Psychosis involves disruptions to a person’s thoughts and perceptions that make it difficult for them to recognize what is real and what isn’t. Many people think of psychosis as a break with reality. These disruptions are often experienced by seeing, hearing and believing things that aren’t real or having strange, persistent thoughts, behaviors and emotions. While everyone’s experience is different, most people say psychosis is frightening and confusing.
It’s important to know that psychosis is a symptom, not a specific illness, and can be one of the symptoms of several different illnesses. It’s also more common than you may think. Research suggests that 15-100 people out of 100,000 develop psychosis each year.
Early or first-episode psychosis (FEP) refers to when a person first shows signs of losing contact with reality. Be aware that the term “first episode” does not mean that there will be additional episodes in the future. What it does mean is that we need to act quickly. Connecting a person with the right treatment during early psychosis or FEP can be life-changing and radically alter that person’s future. Don’t wait to take the first step and prepare yourself with information by reviewing these tip sheets:
There is still much that we don’t understand about why psychotic symptoms occur, but research continues to show that there are likely several factors involved. What we do know is that while teenagers and young adults are at increased risk of experiencing an episode of psychosis, it can actually occur at any age.
There are a number of different contributors to the development of these symptoms. A few of the more well known include:
Psychosis can also occur as part of several different mental health. Each will require a customized treatment plan that integrates these co-occurring conditions. Some of the more common mental health conditions that can include psychosis symptoms are:
In this 2-part podcast series, NAMI Chief Medical Officer Dr. Ken Duckworth guides discussions on early psychosis that offer insights from individuals, family members and mental health professionals. Read the transcript.
Note: Content includes discussions on topics such as suicide attempts and may be triggering.
Reviewed and updated December 2025
Be aware that symptoms of psychosis rarely present suddenly. Usually, a person has gradual, nonspecific changes in thoughts and perceptions, but they may not understand what’s going on. In young people, warning signs can be especially difficult for family members and friends to distinguish from typical teen or young adult behavior. While the presence of these signs should not be cause for alarm, they may indicate the need to consider getting an assessment from a health care professional to learn more.
Treatment is available if it turns out that an episode of psychosis is happening, and attending to this possibility is essential. There are almost 400 programs in the United States, called Coordinated Specialty Care (CSC), designed specifically to serve people in the early phase of psychosis as determined by a health care professional. See Treatment for more information. Remember, the term “early” or “first” does not guarantee that these symptoms will be repeated in later months or years.
Encouraging people to seek help early is important. Families are often the first to see early signs of psychosis and the first to address the need to seek treatment. However, a person’s willingness to accept help is often complicated by delusions, fears, lack of awareness of illness, stigma and feeling unsettled. In this case, families can find the situation even more difficult, but there are engagement strategies that can be helpful to encourage a person to seek treatment. NAMI programs are a great place to start. To learn more visit www.nami.org/programs.
It’s important to get help quickly since early treatment provides the best hope of recovery by slowing, stopping or reversing the negative effects of psychosis. Early warning signs can be nonspecific and include the following:
Determining exactly when the first episode of psychosis began can be hard, but these signs and symptoms strongly indicate that an episode of psychosis may be happening:
Such warning signs often point to a person’s deteriorating health, and a physical and neurological evaluation can help identify the problem. A mental health professional performing a psychological evaluation can determine if a mental health condition is involved and discuss next steps. If the psychosis is a symptom of a mental health condition, early action helps to keep lives on track.
Psychosis includes a range of symptoms but typically includes either or both of the following experiences:
Hallucinations, which involve seeing, hearing or feeling things that aren’t there, such as:
Delusions, which 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:
Reviewed and updated December 2025
Diagnosing psychosis involves a comprehensive medical and psychiatric evaluation. A health care provider will review medical and family history, perform a physical examination, and may order lab tests or brain imaging to rule out uncommon medical causes such as infection, epilepsy, brain tumors or head injury. The use of substances can mimic schizophrenia and are an important area to assess, and if needed, treat.
Reviewed and updated December 2025
Early treatment of psychosis and other symptoms of mental health conditions leads to the best outcomes.
Research has shown significant success using a treatment approach called Coordinated Specialty Care (CSC) for early or first episode psychosis. CSC uses a team of health professionals and specialists who work with a person to create a personal treatment plan based on life goals while involving family members as much as possible.
CSC has the following key components:
SAMHSA maintains an Early Serious Mental Illness (ESMI) Treatment Locator as a source of information for family members who are seeking CSC programs in the US. Portions of their website are available in Spanish. The Early Psychosis Intervention Network (EPINET) Clinic Map may also be helpful.
Traditional treatment for psychosis involves a combination of psychotherapy and medication. Several types of therapy have successfully helped individuals learn to understand and manage their condition. Medication targets specific symptoms and helps reduce their impact.
Antipsychotic medications help reduce hallucinations, delusions, and disorganized thinking. Finding the right medication and dose can take time. There are options available for those who prefer not to take a daily pill. Long-acting injectable (LAI) medications are an effective option that helps maintain steady treatment and reduce relapse risk. Different medicines have different side effect profiles, so be sure to understand them before beginning a medication. NAMI partners with the American Association of Psychiatric Pharmacists (AAPP) to provide information on mental health medications and help you learn what to expect and plan for with each one.
It’s important to specifically mention one medication — clozapine (Clozaril), a unique second-generation antipsychotic — because it is the only FDA-approved medication for treatment-resistant schizophrenia (TRS). It is also the only FDA-approved medication to reduce suicidality in people living with schizophrenia. Clozapine has additional blood monitoring requirements and side effects, but remains an underutilized resource for people who have not responded to treatment with at least 2 different antipsychotic medications. Clozapine has been shown to be the most effective medication in these cases.
With the help of families and individuals sharing their experiences, NAMI and other advocacy organizations successfully advocated for a reduction in paperwork and process to access clozapine at the FDA in 2025. This announcement signaled the removal of the risk evaluation and mitigation strategy (REMS) process, which eliminates some of the barriers to clozapine use.
Therapy helps people make sense of their experiences, learn coping strategies, and strengthen social and occupational functioning. Family psychoeducation, social skills training, and supported employment or education programs also play an important role in recovery. Remember, the most effective treatments involve a combination of approaches.
With early, person-centered care, many people who experience psychosis can manage their symptoms, continue school or work, and lead fulfilling lives. Recovery looks different for everyone — and having consistent support makes a meaningful difference. Some find peer support — both giving and receiving — to be essential elements of recovery. The NAMI Peer-to-Peer education program can provide compassion, understanding and support along this journey.
Reviewed and updated December 2025
Psychosis can come with challenges, but there is help. NAMI is here to provide support for you and your family and information about community resources. NAMI offers a variety of information and programs tailored to the specific needs of people experiencing these conditions and their family members. These programs are all led by people with their own personal experience with these conditions which makes the information they are sharing even more powerful.
To learn more about these programs visit www.nami.org/programs or contact the NAMI HelpLine at 1-800-950-NAMI (6264) or [email protected] if you have any questions about psychosis or finding support and resources. You can also use the Find Your Local NAMI tool to find a NAMI in your own community.
There are many ways to help manage your symptoms to prevent them from getting worse and reduce the chance of experiencing a mental health crisis:
If you live with a mental health condition, learn more about managing your mental health and finding the support you need.
Learning about psychosis will help you understand what your friend or family member is experiencing and trying to cope with. Living with psychosis can be challenging, so here are some ways you can show support:
Find out more about taking care of your family member or friend and yourself.
Reviewed and updated December 2025
NAMI HelpLine is available M-F, 10 a.m. – 10 p.m. ET. Call 800-950-6264,
text “NAMI” to 62640, or email. In a crisis, call or text 988 (24/7).
