Read this information on psychosis from the charity Rethink Mental Illness.
• Epic Friends - This website aims to help young people to support their friends who might be struggling emotionally.
• Talk to Frank - Talk to Frank offers accurate information on drugs and addiction.

Revised by the Royal College of Psychiatrists’ Child and Family Public Engagement Editorial Board (CAFPEB) and the National Collaborating Centre for Mental Health (NCCMH).

This resource reflects the best possible evidence at the time of writing.

Full references for this resource are available on request.