1. Understanding psychosis

Phases of psychosis

Psychosis has three phases. However, not all people who experience an episode of psychosis will experience clear symptoms of all three phases—each person’s experience is different. The length of each phase varies from person to person.

The prodomol phase or phase 1

The prodomol phase or phase 1 is an early phase that occurs before the symptoms of psychosis develop. It can last several months, though the length varies. There are vague signs that “things are not quite right” and people may experience mild or infrequent symptoms. Because psychosis often begins during adolescence, it is often difficult for family members and professionals to differentiate between the normal struggles of youth and the early warning signs of psychosis. This first phase involves symptoms that may not be obvious, such as changes in feelings, thoughts, perceptions and behaviours.

Common prodromal symptoms

    reduced concentration and attention
    disorganized thoughts
    reduced motivation
    changes in energy level
    less interest in usual activities
    social withdrawal
    sleep disturbance
    suspiciousness
    irritability
    anxiety
    depressed mood
    no longer going to school or work, or deteriorating performance
    intense focus on particular ideas, which may seem odd or disturbing to others

These symptoms are very general, and not necessarily a sign of psychosis. Family members should observe these changes and note if they persist.

Acute phase or phase 2

Acute phase or phase 2 is an active stage in which the person experiences clear symptoms of psychosis, such as hallucinations, delusions or confused thinking. Some negative symptoms may also emerge. This phase is the easiest to recognize and diagnose, so it is when most people begin seeking help. There is often a decline in the person’s general functioning.

Recovery, residual phase or phase 3

Recovery, residual phase or phase 3 is the phase where symptoms become less intense, though some may not disappear completely. After recovery from a first episode of psychosis, some people never experience a relapse or second episode. Recovery is a gradual process that varies from person to person. While symptoms are treatable, recovery does not always mean “cure” or total disappearance of symptoms. Once the symptoms of psychosis have responded to treatment, support may still be needed with challenges associated with school, work or relationships. To reduce the risk of relapse, it is important that medication and other treatments are continued, as recommended by the health care team.