Recognising Early Psychosis

Early psychosis can often be recognised through subtle psychological, emotional, and behavioral changes before full-blown hallucinations or delusions become apparent. Recognising these warning signs early is crucial for effective intervention and improved long-term outcomes.
 
The Key Early Warning Signs:
1. Changes in Perception and Thinking
Difficulty telling what is real from imaginary experiences.
Hearing indistinct sounds, jumbled voices, or seeing shadowy figures at the edge of vision.
Increased sensitivity to light, noise, or colours.
Irrational or peculiar statements and illogical thinking.
Believing one has special powers or that outside forces control thoughts.
 
2. Social and Functional Decline
Withdrawal from friends and family, or loss of interest in usual activities.
Drop in academic or job performance.
Difficulty reading social cues or behaving appropriately in social settings.
Suspiciousness or strong feelings of being watched or talked about.
 
3. Emotional and Mood Changes
Heightened anxiety, depression, or emotional blunting, such as inability to feel joy or express emotion.
Periods of inappropriate laughter or crying without clear reason.
Rapid mood swings or periods of euphoria without external trigger.
 
4. Behavioral and Physical Signs
Neglect of self-care and personal hygiene.
Disturbed sleep patterns, either sleeping too little or feeling overly refreshed after minimal sleep.
Odd gestures, posturing, or staring spells.
Speaking very rapidly, or in ways difficult to understand.
Increased agitation, hyperactivity, or alternating states of energy and withdrawal.
 
Screening:
Clinicians use brief tools like the PQ-16, PQ-B, or Prime Screen Revised-5 to screen for psychosis risk. These are not diagnostic but help flag high-risk individuals for further psychological assessment. Early-intervention programmes (EPI, STEP, or NAVIGATE) offer support, medication management, and therapy, often preventing progression into severe illness if started early. Persistent or worsening experiences, such as hearing voices, extreme suspiciousness, or believing one is being controlled, should prompt immediate evaluation by a mental health professional. If psychosis co-occurs with thoughts of self-harm, contacting local emergency services is critical.
 
What immediate steps to take if someone shows psychosis signs:

1. Ensure Safety First
Assess if the person or others are at risk due to their behaviour. If there’s any threat of violence, self-harm, or suicide, call emergency services immediately.
Remove potentially dangerous objects from the environment and avoid physical confrontation.
 
2. Communicate Calmly and Supportively
Speak clearly using short sentences in a calm, non-threatening voice.
Listen empathetically and acknowledge how scary or distressing their experience might be; avoid challenging their beliefs or arguing about delusions.
Do not confront, criticize, joke, or make sarcastic remarks.
Give them time to process your words and respond; keep lines of communication open.
 
3. Encourage Professional Help
If the situation is not an emergency, offer to help them contact their healthcare provider, psychiatrist, or local mental health crisis service for evaluation.
Support them emotionally and practically, for example, by accompanying them to appointments or helping with transportation.
Keep emergency contact numbers for psychiatric clinics or mental health services accessible.
If they are already in treatment, notify their provider or care team promptly.
 
Emergency Psychiatric Crisis Planning:
Develop a crisis plan together with the individual and their caregivers before emergencies occur, including emergency contacts, medication lists, doctor and therapist details, and steps for hospital admission if needed.
Encourage utilizing supportive networks such as friends or family.
Immediate intervention, empathy, and professional support are essential to stabilising the individual and preventing harm during early or acute psychosis.
 
References
 
Guvenek-Cokol, P.E. (2022, October 25). Psychosis: Will Catching Early Warning Signs Help? Harvard Health Publishing.
 
(2025). Psychosis: First Aid Guidelines for Loved Ones. UCSF Medical Center. https://psych.ucsf.edu/sites/psych.ucsf.edu/files/PREP%20MH%20First%20Aid.pdf
 
(2025). Tips for Engaging Individuals with Psychotic Illness in Treatment. Northeast Ohio Medical University. https://www.neomed.edu/wp-content/uploads/Tips-for-Engaging-Individuals-with-Psychotic-Illness-in-Treatment.pdf
 
(2025). Understanding Psychosis. National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/understanding-psychosis
 
(2025). Warning Signs of Psychosis. Early Psychosis Intervention. https://www.earlypsychosis.ca/warning-signs-of-psychosis/
 
(2018, March 1). What to Do if a Family Member or Friend Has Psychotic Symptoms. UNC Health Talk. https://healthtalk.unchealthcare.org/what-to-do-if-a-family-member-or-friend-has-psychotic-symptoms/