7 Warning Signs of a Psychotic Episode

Psychosis is a disrupted mental state that causes a loss of contact with reality. For someone who’s in the midst of a psychotic episode, it’s hard to tell the difference between what’s real and what’s only in their minds.

Psychosis usually begins during adolescence or early adulthood. Every year in the United States, roughly 100,000 teens and young adults experience first-episode psychosis (FEP). All told, about three in 100 people go through a psychotic episode at some point in their lives.

Here at EXIS Recovery in West Los Angeles, we know that early treatment makes a world of difference to someone who’s having a psychotic episode. Let’s explore the phases of psychosis, including common warning signs of an acute psychotic episode.

Phases of psychosis

Psychosis isn’t a condition unto itself. It’s a symptom of an underlying health problem. While it’s most commonly a feature of a mental illness like schizophrenia, bipolar disorder, or major depression, psychosis can also be triggered by trauma, substance abuse, brain disease or injury, and even extreme sleep deprivation. 

Although psychosis is a highly individual experience, a typical psychotic episode progresses through three distinct stages: the prodromal phase, the acute phase, and recovery.

We discussed the prodromal phase at length in a recent blog post about how to recognize the early signs of a psychotic disorder. This initial stage of psychosis, which is marked by gradual changes in a person’s thoughts, feelings, or behaviors, can last for several months to a year or longer.

During the prodromal phase, a person may find it difficult to focus, understand what others are saying, or keep track of their own thoughts. As a result, they may feel irritable, disconnected, overloaded, or suspicious.

Signs of acute psychosis

Eventually, the prodromal phase of psychosis gives way to the acute phase, or what you might recognize as a psychotic episode. It’s during this phase that the characteristic signs of psychosis, including hallucinations and delusions, emerge and become obvious. 

Common warning signs of a psychotic episode include: 


A hallucination is sensing something that isn’t real. A person may see objects or people that aren’t there, hear voices or sounds that don’t exist, feel imagined touch sensations, smell odors that no one else can smell, or experience taste when there’s nothing in their mouth.


A delusion is an unshakeable belief that’s unlikely to be true and seems irrational to others. A person who suffers from delusions may believe that external forces control their thoughts and behaviors or that a person or institution is out to get them. Delusions of grandeur can make a person feel all-powerful or even god-like.

Confused speech

Acute psychosis can cause disturbed thought patterns that make it hard to stay focused. This can take the form of rapid-fire or continuous speech, disrupted speech that switches from one topic to the next mid-sentence, or frequent speech pauses from a lost train of thought. 

Mood changes

A psychotic episode can also give rise to dramatic mood swings, particularly for those whose symptoms are a result of a mental health condition like schizophrenia or bipolar disorder. In such cases, a person may experience a high, elated mood (mania) followed in relatively quick succession by a low, withdrawn mood (depression). 

Improper behavior 

Socially inappropriate behavior is another hallmark sign of acute psychosis. This may take the form of childish or regressive behavior, inappropriate affection, or excessive dependency. This aspect of psychosis can be especially distressing for caregivers, family, and friends.

Severe anxiety 

Losing touch with reality during a psychotic episode can be scary and confusing, and many people become extremely anxious as a result. Persistent feelings of anxiety can lead to disrupted sleep patterns, a lack of motivation, diminished self-care, and difficulty functioning overall. 

Social withdrawal 

Living in an alternate reality can be incredibly isolating, particularly when it becomes clear that others aren’t having the same experience. This deep sense of isolation causes many people to turn inward and withdraw from family and friends.

Treatment and recovery

That a person will transition into the final phase of psychosis, recovery, isn’t a foregone conclusion — it’s entirely dependent on timely intervention and care. People who suffer from psychosis are more likely to recover fully if they receive early treatment, preferably soon after psychotic symptoms are observed.

Understanding the kinds of gradual changes that occur before a psychotic episode, as well as being able to recognize the most common signs of acute psychosis, can give you a head start in helping a friend or loved one get the care they need when they need it. 

As mental health experts who specialize in psychotic disorders, the team at EXIS combines evidence-based practices and treatments with a coordinated care approach to help patients successfully transition from acute psychosis to complete recovery. 

Call 424-244-3513 to reach our West Los Angeles office today, or use the easy online booking tool to schedule an appointment with one of our trusted mental health experts any time.

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