While the exact cause of psychosis is unknown, research suggests it results from a combination of genetic, biological, environmental, and psychological factors.

Biological factors:

• Genetic traits inherited or chemical imbalances in the brain can increase vulnerability to psychosis.
• Some children may be prone to psychosis, and life stresses can trigger a psychotic episode.
• These stresses can include short-term stress, such as upcoming exams or conflicts with friends, and long-term stress, such as pressures from school or ongoing challenges in relationships with family or peers.

Substance abuse:

• Misuse of alcohol or drug can cause psychotic episodes.
• Withdrawal from long-term alcohol or drug use may also trigger psychosis. This refers to the physical and mental symptoms that occur when the body adjusts to the absence of the substance. Common withdrawal symptoms include headaches, fatigue, difficulty sleeping, and irritability.

Proper medical supervision and support, such as services offered by the National Addictions Management Service (NAMS) are crucial for your children undergoing treatment for substance use disorders to minimise the risk of psychosis and other severe withdrawal symptoms.

Psychological factors:

• Mental health conditions such as schizophrenia, depression, or bipolar disorder.
• Lack of sleep.
• Severe stress or trauma.

Social factors:

The environment a child grows up in, including experiences of trauma or abuse, can play a role in the development of psychosis.

Early signs of psychosis:

Here are some early signs of psychosis to look out for in your children. While these initial indicators can often be mistaken for typical teenager behaviour, any significant changes from their usual behaviour or personality should warrant attention:

• Withdrawal from friends and family: In the early stages, your child may start to isolate themselves or lose interest in social activities, preferring to spend time alone. This is often due to feeling overwhelmed with confusion or distress caused by symptoms like hallucinations or delusions. They may also fear feeling misunderstood when sharing their thoughts or experiences, making social interactions difficult or uncomfortable. This may be gradual and mistaken for typical teenage moodiness.
• Declining school performance: Your child may have trouble focusing or understanding information, leading to a drop in school performance. It could start with missing assignments or losing interest in schoolwork.
• Unusual thoughts or beliefs: Your child may begin to express odd or irrational ideas, but these may not yet reach the level of delusions. For example, they might mention strange coincidences or have vague feelings of being watched.
• Confused thinking: Your child may have difficulty organising their thoughts. This can appear as trouble following conversations, struggling with tasks that require mental focus, or seeming lost in their own thoughts.
• Suspicion or paranoia: Mild feelings of paranoia (constantly feeling like everyone is out to harm them, even when no one is) may develop. For example, your child might start to believe that people are talking about them behind their back or that others are judging them, but these thoughts may not yet be fully formed or common.
• Mood changes: Sudden mood swings, irritability, or emotional numbness can occur. These changes might not seem too extreme initially but can still cause concern if they represent a significant shift in your child’s behaviour.
• Changes in behaviour: Early behavioural changes might be subtle, like dressing differently, avoiding social events, or engaging in odd rituals or behaviours that seem out of place.
• Hallucinations: Early hallucinations might be fleeting or vague, such as hearing whispers or seeing something out of the corner of their eye. These experiences may be random and not yet control their perception of reality.
• Sleep disturbances: Your child may experience difficulty falling asleep, staying asleep, or experience unusual changes in sleep patterns (e.g. sleeping much more or much less than usual).

Later signs of psychosis

Later signs tend to be more intense and unmistakable, often signalling the onset of a psychotic episode. These signs are usually more disruptive to the child’s life and often require immediate intervention:

• Severe social withdrawal: By this stage, your child may completely withdraw from friends, family, and school — avoiding all social interactions. This may be due to feeling overwhelmed by symptoms like hallucinations or delusions, which can lead to mistrust, fear or a sense of being unsafe around other people. Feelings like hopelessness, lack of motivation, or confusion may develop, making it hard to connect with others. Thus, they may refuse to participate in previously enjoyed activities and isolate themselves for long periods.
• Marked decline in school performance: Your child may stop attending school altogether, or their schoolwork may become disorganised and incoherent. Their inability to concentrate can be severe, making even simple tasks extremely difficult.
• Fixed and strong delusions: Unusual thoughts become full-fledged delusions. Your child may firmly believe things that are clearly untrue, such as thinking that they have special powers, that people are plotting against them, or that they are being controlled by external forces.
• Disorganised thinking and speech: Your child’s thinking may become so disorganised that their speech is hard to follow, jumping from one topic to another without logical connections. Their thoughts may seem fragmented or incoherent.
• Intense paranoia: Paranoid thoughts may become fixed, with your child being convinced that others are spying on them or plotting against them. These beliefs may dominate their thinking and behaviour.
• Extreme mood swings: Their mood may fluctuate drastically between extreme highs and lows, or they may experience a persistent flat affect, where they seem emotionally unresponsive or detached from their surroundings.
• Erratic and dangerous behaviour: Your child may exhibit increasingly erratic or risky behaviour, such as shouting at strangers, engaging in reckless acts, or responding to hallucinations in ways that put them in danger (e.g., running into traffic to escape imaginary threats).
• Persistent hallucinations: Hallucinations become more pronounced and frequent, often involving clear voices or visions. These hallucinations may direct their actions or reinforce their delusions, such as hearing voices that tell them to do things or seeing things that are not there.
• Disrupted sleep: Sleep problems become more severe, with your child either staying up for long hours due to fear or anxiety or sleeping excessively due to emotional exhaustion or depression.

If your child has been diagnosed with psychosis, here are some ways to help them better manage the condition.

Learn about psychosis and the treatment:

• Talk it over with your child’s mental health professional.
• Ask for written information about your child’s diagnosis and treatment to familiarise with the condition and work towards improvement.
• If the medication is not working well, ask about other medications.
• Attend workshops and seminars designed for caregivers of people with mental health issues.
• Try breathing exercises or progressive muscle relaxation to reduce stress and promote calmness.

Educating ourselves with information related to the condition, can reduce anxiety and help us feel more in control.

Medication, therapy and community services enable many children suffering from psychosis to lead full, independent lives. But support from family, friends and peers remains an essential component in their recovery process.

Supporting your child involves being there for them emotionally and practically. Here are some ways you can help:

• Listen and encourage: Be a supportive listener and encourage your child to stick with their treatment plan.

• Monitor symptoms: Keep an eye on their symptoms and talk to their doctor about any changes.

• Create a routine: Help your child establish a daily routine to provide structure and stability.