Psychosis

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:

Causes

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:

Genetics. Many different genes can contribute to the development of psychosis, but just because a person has one of those genes doesn’t mean they will necessarily experience psychosis. Ongoing studies will help us better understand which genes play a role in psychosis for some people but not for others.
Trauma. A traumatic event such as a death, war or sexual assault can also be involved in an episode of psychosis. The type of trauma — and a person’s age — affects whether a traumatic event will result in psychosis.
Substance use. The use of some substances — such as marijuana, LSD, or amphetamines — 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 contribute to the development of psychosis.
Mental health conditions. Sometimes psychosis is one of the symptoms of a condition like schizophrenia, schizoaffective disorder, bipolar disorder or depression.

Related Conditions

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:

Bipolar Disorder
Schizoaffective Disorder
Schizophrenia
Substance use disorders / Dual diagnosis

Personal Perspectives on Early Psychosis

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.

Early Warning Signs Before Psychosis

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:

A worrisome 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 a lot more time alone than usual
Strong, inappropriate emotions or having no feelings at all

Onset Of Early Or First-Episode Psychosis

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:

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

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

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:

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

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:

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

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 Or First-Episode Psychosis

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:

Case management
Family support and education
Psychotherapy
Medication management
Supported education and employment
Peer support

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.

Psychosis Treatment

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.

Medication

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.

Psychotherapy and Skills-Based Support

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.

Recovery and Long-Term Wellness

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.

Helping Yourself

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:

Manage Stress. Stress can trigger psychosis and make the symptoms of schizophrenia worse, so keeping it under control is extremely important. Know your limits, both at home and at work or school. It’s important not to take on more than you can handle and to take time for yourself if you’re feeling overwhelmed.
Try to get plenty of sleep. If using certain medications, you might need more sleep than the standard 8 hours. Many people with schizophrenia have trouble with sleep, but lifestyle changes such as getting regular exercise and avoiding caffeine can help.
Avoid alcohol and drugs. Substance use affects the benefits of medication and worsens symptoms. If you are concerned about your substance use, seek help from a health care provider.
Maintain connections. Having friends and family involved in your treatment plan can go a long way towards recovery. People living with schizophrenia can have a difficult time in social situations, so surrounding yourself with people who understand you and your symptoms can help. If you feel you can, consider connecting with others through online message boards, peer-education programs like NAMI Peer-to-Peer, or peer support groups like NAMI Connection. You can also get involved with a local church club or other organization.
Partner with your health care providers. Give your health care provider all the information they need to help you recover — including any reactions to medications, your symptoms or any triggers you notice. Develop trust and communicate openly. If you don’t feel comfortable with your provider, that’s okay, too. Not all providers will be a good fit for everyone. Consider exploring other options — you might try to find providers that share your cultural background or have worked with people who have similar experiences.
Consider sharing your story. When you are ready there can be great power in helping others and yourself when you share your experience. This can be done in a confidential support group or on larger public platform as you see fit.
Know what to do in a crisis. Be familiar with your community’s crisis hotline or emergency walk-in center. Know how to contact them and keep the information handy. Wherever you are, you can call or text or chat 988, the national Suicide & Crisis Lifeline, 24 hours a day, 7 days a week for support during 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.

Helping A Family Member or Friend

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:

Respond calmly. To your loved one, hallucinations or delusions seem real, so it doesn’t help to say they aren’t. Calmly explain that you see things differently. Be respectful without tolerating dangerous or inappropriate behavior. If your loved one is reluctant to seek support, the techniques of motivational interviewing can sometimes encourage a person to seek support and help. Even though you aren’t a trained therapist, understanding these techniques help you feel more prepared.
Pay attention to events that can cause symptoms to occur or worsen. You can help your family member or friend understand, and try to avoid, the situations that lead to their symptoms or disrupt normal activities.
Help ensure medications are taken as prescribed. Many people question whether they still need medication when they’re feeling better or if there are unpleasant side effects. Encourage your loved one to take their medication regularly to prevent symptoms from coming back or getting worse. If it seems like side effects are really bothering them, you can suggest they speak to their health care provider to see if there are any other options.
Understanding lack of awareness (anosognosia). Your family member or loved one may be unable to see that they are experiencing psychosis or have schizophrenia. Rather than trying to convince them, you can show support by helping them feel safe, regularly see their health care providers and take any prescribed medications, and manage their symptoms by living a healthy lifestyle.
Help avoid drugs or alcohol. These substances are known to trigger psychosis and worsen symptoms. If your loved one develops a substance use disorder, getting help is essential.
Find emotional support from others. Share your thoughts, fears and questions with other people who have loved ones with similar conditions. Connect with others through online message boards, NAMI Family-to-Family education programs, NAMI Family Support Groups, or other NAMI information and support programs.

Find out more about taking care of your family member or friend and yourself.

Additional Resources

Catatonia is a neuropsychiatric condition involving abnormal movements, behaviors, and speech that can be associated with psychosis (and other mental health conditions). For information and resources on catatonia, visit the Catatonia Foundation.
For advice from professionals, advocates, and other NAMI experts related to schizophrenia and other mental health topics, view past recordings of NAMI’s Ask the Expert series. Presentations that may be particularly useful include:
For stories from real people about their experiences with mental health, including schizophrenia, check out NAMI’s book series: You Are Not Alone: The NAMI Guide to Navigating Mental Health and You Are Not Alone for Parents and Caregivers: The NAMI Guide to Navigating Your Child’s Mental Health.
Learn how to have more effective, empathetic conversations about schizophrenia with NAMI’s Schizophrenia and Psychosis Lexicon Guide. This resource merges professional insights with lived experiences to recommend language that conveys respect, understanding, and support — helpful for clinicians, family members, the media, and the general public. Learn more and download the guide here.
- And for quick reference, download the new, single-page Your Language Matters – Schizophrenia and Psychosis resource.

Reviewed and updated December 2025.