- What are Adolescent Psychotic Disorders?
- How Common Are Psychotic Disorders?
- What Are The Early-Onset Signs of Psychosis and Psychotic Disorders?
- What Are The Later Signs and Symptoms of Psychotic Disorders?
- What are the Types of Psychotic Disorders?
- What Are The Causes and Risk Factors for Psychotic Disorders in Teens?
- What Are Treatments for Psychotic Disorders?
What are Adolescent Psychotic Disorders?
Psychotic disorders are intense and severe mental illnesses characterized by severe impairment of an adolescent’s or teen’s ability to think clearly, communicate appropriately, react emotionally, understand reality, and behave in an appropriate manner. Teen psychotic disorders severely interrupt the ability of a teen to function normally in daily activities and are often quite debilitating and disabling. Psychosis, a feature of teen psychotic disorders, is defined as the loss of contact with reality that is not a part of a teen’s culture. Psychosis is a symptom rather than a diagnosis.
Psychotic disorders are characterized by the presence of hallucinations and delusions:
Hallucinations are a strange sensory perception perceived in the absence of an outside stimuli. These sensory perceptions can be an auditory experience, such as hearing voices or, less commonly, smelling, seeing, or feeling things that are not experienced by others. Through neuroimaging, it’s been understood that auditory hallucinations, or hearing voices, is the result of increased activity in the auditory cortex of the brain. It’s important to remember that these auditory hallucinations, or voices, are very real for the teen hearing them, which can be incredibly confusing for others to witness. These voices may be critical (i.e. “you’re ugly”), threatening (i.e. “I will hurt you”), or neutral (i.e. “it is cold today”), and often involve voices unknown to the person hearing them.
Delusions are false yet fixed beliefs and may be paranoid (i.e. “the CIA is judging my Internet searches”) or of mistaken identity (i.e. “you’re not my father!”). These beliefs are considered delusional as they do not change or adapt when the person experiencing them is presented with contradictory proof or facts. Delusions are also associated with other impairments in cognition – difficulty paying attention, confused thinking, and feeling as though a person’s “thoughts are blocked.” Sometimes, delusions may be short-lived, such as the result of drugs taken, a short-onset psychotic break, or periodic, which occurs when the psychosis is associated with a mental health disorder.
Psychosis can be transient, periodic, short-term, or as a feature of a mental disorder. Early identification and assessment of teen psychiatric disorders is vital for the health and wellbeing of the teen, as early intervention leads to more positive outcomes. Learning more about psychosis and its symptoms can help teens and their loved ones seek the care they require.
How Common Are Psychotic Disorders?
Information regarding prevalence of psychotic disorders in teens is currently unavailable, however, 5% of adults who experience psychosis state that the first time they experienced the early-onset, more non-specific signs of a psychotic disorder was before the age of 15 years. In the United States, one out of every 100 people qualifies for a schizophrenia diagnosis, which translates to 3 million people in the US with the disorder. Generally, the symptoms of a psychotic disorder begin between the ages of 18 and 24, but the onset of less severe symptoms usually begin during early teen years.
What Are The Early-Onset Signs of Psychosis and Psychotic Disorders?
Often, thought processes and behaviors are impacted by hallucinations or delusions; adolescents or teens experiencing new-onset psychosis may have trouble organizing thoughts, feeling as though they are “in a dream,” and wondering if their mind is “playing tricks” on them. Teens may be distracted by hallucinations, which can impact attention span, ability to prioritize tasks, and ability to make decisions. Some adolescents may experience agitation, which can provoke terrifying anxiety and panic attacks. Many teens feel humiliated and ashamed by this sudden change and may not want to report the symptoms for fear of being labeled as “crazy.”
However, as early identification and treatment of psychotic disorders is vital to achieve favorable outcomes, knowing the early signs of psychosis can make a world of difference for your teen. Some of the typical early warning signs that a teen is experiencing psychosis may include:
- Unusual, extraordinarily intense new ideas
- Strange new feelings
- Suddenly not having feelings
- Mistaking noises for voices
- Increased sensitivity to sounds or sights
- Spending more time alone than usual
- Dramatic and worrisome drop in academic performance
- New trouble concentrating or thinking clearly
- Suspiciousness and uneasiness around other people
- Marked decline in personal hygiene or self-care
These signs are of particular importance when they are new or have dramatically worsened in the past year, most especially if the teen has a close relative who was diagnosed with psychosis.
What Are The Later Signs and Symptoms of Psychotic Disorders?
In the later stages of a psychotic disorder, the symptoms become more notable as the person with the psychotic behavior experiences a change in their inner world, provoking behavioral changes. These symptoms may be expressed in the later teens and early twenties.
The most common symptoms of psychotic disorders include:
- Disorganized speech and behaviors
- Social withdrawal
- Catatonia – body rigid and unresponsive to outside stimuli
- Loss of interest in previously-enjoyed activities
- Loss of interest in personal hygiene
- Problems at school
- Problems with interpersonal relationships
- Cold, detached manner with the inability to properly express emotions
- Changes in eating patterns, notably loss of appetite
- Weight loss
- Worsened personal hygiene
- Slowed, unusual movements
- Disorganized thoughts
- Confused thinking
- Making up words that have no meaning
- Inability to follow directions
- Difficulties processing information
- Changes in short-term memory
- Inability to understand the environment
- Inability to make plans for the future
- Decreased ability to pay attention to external stimuli
- Mood swings
- Depersonalization – intense feelings of anxiety and feelings of things being unreal
- Sense of being controlled by external forces
- Suicidal ideation
- Anhedonia – inability to feel pleasure
- Blunted emotional affect
What are the Types of Psychotic Disorders?
There are a number of mental illnesses and other disorders that can lead to the development of a psychotic disorder in teens.
Schizophrenia is the major cause for psychotic disorders in teens and adults. Schizophrenia is a chronic, severe mental illness that affects a number of teens and adults.
Brief Psychotic Disorder is a short-term illness that features symptoms of psychosis: hallucinations and delusions. Symptoms tend to appear suddenly and last for less than one month, after which the affected person recovers completely.
Delusional Disorder, formerly called paranoid disorder, is a very serious mental illness that involves both hallucinations and delusions. People who have delusional disorder often experience non-bizarre delusions that could actually occur in real life, such as being followed, poisoned, conspired against, or loved from a distance. These delusions often involve misperceptions of experiences. In reality, these situations are either much exaggerated or entirely untrue.
Schizoaffective Disorder is a mental disorder characterized by persistent psychotic symptoms along with symptoms of a mood disorder, such as depression or bipolar disorder. People who have schizoaffective disorder experience hallucinations and delusions along with the mania of bipolar disorder and/or the lows of depression.
Substance-Induced Psychotic Disorder occurs when a person uses legal or illegal substances in a manner that inadvertently induces psychosis. A number of psychoactive substances have been noted to cause or worsen psychosis among those who use them. Substances that have been linked to psychosis include:
- Alcohol is a very common cause for psychotic episodes and may occur during intoxication, as a result of chronic alcoholism, during alcohol withdrawal, or as exacerbation of preexisting disorders.
- Marijuana, especially strains containing large amounts of THC (the ingredient that causes feelings of intoxication), have been shown to lower the threshold for psychosis, thereby helping to trigger psychotic behavior in some people.
- Sedative/Hypnotics are legal medications prescribed for insomnia, seizure management, and anxiety disorders, which can cause complications known as a “paradoxical reaction.” During a paradoxical reaction, the person exhibits some signs of psychosis. More commonly, psychosis is linked to benzodiazepine withdrawal syndrome.
- Cocaine/Amphetamines are each a type of stimulant that have the potential to induce psychosis in the users. Most amphetamines are prescription medications while cocaine is an illegal street drug; both can cause “stimulant psychosis” in high doses. In fact, over half of cocaine users reported experiencing some psychotic symptoms.
- Hallucinogens (LSD, Psilocybin, and Mescaline) are illegal drugs that disrupt the way in which a person perceives reality, causing users to see, feel, and hear things that don’t exist, and impairing communication. These recreational drugs are known to cause symptoms of psychosis in users; some report a continual presence of sensory disturbances (trails, halos, auras) after sobering up, as a result of overuse of these drugs.
- Shared Psychotic Behavior/Folie à deux is a shared psychosis in which the symptoms of a delusional disorder are shared between two people. These delusions are passed on by one person who has a psychotic disorder to an otherwise healthy person; the delusions usually disappear once the two are separated.
- Depressive Disorder/Psychotic Depression is a type of major depressive disorder that occurs when a severe case of depression includes a form of psychosis. The psychotic symptoms may include hallucinations, delusions, or other breaks in reality.
- Bipolar Disorder can trigger psychosis. During the manic or depressive phase of bipolar I disorder, aspects of psychosis or psychotic features may occur, including both hallucinations and delusions.
What Are The Causes and Risk Factors for Psychotic Disorders in Teens?
While some of the psychotic disorders are the result of substance use, most psychotic disorders do not have a single known root cause. Most researchers tend to believe an interplay between genetic, physical, environmental, and risk factors is involved in the development of these disorders.
The most commonly cited reasons for psychotic behavior in teens may include:
Genetic: It’s understood that psychotic disorders may run in some families. Teens who have a family member who struggled with a psychotic disorder, such as schizophrenia, are at greater risk for developing the disorder themselves. It’s worth noting that while a genetic predisposition is a risk factor, not all people who have relatives with psychotic disorders will go on to develop one.
Physical: Current neuroimaging studies of the brains of those who have psychotic disorders have identified very subtle changes in the structure and function of the brain. Neurotransmitters, especially dopamine, serotonin, and glutamate, are thought to play a role in the development of these disorders. Additionally, psychosis is more likely to develop in those who have poor medical health and/or chronic medical conditions.
Environmental: Children and teens who have endured many negative life events, poor housing, familial isolation from others, and those who lack a support system are at greater risk for developing a psychotic disorder.
- History of mental illness
- Problematic drinking
- Usage of marijuana, stimulants, hallucinogens
- Maternal infections, placental insufficiency, or hypertension during pregnancy
- High, extreme amounts of stress in life
What Are Treatments for Psychotic Disorders?
As most psychotic disorders require long-term care and management, there are a variety of treatment methods employed. While many of the methods are similar, it’s vital for any teen experiencing psychosis to have a unique treatment plan designed for their form of psychotic disorder as well as any co-occurring mental health disorders.
First and foremost, any teen who is experiencing acute psychosis has to have their immediate safety needs met. The potential for violent behavior directed toward themselves or another should be the first thing addressed by any clinician. If the person is a danger to themselves or others, it’s vital that they are immediately stabilized and placed in an area where there can be no harm inflicted.
The cornerstone for psychosis treatment involves antipsychotic medications, which have been proven to be effective for both acute and long-term psychotic symptoms and can reduce the risk for future psychotic episodes. During an acute psychotic break, the dosage of the antipsychotic may be higher and tapered slowly down as the acute psychotic crisis symptoms dissipate. The maintenance dose, used when the person is no longer in crisis, will be lower and potentially life-long. If treatment with antipsychotic medication is intended to be life-long, the dose will be reduced to the minimum amount that will still prevent against relapse. While the typical antipsychotics, available since the 1950s, had a number of unpleasant side effects, including extrapyramidal symptoms (EPS) which led many people to stop taking their medication, the newer, atypical antipsychotics are more effective at treating the psychosis and involve fewer unpleasant side effects.
Antidepressants may also be used in the treatment of the symptoms of psychotic disorders as many people who have these disorders also develop depression. These medications can make it much easier for those who have psychotic disorders to cope with daily life.
One of the biggest challenges in treating those who have psychotic disorders is medication noncompliance. Many people who have psychosis do not believe that they are ill and require long-term medication to reduce the symptoms. Others may dislike the side effects from the medications, have unrealistic expectations of treatment, or struggle with substance abuse. Irregular usage and medication noncompliance increases the risk for a relapse of psychotic symptoms. This is why many people who have psychotic disorders follow a treatment plan that has been developed by their treatment team that includes taking the right medication at the right time, attending regular therapy sessions, and following other treatment recommendations.
Individual therapy using cognitive-behavioral therapy (CBT) is an evidence-based treatment that has shown be extremely helpful for teens struggling with psychotic disorders. Cognitive-behavioral therapy (CBT) can be used to target any persisting delusions and hallucinations that are not managed by antipsychotics. CBT has been shown to improve symptoms and outcomes for people who have schizophrenia and other psychotic disorders.
Group therapy has been shown to be an effective way of helping people who have psychotic disorders work with others who have similar struggles so that they all can grow, learn, and heal. Group therapy creates a safe, supportive atmosphere for those struggling with psychotic disorders and promotes independence, therapeutic relationships, and better self-knowledge. Group therapy topics may focus upon medication compliance, the development of life and social skills, managing side effects, and adaptive coping skills.
Family therapy is very important in the care of any teen who has a psychotic disorder as the family is integral to the treatment team. Family sessions may focus upon medication compliance, ways the family can cope with the illness, tips for preventing relapse, and the safe expression of emotions related to the diagnosis.