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 teens may be prone to psychosis, and life stresses can trigger a psychotic episode. Stresses include short-term stress like preparing for exams or conflicts with friends, and long-term stress, such as academic expectations or ongoing challenges in family or peer relationships.

Substance abuse:

• Misuse of alcohol or drug can cause psychotic episodes.
• Withdrawal from long-term alcohol or drug use may also trigger psychosis. Withdrawal symptoms can include headaches, fatigue, difficulty sleeping, and irritability, which may further complicate the recovery process.

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

Psychological factors:

• Mental conditions such as schizophrenia, depression and bipolar disorder.
• Sleep deprivation.
• Severe prolonged stress or trauma.

Social factors:

This refers to lived experiences such as traumatic events or the environment we grew up in. Traumatic events can be experiencing violence, being bullied, or going through any form of abuse. Some examples of the social environment include growing up in a difficult situation, like having financial struggles or not getting proper care at home. These factors can also increase a person’s risk of developing psychosis.

Psychosis can show up in different ways, but common signs include changes in perception, thinking, emotions, and behaviour.

These changes can be distressing and may make it harder to cope with daily activities or connect with others.

Early signs of psychosis:

Recognising early signs of psychosis is important, even if some may initially seem like typical adolescent behaviour. Significant changes in usual behaviour or temperament warrant attention:

• Withdrawal from friends and family: The individual may start to isolate themselves or avoid social activities, preferring to spend time alone. This may stem from confusion or distress caused by symptoms like hallucinations or delusions. They may also feel misunderstood or uncomfortable in social settings, which could be mistaken for typical teenage moodiness.
• Declining school performance: Difficulty focusing or processing information may lead to subtle academic struggles, such as missing assignments or losing interest in schoolwork.
• Unusual thoughts or beliefs: The individual might share odd or irrational ideas, but these may not reach the level of delusions yet. For example, thinking their peers are talking about them behind their backs without evidence.
• Confused thinking: Trouble organising thoughts may make it hard for some to follow conversations or complete tasks that require mental focus, leaving them seemingly lost in their own thoughts.
• Suspicion or paranoia: Mild paranoia (constantly feeling like everyone is out to harm them, even when no one is) may develop. With the individual believing others are judging or talking about them. These thoughts may not be fully formed or present.
• Mood changes: Sudden shifts in mood, irritability, or emotional numbness can occur. While these changes might not seem extreme, they can indicate an underlying issue if they’re a drastically different from typical behaviour.
• Changes in behaviour: The individual may display subtle behavioural changes, like dressing differently, avoiding social events, or engaging in unusual habits or rituals.
• Hallucinations: Early hallucinations might be brief or unclear, such as hearing faint whispers or seeing something out of the corner of their eye. These experiences may be random and not yet dominate their perception of reality.
• Sleep disturbances: Difficulty falling or staying asleep, or significant changes in sleep patterns (e.g. sleeping too much or too little).

Later signs of psychosis

As psychosis progress, symptoms become more intense and disruptive, often requiring immediate intervention:

• Severe social withdrawal: The individual may stop interacting with friends and family, avoiding even those they were once close to. They may isolate themselves for long periods, feeling mistrustful or unsafe due to hallucinations or delusions.
• Marked decline in school performance: Schoolwork may become disorganised and incoherent, and their attendance may stop altogether. Severe concentration issues make even simple tasks feel overwhelming.
• Fixed and strong delusions: Unusual thoughts become full-fledged delusions. Individuals may firmly believe things that are clearly untrue, such as they have special powers, that others are plotting against them, or that they are being controlled by external forces.
• Disorganised thinking and speech: Thoughts may become so disorganised that speech becomes fragmented and hard to follow, with abrupt topic changes and illogical connections.
• Intense paranoia: Paranoid thoughts may become fixed, such as fears of being spied on or harmed. These beliefs may dive their thinking and behaviour.
• Extreme mood swings: Emotional shifts may range from extreme highs and lows, to a flat, detached demeanour, where they show little emotion with little or no clear trigger.
• Erratic and dangerous behaviour: The individual may exhibit 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 frequent and vivid, involving clear voices or visions that might influence their actions.
• Disrupted sleep: Sleep problems worsen, with the individual staying up for long hours due to anxiety or sleeping excessively due to emotional exhaustion or depression.