What Is First-Episode Psychosis?

Medically Reviewed by Melinda Ratini, MS, DO on May 10, 2022
5 min read

Early or first-episode psychosis (FEP) is a term doctors use to describe the situation when a person first starts to show signs of losing touch with reality. Psychosis is often a sign of a serious mental or physical condition. People between their late teens and mid-20s are the ones most commonly affected. It’s more common than most people think. Research shows that 3 in 100 people experience psychosis at least once in their lifetime and more than 100,000 adolescents in the United States experience it each year.

A psychotic episode can be a frightening, stressful, or confusing experience, so It’s important to spot the early warning signs and get medical attention as soon as possible. The right treatment and medications can determine your recovery and future well-being.

Early psychosis rarely happens suddenly. It usually happens gradually and can last for months. You may start to notice small changes in your thoughts, or you might find it hard to figure out what’s going on around you. You may feel like something is not quite right.

Sometimes, symptoms may not be obvious. Some of the early signs and behaviors may resemble how teenagers or young adults sometimes act.

If you’re at risk for psychosis, you may have a few early warning signs such as:

  • A drop in school or job performance
  • Problems with thinking clearly or concentrating
  • Feeling uneasy or suspicious around people
  • Lack of self-care or personal hygiene
  • Spending more time alone
  • Strong or inappropriate emotions, or no feelings
  • Hearing, seeing, tasting, or believing in things that others around you don’t
  • Having recurring, unusual thoughts that you can’t ignore
  • Withdrawing or becoming closed off from family or friends

If you notice such signs or other things that seem out of the ordinary, it’s best to talk to your doctor. If caught early, treatment and medication can make a big difference. It can help to slow down the effects, aid recovery, and in some cases, reverse the effects of psychosis.

Signs of early or first-episode psychosis vary from person to person. It might be hard to pinpoint exactly when it happens as it may be a cluster of symptoms. But the possibility of psychosis is strong if you or your loved one have one of the two major symptoms:

Hallucinations. This is when you feel, see, or hear things that aren’t really there. You may:

  • Hear voices (auditory hallucinations)
  • Feel strange or unexplainable sensations
  • See distorted or blurry images of objects or people

Delusions. This is when you hold strong beliefs that are likely not to be true or that might seem irrational to those around you. You may:

  • Believe that forces other than you are controlling your thoughts, feelings, or behaviors
  • Believe that random comments, events, or objects have personal meaning or significance
  • Believe you have special powers, or that you’re on a special mission
  • Believe you are God or god-like

Other symptoms may include disorganized speech, thoughts, and behavior. For instance, your speech may be jumbled so that others may find it hard to understand. During an episode, the speed of your thought patterns may vary. You may think very quickly, slow down the next minute, or jump to talking about an entirely new subject. Your words may not connect in a way that makes sense to those around you.

Experts aren’t sure what exactly triggers the first episode or the early warning signs. But many things can lead to psychosis:

Genetics. Several specific genes and a family history of psychosis may make it more likely for you to develop it. But having a certain gene doesn’t mean you’ll definitely have an episode. Experts need to do more research to better understand. If you have a family history of psychosis, let your doctor know.

Trauma. Events such as a death, sexual assault, or war can trigger an episode. But other life events such as pregnancy and childbirth, accidents, loss of a job, or trouble with the law can also put you at risk for one.

Substance use. If you use mind-altering drugs like cocaine, LSD, amphetamines, and other substances, you may have what doctors call a “drug-induced psychosis.” You’re more likely to have an episode if you:

  • Take too much
  • Mix different substances
  • Have withdrawal from a drug

In rare cases, if you’re highly sensitive, prescription drugs may trigger psychosis even if you took them just as your doctor ordered.

Brain diseases or injury. Severe brain injuries and certain physical illnesses may also increase your risk for psychosis, such as:

  • Brain tumors
  • Strokes
  • Parkinson’s disease
  • Alzheimer’s disease
  • Dementia

Mental health conditions. Psychosis is sometimes a symptom of mental health conditions like:

  • Schizophrenia
  • Schizoaffective disorder
  • Bipolar disorder
  • Depression

If you’ve noticed early warning signs or actual symptoms of psychosis for the first time, it’s important not to ignore it. Seek medical help immediately or find someone you trust such as a close family member or friend, and let them know what’s happening.

If you notice psychosis symptoms in a close family member or friend, they may not be aware of what’s happening and able to take care of themselves or get the right help. You or another trusted person may need to step in to help and call a doctor.

Psychosis is treatable. But some people with first-episode psychosis may never experience another episode. Still, talk to a doctor as soon as possible so they can help set you up with appropriate treatment options. The sooner you get help, the greater your chances of recovery. It also reduces your risk for a relapse.

You or your loved one may need emergency psychiatric help if you have:

  • Suicidal thoughts
  • Uncontrollable anxiety
  • Episodes of hearing voices or seeing things that prompt injury to yourself or others
  • Extreme confusion or heightened emotions
  • Uncontrollable anger
  • Reactions to antipsychotic medications

Call 911 or head to the nearest hospital for medical attention.

Soon after your first psychosis episode, treatment is essential and can lead to better long-term outcomes. Many experts recommend a treatment approach called coordinated specialty care (CSC). With this treatment approach, several health specialists work together to create a personal treatment plan tailored to suit your specific needs. It involves close family and friends as much as possible in treatment decisions.

CSC treatment includes:

Case management. Health providers like doctors, nurses, social workers, and counselors work with you to develop problem-solving skills, manage medications, and coordinate services you might need as part of your treatment.

Psychotherapy. This involves mental health professionals who help you learn to focus on managing symptoms, developing coping skills, and improving overall well-being.

Medication management. Your doctors will help you find medications to manage your condition with the lowest dose possible. If these don’t work for you, they’ll help you look for alternatives that better suit your needs.

Supported education and employment. CSC provides assistance and support to help you continue or return to school or work after an episode.

Peer support. CSC will help you or your family members connect with those who’ve been through similar experiences. This helps you build a community that you can turn to for support, advice, or suggestions.

Family support and education. This gives family members or friends the education and support they need to help you through the recovery process.