Psychosis is a symptom that can be caused by multiple mental and physical illnesses. 

For example: 

• it can occur in mental illnesses such as bipolar disorder, depression, or schizophrenia
• it may be induced by substances, including medications
• it can result from a brain injury or seizure disorder
• it can happen with delirium during medical illnesses
• it can occur with a tumor or cyst within the brain

In many of these conditions, there are other signs or symptoms that help determine what medical investigations are needed. Psychosis due to an underlying mental health challenge is quite common and affects up to 3% of the population. It is very important to get help as early as possible, as research shows that the earlier intervention happens, the better the treatment outcome. 

Psychosis involves a loss of contact with reality. When you have psychosis, what you think is real is not the same as what others think is real. For some, a major symptom of psychosis can be difficulty organizing and expressing their thoughts. 

Most cases of psychosis are caused by a combination of genetics and environmental factors. Those born with some genetic vulnerability will experience psychosis, while others are born with the same genetic risk may never get it. Sometimes, those who do develop psychosis have experienced a “trigger” like a traumatic life event, injury, illness, or have used substances such as cannabis or stimulants. These kinds of triggers can increase the risk of developing symptoms, but when an individual has a mental health disorder associated with psychosis, this is unlikely to be due to a single cause.

If you are worried that your child may be experiencing psychosis, it’s always a good idea to have them assessed by a health care provider. You may notice your child is acting differently. They may be moody or get angry more often. Their grades at school may go way down and they may start spending more and more time alone. Family and friends may think they are just “going through a phase” or wonder if they’re using substances. Many of these behaviours may also be explained by other things, which is why medical assessment is needed to determine how best to support your child. 

Signs and Symptoms

Symptoms of psychosis can include the following:

• Hallucinations: When a person hears, sees, tastes, smells, or feels things that are not actually there
• Delusions: New and firmly held beliefs that are different from usual for a person and are not based in reality (considering their usual belief systems, developmental level, and culture)
• Changes in thinking or speech compared to a person’s usual patterns, which can cause others to have difficulty understanding what they are saying or thinking
• Changes in behaviour, which can become more disorganized compared to usual and does not fit the situation. This may include becoming suspicious or paranoid.
• Negative symptoms, which do not mean they are “bad” but that there is a loss of usual functioning. These symptoms can be hard to notice and need careful checking. They might include showing fewer feelings, changes in how someone talks, trouble starting tasks, and less motivation to do things.

It’s also important to recognize the difference between beliefs that are normal in someone's culture (like spiritual beliefs) and delusions, which are false beliefs that happen during psychosis. Diagnosing someone involves understanding their unique ways of thinking and speaking. Treatment should also consider the history of medical and other trauma experienced by groups affected by racism and colonialism, including Indigenous peoples.

How is it diagnosed?

No two individuals will have exactly the same symptoms or warning signs. But these are signs that may indicate that your child needs help. It’s important to see a doctor right away. Psychosis can have long lasting effects, so it needs to be identified and treated as soon as possible. A doctor can also ensure that the right medical tests have been done and are completed over the course of treatment.

For most, symptoms of psychosis first begin between the ages of 13 and 30, with the symptoms most commonly occurring between ages 18 and 24. All genders have the same chance of develop psychosis. The risk for psychosis is greater if other family members have experienced psychosis. 

If you suspect that your child might have psychosis, talk to a health care provider as soon as possible. You may be referred to another doctor or psychiatrist. Getting help as early as possible during a first episode of psychosis is important. Studies have shown that the earlier psychosis is recognized, and symptoms treated, the more likely the person will be able to manage their illness and the better their future outcomes. Most areas in BC have Early Psychosis Intervention (EPI) programs to help youth who have psychosis. EPI programs are a very good place to start if you think your child might have psychosis.

Treatment and strategies

• Medication is very important. It often takes a while to find one that is right, as everyone’s brain is different. Sometimes a combination is needed which may depend on the underlying illness contributing to psychosis. Learn more about medications used to treat psychosis.
• Learn about psychosis
• Learn ways to deal with stress and keep stress low to help reduce the risk of the return of the illness
• Be patient – it will take time to find the best treatments and strategies that will work for each person
• Psychosocial treatments (treatments that address a person’s thoughts and behaviours and help them develop new skills to be used in social contexts) are helpful when used in conjunction with medication

• Identify what lifestyle changes could lead to better overall physical and mental wellness

• Support – having a brain illness can be hard and lonely. It helps to have caring people to talk to about it

Tips for parents

Psychosis almost always needs medical treatment, but there are things that parents can do to support their child. Some tips that may help:

• Encourage them to take part in light exercise or other activities they enjoy. It’s best to start with only one or two other people around.
• Support them in getting help to limit the brain’s exposure to substances, so that it can heal and stay well.
• Help them to keep stress low and do things that help lower stress. Take a few minutes together to breathe slowly and deeply or consider another activity that is calming which you can enjoy together.  
• Encourage them to get enough sleep. If your child is having trouble sleeping or sleeping too much, talk to the doctor.
• Appreciate that getting well may happen slowly and steadily. Your child may want to spend quiet time alone and may not talk or join in much. They might have trouble focusing or getting things done. While the brain is healing, it takes a while to be able to think clearly again and start to feel normal.
• Try to speak in short, simple sentences that are easier to understand.
• Be gentle and positive. Acknowledge and validate their feelings.
• Encourage nutritious meals and snacks to support physical and mental wellness. Read through and use the Early Psychosis Intervention’s Dealing with Psychosis Toolkit (DWP)

• If you are concerned that your child may be experiencing a first episode of psychosis, make an appointment to see a primary care provider (e.g. family physician, nurse practitioner, walk-in clinic, Foundry BC).
• For imminent concerns about your own or others’ safety, call 911 or go to your nearest emergency department.
• You can also call the early psychosis intervention (EPI) program in your region directly to make a self-referral. There is a list of all the programs in BC at the BC Early Psychosis Intervention Program website. EPI programs are made for youth and help them get quick access to treatment services.
• If there is no early psychosis intervention program in your area and you do not have access to a primary care provider, then call 811 to ask for the number of your local mental health team or to find out how to connect to the intake process for local mental health and substance use services.

Looking for more information on this topic? Connect with a family peer support worker at the Kelty Centre to discover additional resources, learn more about support and treatment options, or just to find a listening ear.