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Psychosis, Schizophrenia and Prodromal Symptoms in Teens: What’s the Difference?

Written by Evolve's Behavioral Health Content Team​:

Alyson Orcena, LMFT, Melissa Vallas, MD, Shikha Verma, MD, Ellen Bloch, LCSW, Lianne Tendler, LMFT, Megan Johnston, LMFT Meet The Team >

If your teen is experiencing hallucinations or delusions, you might hear certain terms being thrown around by mental health professionals. Like “psychosis.” “Prodromal symptoms.” “Schizophrenia.”

What exactly do these terms mean? And how are they different?

What is Psychosis?

First, let’s talk about psychosis. When someone is experiencing psychosis, they are experiencing “a break from reality,” says Lauren Cona, LCSW, Clinical Program Director for Evolve Treatment Centers in Woodland Hills. Cona, based in Los Angeles, has years of experience working with adolescents going through psychosis or prodromal symptoms.

“When we say reality, we mean ‘consensus reality,’ because everyone’s reality is different, of course,” she clarifies. Teens with psychosis start seeing and/or hearing things that others are not. These are called hallucinations. Or they’re having bizarre delusions that aren’t known to be true (by consensus reality). And, most importantly, explains Cona, a teen with psychosis is fully convinced that what they’re experiencing is real.

What are Prodromal Symptoms?

Meanwhile, prodromal symptoms are early warning signs that there’s something wrong. In full-fledged psychosis, teens can’t separate their experiences from reality; if they’re experiencing prodromal symptoms, they think it’s their mind playing tricks on them.

“So a teen could say, ‘I think I keep seeing certain shadows, seeing a light.’ But they’re still unsure about it, which means they haven’t yet converted to psychosis,” says Cona. These sorts of symptoms are often precursors to a possible episode of psychosis…but not always. Meaning, a teen could be seeing or hearing things without being diagnosed with psychosis. They’re just experiencing prodromal symptoms.

Keep in mind that prodromal symptoms for psychosis only occur in teens. (Since a psychotic episode usually occurs for the first time in late adolescence or early adulthood.)

Can You Have Psychosis Without Prodromal Symptoms?

Of course, it can also go the other way around. One can have psychosis without first experiencing prodromal symptoms. For example, using certain drugs (like methamphetamine or marijuana) can cause a teen to experience hallucinations and delusions—the hallmarks of psychosis.

What is Schizophrenia?

So where does schizophrenia come into the picture? Schizophrenia is a mental health diagnosis comprised of a set of symptoms. Psychosis is just one of the symptoms.

“I think of psychosis as an experience. Schizophrenia is a mental health diagnosis for which certain criteria needs to be met,” says Cona. Among these are disorganized thinking, difficulty concentrating or speaking, emotional and cognitive dissociation, and yes, hallucinations and delusions.

Someone can experience psychosis without having schizophrenia. However, those with schizophrenia almost always experience psychosis. Schizophrenia can occur at any age, but the average age of onset is the late teenage years or early adulthood, according to NAMI.

When to Get Help

If your teen is seeing or hearing things that aren’t there, visit a physician and mental health professional right away. What they’re experiencing could be the prodromal symptoms for psychosis or schizophrenia. Early intervention is crucial, so immediate action is imperative.

Likewise, your teen acting differently than usual also warrants a professional’s visit. Warning signs include withdrawing from friends or family, different eating and sleeping patterns, lack of concern with hygiene, loss of motivation, changes in personality, mood swings, and more.

Keep in mind, though, that these symptoms are very similar to other mental health issues—such as depression. Only a qualified mental health professional can diagnose your teen, and an accurate diagnosis may take some time to determine.

Our Behavioral Health Content Team

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