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 youths 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 or work 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 youths 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 and bipolar disorder.
• Sleep deprivation.
• Severe prolonged stress or trauma.

Social factors:

This refers to lived experiences such as traumatic events, child abuse or the environment we grew up in.

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:

Early signs of psychosis in individuals can often be subtle and mistaken for stress or emotional challenges.

Therefore, recognising these signs early is crucial for proper intervention. Common early indicators include:

• Hallucinations – Hallucinations occur when one hears, sees, feels, smells, or tastes things that aren't there. For example, they might hear voices telling them what to do, even though no one is actually speaking.
• Delusions – Delusions are strong beliefs that don’t match reality and don’t change, even when there’s evidence that they aren’t true. For example, individuals with psychosis may believe others are plotting against them or trying to harm them.
• Disorganised thinking or speech – Individuals with psychosis have trouble thinking in an organised way. They have difficulty getting to the main point of a conversation and may talk about various subjects before reaching the intended topic. Sometimes, they make up words or say things that do not make sense.
• Bizarre or erratic behaviour – Individual may engage in strange or inappropriate behaviours, such as talking to imaginary people, acting aggressively, or performing unusual rituals. These behaviours may appear out of place or irrational to others.

As psychosis progresses, certain normal behaviours and activities may decrease or stop altogether:

• Social withdrawal: Some may avoid social interactions entirely, feeling overwhelmed or distressed by hallucinations or delusions. They might isolate themselves at home, withdrawing from friends, family and activities. This is often due to the fear of feeling misunderstood.
• Neglect of personal care: Basic self-care routines, such as bathing, dressing, or grooming may be abandoned. The individual may stop paying attention to hygiene appearance.
• Reduced daily functioning: Tasks that were once manageable, such as studying, working, or maintaining a home, may feel overwhelming. The individual may stop attending school or work, or managing household responsibilities altogether.
• Decreased motivation: A noticeable lack of interest or drive in previously enjoyed activities may emerge, affecting every aspect of daily life.

Later signs of psychosis

Later signs tend to be more intense and disruptive, often requiring immediate intervention:

• Severe social withdrawal: The individual may completely avoid social interactions, including close friends or family. Symptoms like hallucinations or delusions can create a sense of mistrust, fear, or hopelessness, leading to prolonged isolation.
• Fixed delusions: Unusual thoughts become full-fledged delusions, such as thinking that their home is bugged, classmates are sabotaging them, or they are being followed. These delusions dominate their thoughts and behaviours.
• 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).
• 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.
• Disorganised thinking and speech: Thoughts may become so disorganised that speech becomes fragmented and hard to follow, with abrupt topic changes and illogical connections.
• Persistent hallucinations: Hallucinations become more frequent and vivid, involving clear voices or visions that might influence their actions.

Psychosis can have a profound effect on emotions, either intensifying them or causing emotional detachment:

• 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.
• Emotional flatness: Some individuals may show a lack of emotional response, appearing detached or indifferent to events around them. They may speak in a monotone or show little to no facial expressions.
• Heightened anxiety or fear: Anxiety or fear may become overwhelming, especially in response to hallucinations or delusions. The individual may feel constantly on edge or unsafe, even in familiar environments.
• Depression: Psychosis can also lead to profound feelings of sadness, hopelessness, or worthlessness, causing further withdrawal, or in some cases, self-harm.