The risk to develop a psychotic disorder is not the same in all people, nor does it remain stable across different life stages (what are the causes of psychosis?). Some people are more susceptible than others to psychosis, or become more vulnerable in the course of their life. 

This vulnerability is in itself no illness and can even be associated with a high degree of sensitivity or originality in thinking. However, if it is combined with stress (e.g., in the form of conflicts or emotional crises), then it may lead to increased risk for manifesting psychotic symptoms. Increased psychosis risk can be detected through specific warning signs. Ideally, the person can recognize such symptoms and seek help at this early stage, so that a psychotic episode can be avoided by mobilizing resources and improving coping strategies.  

Psychotic disorders can affect performance capacity and quality of life, especially if treatment is delayed. Scientific studies have shown that timely treatment can improve the clinical course of these disorders and help avoid negative consequences such as social isolation or unemployment.

Therefore, it is particularly important to detect risk signs of psychosis in adolescents and young adults early on. At these early stages, targeted interventions can help relieve symptoms, improve illness course or even prevent a psychotic outbreak altogether, and in this way minimize the impact of the illness on the professional and personal life of the individual.

The following symptoms may suggest an increased risk to develop a psychotic disorder:

  • Feelings of alienation: The self, other people or the surroundings are experienced as strange, or significant others perceive the person as changed
  • Changes in thinking and speech:The individual has difficulty putting his/her own thoughts into order, or other people cannot follow his/her associations when talking to them
  • Changes in perception: Shapes or sounds are perceived as being distorted, or there are hallucinations (e.g. simple sounds or shapes, voices, figures)
  • Suspiciousness / Unusual ideas: The individual may have the impression of being watched or persecuted, attach special significance to random events, or express ideas and interests that are untypical of him/her or are difficult for others to comprehend 
  • Functional impairment / social withdrawal: Difficulty in meeting obligations relating to school or work, neglecting the household or personal hygiene, or withdrawal from friends and acquaintances for no apparent reason other than loss of interest
  • Cognitive difficulties: Changes in the usual performance levels such as difficulty in concentrating, understanding written or spoken language, or understanding abstract concepts or metaphors

No, not necessarily. As you can probably infer from the above descriptions, many of these risk signs are unspecific. They may signal a beginning psychotic disorder, but this may very well not be the case. In fact, only a minority (about a third) of people exhibiting such early warning signs go on to develop a psychosis in the next years. However, this is still an increased risk compared to the general population, in which the risk of psychosis is around 1%. Psychiatric/psychological assessment is therefore recommended, also for the following reasons:

  • Regular follow-up assessments may help detect subtle signs of an unfavourable illness course and take countermeasures quickly
  • People who show signs of increased psychosis risk often experience significant distress, may suffer from non-psychotic mental conditions such as depression or anxiety, or have difficulties in fulfilling their social and occupational roles. Early specialized intervention can help mobilise their resources and contain beginning crises

The aims of early intervention are

  • decrease in distress, depression or anxiety
  • treatment of substance abuse
  • improvement of coping strategies and support in dealing with crisis situations 
  • prevention or improvement of functional impairments at school, at work or in personal relationships 

In most cases, psychological and/or psychosocial interventions suffice to improve symptoms and quality of life. Treatment with medication is not always necessary, although sometimes antidepressants or mild sedatives may be helpful in relieving depression or anxiety. Antipsychotics are generally not recommended at these early stages and are reserved for temporary use, when quick management of progressing symptoms is required for the person to be able to benefit from psychological therapies.