Psychosis

The term ‘psychosis' is used to describe when a person loses touch with reality. Young people can behave very differently when they are feeling stressed, confused or very upset. In fact, these are rarely signs of mental illness. Psychosis is usually more severe and disabling.

‘Psychosis' can affect people of all ages, but becomes increasingly common as people reach young adulthood.

When a person has a psychotic episode, it can be a signal of an underlying illness. You can have a ‘psychotic breakdown’ after a stressful event like losing a close friend or relative. It can also be the result of a physical illness like a severe infection, the use of illegal drugs like cannabis, or a severe mental illness like schizophrenia or bipolar disorder. Sometimes it is difficult to know what caused the illness.

When a person has psychosis, they may have unusual thoughts and experiences. These may appear suddenly, or develop gradually over time. They may have one or more of the following symptoms:

• Unusual beliefs called delusions. These unshakeable beliefs are obviously untrue to others, but may not be to the young person themselves. For example, when a young person is ill, they may think that there is a plot to harm them, or that they are being spied on by the TV, or being taken over by aliens. Sometimes they may feel they are a special person or have special powers. 
• Thought disorder is when they are not able to think straight. It may be difficult to understand what they are saying; their ideas may seem jumbled, but it is more than being muddled or confused.
• Unusual experiences called hallucinations are when they can see, hear, smell or feel something that isn't really there. The most common hallucination people experience is hearing voices. In psychosis, hallucinations are totally real to the person having them. This can be very frightening and can make them believe that they are being watched or picked on.

Having these strange thoughts and experiences can affect a young person at school, home or when with friends. They may find it difficult to concentrate and enjoy what they normally did. It can even affect their sleep, appetite and physical health. 

The earlier it is recognised that a young person is ill, the better the chances of getting effective treatment. This speeds recovery and reduces long-term harm. Some people can make a complete recovery.

Medications called ‘antipsychotics’ are an important part of treatment. They may need to be taken for a long time in order to stay well. As with medication of any kind, there may be side-effects; the psychiatrist will be able to advise on what they are and what can be done to help. The risk of side-effects needs to be balanced against the risk of the damaging effects of the illness on a young person’s life.

Some of the medicines for the treatment of psychosis are ‘unlicensed’ in children and young people. This does not mean they do not work for young people, but simply that the drug company has not applied for a license. If you are worried about this, you should speak to the doctor or pharmacist.  Further information is also available from the Royal College of Paediatrics and Child Health.

If the psychosis is related to drug use or underlying physical problems, your child may need specific help and treatment to manage this.

Other forms of treatment in addition to medicine are also important. Talking treatments can be helpful. The whole family will need help to understand more about the illness, to cope successfully, and to help prevent the illness coming back. 

Most young people with early help and treatment recover from their psychotic episode. If the illness is due to an underlying physical illness or the use of drugs, they may be able to avoid having another episode by taking appropriate treatment and avoiding using drugs.

When a young person has a `psychotic breakdown', not due to drug use, it can be difficult to know what the long-term effects will be, and a definite diagnosis may not be possible straight away. Some young people may eventually be diagnosed with a severe mental illness like schizophrenia or bipolar disorder.

Is there anything else I should do?

You can help as a parent by supporting your child to continue with any treatment offered and to keep a balanced, healthy lifestyle. You may be able to identify the signs early if their illness recurs in the future, and seek help more quickly.

"I was about 14 when it happened. I had a good family, did well at school and had 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 is 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 few months or year.

She then introduced me to Kay, a worker from Early Intervention Psychosis team. Kay explained to me and my family all about psychosis, what we could 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 etc... I take my meds and stay away from drugs and alcohol."

• Mind - A national mental health charity for England and Wales.
• TalktoFrank - For drug induced psychosis.
• Young Minds - A charity that offers information to young people about mental health and emotional well-being.

References 

Rutter’s Child and Adolescent Psychiatry, Fifth Edition (2008). Publisher: Wiley-Blackwell.

National Institute of Clinical Excellence (NICE, 2009), Clinical Guidelines, CG82: Core interventions in the treatment and management of schizophrenia in primary and secondary care (update).

Credits

Revised by the Royal College of Psychiatrists’ Child and Family Public Engagement Editorial Board (CAFPEB).

With grateful thanks to Dr Virginia Davies, Dr Vasu Balaguru, and Thomas Kennedy.

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