The word psychosis is used to describe conditions that affect the mind, where there has been some loss of contact with reality. When someone becomes ill in this way it is called a psychotic episode. During a period of psychosis, a person’s thoughts and perceptions are impacted and the individual may have difficulty understanding what is real and what is not.  Symptoms of psychosis include delusions (beliefs or ideas that seems strange to others or are not based in reality) and hallucinations (seeing, hearing, feeling, or tasting things that others do not). Other symptoms include paranoia (fear or distrust of others), incoherent or nonsense speech, and behavior that is inappropriate for the situation. A person in a psychotic episode may also experience depression, anxiety, sleep problems, social withdrawal, lack of motivation, and difficulty functioning overall. The experience of psychosis varies greatly from person to person and individuals experiencing psychosis may have very different symptoms. People experiencing psychosis are also at risk of unemployment, substance use problems, self-harm or suicidal thoughts/behaviors, and legal issues.

Psychosis itself is a condition and is not a particular disorder.  Rather, psychosis can be a symptom of many different mental health conditions, just as a high temperature is a condition that can be associated with many different illnesses. Unlike taking someone’s temperature, recognizing whether psychosis is present can be difficult – especially when it is in its early stages. These early stages can be associated with a wide variety of nonspecific changes such as mood swings, taking up of new philosophies or “odd” behaviors or beliefs.  Often, because psychosis affects young people, the early symptoms are mistaken for normal teenage behavior. Also, people with psychosis sometimes do not realize they are ill, which can make getting treatment more difficult.

Psychosis is associated with many different mental health diagnoses, including:

• Schizophrenia
• Schizophreniform disorder
• Brief Psychotic disorder
• Bipolar Disorder
• Delusional Disorder
• Substance-induced Psychosis
• Major Depressive Disorder with Psychotic Features
• Schizoaffective Disorder

Sources: NIMH and Early Psychosis Intervention Program

We are still learning about how and why psychosis develops, but several factors are likely involved. We do know that teenagers and young adults are at increased risk of experiencing an episode of psychosis because of hormonal changes in their brain during puberty.

Several factors that can contribute to psychosis:

• Many genes can contribute to the development of psychosis, but just because a person has a gene doesn’t mean they will experience psychosis. Ongoing studies will help us better understand which genes play a role in psychosis.
• A traumatic event such as a death, war or sexual assault can trigger a psychotic episode. The type of trauma—and a person’s age—affects whether a traumatic event will result in psychosis.
• Substance use. The use of marijuana, LSD, amphetamines, and other substances can increase the risk of psychosis in people who are already vulnerable.
• Physical illness or injury. Traumatic brain injuries, brain tumors, strokes, HIV, and some brain diseases such as Parkinson’s, Alzheimer’s and dementia can sometimes cause psychosis.
• Mental health conditions. Sometimes psychosis is a symptom of a condition like schizophrenia, schizoaffective disorder, bipolar disorder, or depression.

Psychosis can also be a side effect of medications.

Source: NAMI

Psychosis rarely comes on suddenly. Usually, a person has gradual, non-specific changes in thoughts and perceptions, but doesn't understand what's going on. Early warning signs can be difficult to distinguish from typical teen or young adult behavior. While such signs should not be cause for alarm, they may indicate the need to get an assessment from a medical provider.

Families are often the first to see early signs of psychosis and the first to address the issue of seeking treatment. However, a person's willingness to accept help is often complicated by delusions, fears, stigma and feeling unsettled. In this case, families can find the situation extremely difficult, but there are engagement strategies to help encourage a person to seek help.

It's important to get help quickly because early treatment provides the best path toward recovery by slowing, stopping and possibly reversing the effects of psychosis.

Early warning signs include the following:

• A drop in grades or job performance
• Trouble thinking clearly or concentrating
• Suspiciousness or uneasiness with others
• A decline in self-care or personal hygiene
• Spending more time alone than usual
• Strong, inappropriate emotions or having no feelings at all

Symptoms of an episode of psychosis include:

• Hearing, seeing, tasting, or believing things that others don’t
• Persistent, unusual thoughts or beliefs that can’t be set aside regardless of what others believe
• Strong and inappropriate emotions or no emotions at all
• Withdrawing from family or friends
• A sudden decline in self-care
• Trouble thinking clearly or concentrating

Source: NAMI

Hallucinations are seeing, hearing, or feeling things that aren’t there, such as the following:

• Hearing voices (auditory hallucinations)
• Strange sensations or unexplainable feelings
• Seeing glimpses of objects or people that are not there or distortions

Delusions are strong beliefs that are not consistent with the person’s culture, are unlikely to be true and may seem irrational to others, such as the following:

• Believing external forces are controlling thoughts, feelings, and behaviors
• Believing that trivial remarks, events, or objects have personal meaning or significance
• Thinking you have special powers, are on a special mission or even that you are God.

Source: NAMI

A great referral for Phoenix is someone who is interested in participating in the program, wants to better understand their symptoms, and is motivated to learn tools to enhance wellbeing and build a meaningful life. Phoenix is different from traditional outpatient care as it provides specific wrap around services which are shown by research to enhance outcomes for youth with Early or First Episode Psychosis. At a minimum, we ask that Phoenix participants engage in:

• Individual therapy
• Psychiatry (medication is not mandatory)
• Supported Employment
• Supported Education
• Family Psychoeducation and/or Family Therapy
• Regular Engagement in Groups
• Peer Support

Phoenix is most effective when youth and their families/loved ones take advantage of multiple components of the program.

At minimum, youth in the Phoenix program should:

• Be between the ages of 15-26
• Live in Denver County
• Have experienced symptoms of psychosis (see above) for less than two years
• Be willing to participate in at least three components of the program (individual therapy, psychiatry (medication is not mandatory), and one other component)

Source: NAMI

If you are already receiving services from the WellPower, you should speak with your therapist or case manager and they can help refer you for Phoenix. If you are not currently receiving services with WellPower, call the Access Line at 303-504-6500 and let them know you are interested in Phoenix. For more information, please call the Emerson St. front desk at 303-504-3988 and we will connect you with the Phoenix program coordinator.

Yes, youth engaged in our outpatient program have access to the same types of programming that participants of the Phoenix program have access to (individual therapy, family therapy, psychiatry, supported employment/education, peer support, case management). However, Phoenix is an evidenced-based practice for the treatment of early episode psychosis and utilizes the Recovery After Initial Schizophrenia Episode (RAISE) model. As Phoenix is a program with specialty care coordination, all multidisciplinary treatment providers on the Phoenix team meet weekly to coordinate care specific to participants in the Phoenix program. Additionally, while an outpatient level of care offers voluntary access to additional treatment components, the Phoenix model requires at baseline that participants engage in therapy, psychiatry and at least one other component of the program. 

At Emerson St. we encourage youth who voluntarily sign themselves into treatment to include their families as supports, but we do not require it as part of treatment. Sometimes families can be a great resource and we recognize the value of helping youth connect with parents and caregivers for ongoing support and understanding. Sometimes youth would rather involve friends, teachers, mentors, or other folks in their treatment journey. We want to support youth with involving the people they trust in their treatment, if they are open to doing so.

Phoenix is designed to support youth with initial psychosis symptoms and to get youth connected to care; it is not meant to be a life-long commitment. If someone has successfully worked on Phoenix program materials, achieved consistent stability, and is interested in less intensive options for care, they may graduate to appropriate services with a single provider, such as psychiatry-only for medication management, or biweekly therapy with an outpatient therapist to continue working on goals. If someone ages out of eligibility for services at Emerson (our age range is 15 to 26), they may transition to other services offered by our Adult Recovery Services department, working with a case manager, outpatient therapist, or psychiatrist who provides care to adults throughout the lifespan.

People with mental illness, including psychosis, are no more violent than anyone else, especially when they are receiving effective treatment and are not using substances. Sometimes individuals with psychosis can be at a higher risk of violence if they have a history of violent or aggressive behavior, are responding to hallucinations or delusions that cause them to hurt themselves or others, or are experiencing paranoia. If a person with psychosis becomes escalated and exhibits signs of becoming violent, it's important to speak to them calmly and clearly, give them physical space, avoid a confrontation, and seek professional support or emergency services if necessary.

Absolutely! Supported education and supported employment are essential components of treatment at Emerson St., including for the Phoenix Program, because work, school, and meaningful daily activities are critical for everyone’s overall wellbeing and for recovery from mental health challenges of all kinds. Per SAMHSA, “with proper, timely interventions, and the support and maintenance of important roles like student, worker, friend, and family member, etc., many people with a diagnosis of a mental illness can expect to live a normal life.” We know that people with psychosis and other mental illnesses want to work and go to school and can succeed in these goals when they find opportunities that fit their interests, leverage their strengths and talents, and have access to support and accommodations. Involvement in work and school actually improves mental health outcomes. Our education and employment specialists help the youth we serve with to explore their interests in work and school and take action on their goals.

https://www.earlypsychosis.ca/diagnosis-of-psychosis/

https://www.nimh.nih.gov/health/topics/schizophrenia/raise/what-is-psychosis

https://www.nimh.nih.gov/health/topics/schizophrenia/raise/fact-sheet-first-episode-psychosis

https://www.nimh.nih.gov/health/topics/schizophrenia/raise/raise-questions-and-answers

https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Psychosis