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Key points
- The onset of psychosis typically occurs in young adulthood, just as folks are taking steps toward life goals.
- Early psychosis can lead to a sense of hopelessness and a risk of suicide.
- Many who experience psychosis make a full recovery, and there is cause for hope.
Like a popped balloon, I remember how my aspirations fell during my freshman year of high school. Each year of middle school proved trickier than the next, with the onset of major mental health symptoms and the beginning of my treatment. The summer prior had brought me through three hospitalizations, leading me to ask, "Will my life now be an endless carousel of inpatient stays?" College seemed unrealistic. I thought to myself, "Why even go to school?" I wondered if I had lost respect from those around me as they seemed to act quite differently. I felt hopeless.
In time, however, I did recover. I have a combination of medications that handle my mental health symptoms effectively. Each day, I enjoy getting to do work that is meaningful to me: providing psychotherapy, encouraging others, writing, and speaking. I have a relationship with genuine love and get to lay in my hammock and watch the squirrels. I am thankful that I stayed alive.
Early Psychosis and the Risk of Suicide
Psychosis is an experience in which perceptions, beliefs, and thought organization become altered. Typically, a person's journey to psychosis begins around late adolescence with subtle changes. In this 'prodromal' or 'clinically high risk' phase, more subtle changes to attributes like concentration, mood, and social experiences are common. Sometimes, a person might also encounter illusions such as seeing a floor appear to move or unusual but not impossible ideas, like the thought that a teacher could be picking on them. For some, it ends here, and the individual does not transition into psychosis. Others go on to experience a first episode of psychosis marked by full-fledged versions of the experience.
After the first episode of psychosis, some never have another episode of psychosis. Still, many others go on to develop mental health conditions such as major depression with psychotic features, bipolar disorder, or schizophrenia.
Death by suicide is a real risk for individuals experiencing early psychosis. A meta-analysis found that among the 17 studies of individuals in early psychosis intervention surveyed, around 21% of those experiencing early psychosis attempted suicide (Sicotte et al., 2021). Past research indicated that roughly one in 10 individuals living with schizophrenia would die by suicide. Yet, more recent research suggests that the figure may be closer to one in 20 (Palmer et al., 2005).
The reality is that most individuals experiencing a psychotic disorder who die by suicide do so in the first two years of illness (Palmer et al., 2005).
The loss of hope and disengagement from life roles many experience after the shock of a first episode of psychosis may be contributing factors.
In tragic ways, this makes sense. Psychosis typically strikes in young adulthood, just as we are opening our wings in terms of career, relationship, and educational goals. With symptoms such as hallucinations, delusions, and disorganized thinking, as well as breaks one might take for treatment that may include hospitalization, most experience some interruption to their life plans. One study of 35 individuals who had experienced a first episode of psychosis found that 77% had experienced some disruption in their life, 80% reported traumatic experiences since the onset of illness, and 60% expressed less hope for future aspirations (Tarrier et al., 2007).
In short, a first episode of psychosis can be a shocking experience that can shake one's confidence both in the present and future.
Hope and Coordinated Specialty Care
Many people make a full recovery after an episode of psychosis. Recovery can look like a return to life with re-engagement in activities like school, work, and relationships. The experience of psychosis is also often episodic, such that a person might have a storm of it followed by some improvement.
Seeking support can improve the chances of recovery. Specialized programs known as coordinated specialty care provide this to individuals experiencing psychosis in several community mental health centers and other spaces throughout the United States and abroad.
Coordinated Specialty Care (CSC) combines family psychoeducation, individual therapy, specialized psychiatric services, community support, peer support, and educational/vocational rehabilitation in a team-based approach is especially effective.
A research study investigating the impact of a CSC program for individuals experiencing first-episode psychosis found that six months following the initiation of the program, 80% of participants were actively attending work or school (Nossel et al., 2018). This measure is meaningful as a return to these activities represents more than a pause of symptoms, active steps toward recovery of life roles. The number of hospitalizations among participants also fell sharply after six months of intervention.
One CSC program has piloted an integration of principles from Open Dialogue, a Finnish approach to early psychosis that emphasizes equality, inclusion of individuals' support system, and group conversations around the person at the 'center of concern' (Uehling et al., 2024). This broader community and family focus may add greater hope by targeting relationships that could be affected after the onset of illness.
Other means of sparking hope include the open sharing of success stories by individuals living well with mental health conditions. Employing peer support specialists who have walked their journeys toward recovery can also be encouraging to young people experiencing a first episode of psychosis.
In Closing
While the risk of suicide for individuals experiencing a first episode of psychosis remains high, and psychosis can create a detour from one's life goals, there is much reason for hope. Many recover and resume their lives after the onset of psychosis. The illness can be frightening, but sharing hope while validating the real pain often ignited by this experience is vital as we support individuals early in the course of psychosis.
If you or someone you love is contemplating suicide, seek help immediately. For help 24/7 dial 988 for the National Suicide Prevention Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. To find a therapist near you, visit the Psychology Today Therapy Directory.
References
Palmer, B. A., Pankratz, V. S., & Bostwick, J. M. (2005). The lifetime risk of suicide in schizophrenia: a reexamination. Archives of general psychiatry, 62(3), 247-253.
Nossel, I., Wall, M. M., Scodes, J., Marino, L. A., Zilkha, S., Bello, I., & Dixon, L. (2018). Results of a coordinated specialty care program for early psychosis and predictors of outcomes. Psychiatric Services, 69(8), 863-870.
Sicotte, R., Iyer, S. N., Kiepura, B., & Abdel-Baki, A. (2021). A systematic review of longitudinal studies of suicidal thoughts and behaviors in first-episode psychosis: course and associated factors. Social psychiatry and psychiatric epidemiology, 56(12), 2117-2154.
Tarrier, N., Khan, S., Cater, J., & Picken, A. (2007). The subjective consequences of suffering a first episode psychosis: trauma and suicide behaviour. Social psychiatry and psychiatric epidemiology, 42, 29-35.
Uehling, M., Van Tiem, J., Broussard, B., Cubellis, L., Othman, A., Ackleh, Y., ... & Cotes, R. O. (2024). Integrating Open Dialogue with coordinated specialty care in a Southeastern US public hospital: A qualitative study of clinicians’ perspectives. SSM-Mental Health, 5, 100311.
