Evolve Adolescent Behavioral Health

Adolescent Psychosis

Psychosis is the clinical term used when an individual loses touch with reality.  In adolescents, psychosis can be caused by many different factors, ranging from substance abuse to the onset of a serious mental health disorder.

The unusual and often bizarre behaviors associated with psychosis can be particularly frightening and confusing for any parent to observe in their child, let alone know how to handle.  This brief guide is designed to help you identify the signs and determine the best course of action if you suspect your teen is becoming psychotic or experiencing a full-blown psychotic episode.

Adolescent Psychosis Statistics

Looking for and Recognizing the Signs of Psychosis in Teens

While many parents have at least some familiarity with common symptoms of depression, anxiety, or ADHD, psychosis can catch even the most sophisticated and savvy parent off guard.

Understanding what to watch for and how to recognize symptoms of psychosis are the first – and perhaps the most critical – steps you can take as a parent.  This is because early intervention may significantly lessen the long-term impact.  One of the most important things to remember is this:

For example, if your teen is normally outgoing and articulate, increased isolation and slowed or stilted speech could be early indicators of psychosis.

With psychosis, your teen’s behavior will become increasingly bizarre, reflecting the chaos and confusion going on inside his or her mind.

Signs to watch for may include the following:

*Self-harm, suicidal thoughts or behaviors, and homicidal thoughts or behaviors should always be taken very seriously and never ignored, even if no other symptoms are present. 

It’s not uncommon for teens to occasionally exhibit some of the symptoms listed above, particularly when they’re under a lot of stress or feeling blue.  However, if several of the symptoms start to gradually appear simultaneously, or if your teen suddenly starts acting bizarrely, assume it’s serious and don’t wait to take action.

One of the most serious mistakes you can make as a parent is to assume your child is just “going through a phase” – attributing unusual behaviors or personality changes to a temporary “adolescent identity crisis” or play for attention.  It can be difficult for any parent to accept the possibility their child is using drugs or, even worse, developing a very serious psychiatric disorder.

Knowing the First Steps to Take

If you believe your teen is exhibiting signs of psychosis, the first steps to take towards handling the situation are to:

1. Sit down and talk to your child. Try to get a sense of what’s going on in his or her mind – and stay calm if your teen’s response reinforces your worst fears.

Ask your teen if there’s something bothering him or her – but don’t force the issue.  Keep in mind, if your teen is experiencing paranoia (which is common with psychosis), he or she will be reluctant to tell you anything.

2. Set up an appointment for an evaluation as soon as possible. Your family doctor or pediatrician can be a good place to start.  He or she can do an initial examination and preliminary diagnosis, use lab tests to determine if a substance (e.g. recreational drugs) or medical condition (e.g. an electrolyte imbalance) may be causing the symptoms, and prescribe short-term medication until you can get your child to a psychiatrist or other mental health professional.  Your family doctor should be able to give you a referral or recommendation to a psychiatrist, or, if your child’s symptoms warrant acute treatment, facilitate admission to the hospital.

With psychotic symptoms, it’s usually best to have your teen evaluated by a psychiatrist as soon as possible – especially if substance abuse or a medical cause has been ruled out.  It’s preferable to find one who specializes in treating children and adolescents.  A psychiatrist:

3. Get your child into treatment.** Once your child has been evaluated and a diagnosis has been determined, the next step is to get your child into the appropriate type of treatment.  The type and course of treatment will largely depend on the underlying cause of the psychosis.

If the psychosis is due to a psychiatric disorder (e.g. schizophrenia, bipolar disorder, or severe depression), treatment may include:

If your teen’s psychosis is due to substance abuse or an underlying medical condition, treatment will need to focus primarily on those specific issues (e.g. drug rehab or medical treatment).  Talk therapy can address related emotional issues and enhance coping skills.  Family therapy can also be very beneficial.

**It should be noted that, if your child’s symptoms are severe – regardless of the underlying cause – inpatient treatment may be necessary for safety and stabilization.  Your child will be evaluated in the hospital and treatment recommendations will be made prior to discharge.

Supporting and Encouraging Your Child

Figuring out how to best support and encourage your teen can be particularly bewildering – and seem counterintuitive at times – when it comes to psychosis.  With psychosis, it’s important to remember the following:

  1. It isn’t a sign of weakness
  2. It can be very frightening and confusing for your child
  3. It can’t be “overcome” by sheer determination
  4. It may be the beginning of a lifelong and particularly challenging mental health disorder

Several things you can do to help your child include:

What to Do When Things Escalate

Psychosis in adolescents can be extremely unpredictable and even dangerous, regardless of the underlying cause.  While some teens will respond well to treatment and begin to improve relatively quickly, others may become progressively or suddenly worse.

Medication, which is frequently indicated for psychosis, doesn’t always work – or work well enough – and often involves some trial and error.  This can be frustrating for both you and your child.

It’s not uncommon for individuals with psychosis to stop taking their medication due to paranoia or unpleasant side effects.  Command hallucinations (voices telling them to do something specific, like kill themselves), hopelessness and despair, or co-occurring depression may also cause them to become actively suicidal.

If things do escalate – for example, your child’s psychosis worsens, he or she becomes manic, or your child becomes a danger to himself or others – seek help immediately.

When Individual Therapy isn’t Enough

With psychotic disorders, individual therapy and medication often aren’t sufficient to keep your child safe and stable on an ongoing basis.  If your child is:

then it’s time to consider a more intensive level of treatment.  This may involve:

Intensive outpatient treatment (sometimes called psychiatric day treatment or partial hospitalization) can vary in terms of the amount of time spent and how often (e.g. 2 to 5 days) your child is required to go.  These programs are the next step up from regular outpatient treatment (i.e. an hour of therapy once or twice a week).

Residential treatment involves having your teen stay 24/7 at non-hospital treatment facility. Residential programs specialize in treating adolescents with serious psychiatric disorders.  Treatment typically lasts from 28 to 180 days, depending on your teen’s disorder and its severity.

Inpatient psychiatric treatment is the highest and most intensive level of treatment for adolescents and requires admitting your child to a secure adolescent psychiatric hospital inpatient unit.  Treatment may last for a few days to a few weeks, and medical staff is on hand to monitor patients 24/7. Inpatient treatment is particularly beneficial for adolescents who are too impaired to function,  need to be stabilized on medication, or are a danger to themselves or others.

Each of these higher levels of treatment typically provides frequent – sometimes even daily – visits with a psychiatrist and daily therapy (often both group and individual, and a combination of different types, such as psychotherapy, art therapy, occupational therapy, etc.).

Taking Care of Yourself

While psychosis due to substance abuse can easily become a lengthy ordeal, especially if your child frequently relapses, a psychotic disorder such as schizophrenia can mean a very long road ahead.  The inevitable challenges can take quite a toll on your emotional, mental, and physical health.  That’s why it’s so important to get the support you need and take good care of yourself.

Support can come in many forms including:

Self-care can include making sure you:

Dealing with psychosis will probably be one of the most difficult things your teen will ever face.  He or she will be looking to you for guidance, support, encouragement, and hope.  Taking good care of yourself will help ensure that you’ll be there to support and encourage your child.