Psychosis

Psychosis is a mental health condition where a person loses touch with reality. This means they might see, hear, or believe things that aren’t real. It’s more common in older teens and young adults, but it can happen in children too, though it’s rare. When psychosis begins in childhood, it often starts slowly. A child might become more withdrawn, have trouble paying attention, or seem anxious because they are experiencing things others can’t see or hear. These experiences can be very scary, especially if the hallucinations are threatening or accusatory. Caregivers might notice changes in their child’s behaviour, like irritability or trouble sleeping. It’s important to understand that these behaviours are not just rebelliousness but signs of distress. Early recognition and treatment can help manage symptoms and improve outcomes.

What are the symptoms of psychosis?

It’s common for young children to have active imaginations. They might have imaginary friends, talk to themselves, or believe in magical creatures. This is a normal part of development. As children grow, they learn to distinguish between fantasy and reality. Here’s what you might typically see: Children engage in pretend play and may have imaginary friends. Children start to understand the difference between real and pretend, but their imaginations are still active. Children’s thinking becomes more logical and realistic. Children’s thinking becomes more abstract and complex, but they generally understand reality.

Core symptoms of psychosis

  • Delusions: These are strong beliefs that aren’t true, like thinking someone is out to get them or that they have special powers. A child might feel that a powerful person is sending them messages or that someone they know has been replaced by a look-alike.
  • Hallucinations: This means seeing or hearing things that aren’t there. A child might hear voices that no one else can hear or see things that others don’t see.
  • Disorganised speech: This can include talking in a way that doesn’t make sense or jumping from one topic to another without a clear connection. A child might have mixed-up thoughts that others can’t understand.
  • Disorganised or catatonic behaviour: This includes acting in ways that seem odd or not moving at all. A child might talk to themselves in public or feel like they’re not in control of their body.

Early signs associated with psychosis

Early signs, referred to as prodromal signs, might indicate the beginning of psychosis in a child or adolescent. These can include:

  • Withdrawing from friends and family
  • Changes in sleeping or eating patterns
  • Less concern with appearance or hygiene
  • Difficulty organising thoughts or speech
  • Loss of interest in usual activities
  • Unusual ideas or behaviours
  • Unusual perceptions, like seeing shadows or hearing voices

These symptoms can be related to several disorders, such as schizophrenia, schizoaffective disorder, or brief psychotic disorder. Schizophrenia involves persistent symptoms like delusions and hallucinations, while schizoaffective disorder includes mood episodes along with psychotic symptoms. Brief psychotic disorder is a short-term condition with similar symptoms.

Psychotic symptoms in children and adolescents can also occur alongside other mental health disorders like depression or bipolar disorder, or due to medical conditions or substance use. It’s important to get a proper diagnosis to understand the cause and find the right treatment.

How is psychosis diagnosed?

Diagnosing psychosis involves a thorough evaluation by a health professional (Paediatrician) and an appropriately trained and experienced child and adolescent mental health professional (psychiatrist or psychologist)

The paediatrician will need to rule out any medical conditions or substance use. After that, the mental health professional will assess the child. This process might take several visits to understand how symptoms develop and change over time. A key part of the diagnosis is determining whether the child or adolescent can recognise that their experiences are not real. If they can, it suggests the symptoms are in the early stages. As symptoms become more severe, these beliefs become harder to challenge. The mental health professional will use interviews, questionnaires, and observations to make a diagnosis and decide on the best treatment plan.

Clinical subject facts

Worldwide frequency of the condition:
Clinical Subject is estimated to be present in between 0.3% and 0.7% of the world’s population, although it varies widely between different groups and different studies. However, the prevalence of psychotic symptoms among children and adolescents ranges from 7.5% to 17%. There is no recent, specific data for Greece.

Gender ratio:

Gender data for Clinical Subject shows that males are diagnosed more than females at a rate of 1.54:1.

Peak age of onset:

The peak age of onset for Clinical Subject is estimated to be 20.5 years of age.

Proportion of the condition that emerges before age 18:

About 8.2% of individuals with Clinical Subject will have been diagnosed by the time they are 18 years old.

Burden of the condition in South Africa:

There is no recent, specific data for South Africa on the prevalence of psychosis in the population.

What are the associated factors for psychosis?

Some common factors linked with psychosis are:

  • Childhood adversities: Experiences like maltreatment by adults, bullying by peers, and caregiver death can increase the risk of developing psychosis.
  • Medical and genetic factors: Some medical conditions, genetic syndromes, and disorders like epilepsy can contribute to psychosis.
  • Prenatal and early life factors: Complications during pregnancy, maternal illness, and stressful family environments can be risk factors for psychosis.
  • Environmental and sociodemographic factors: Living in urban areas, being an immigrant, and having a lower socioeconomic status are associated with a higher risk of psychosis.

What other disorders co-occur with psychosis?

Psychosis often occurs alongside other disorders. Many individuals with psychosis also have substance use disorders, with a high prevalence of tobacco use. Anxiety disorders, such as obsessive-compulsive disorder and panic disorder, are also common. Additionally, conditions like schizotypal or paranoid personality disorder may precede the onset of psychosis. Depression is another frequent co-occurring disorder, significantly affecting the quality of life and functioning of those with psychosis. Understanding these co-occurring conditions is important for effective treatment and management.

How is psychosis treated?

Treating psychosis involves a combination of approaches tailored to the individual’s needs. Early intervention is crucial to manage symptoms and improve outcomes.

Psychotherapy is an important part of treatment. Cognitive Behavioural Therapy for psychosis (CBTp) helps individuals change their thinking patterns and cope with symptoms. Family education and support are also key, as they help families understand the condition and support their loved one. Lifestyle adjustments, such as reducing stress and ensuring a supportive environment, can also be beneficial.

Medications play a role in managing psychosis. All psychiatric medication needs to be prescribed by a psychiatrist, a medical officer or a psychiatric nurse.

Antipsychotic medications help reduce symptoms like hallucinations and delusions. It’s important to use the lowest effective dose to minimise side effects. These medications can take several weeks to show full effects, so ongoing monitoring by a healthcare professional is essential.

Combining medication with therapy and support can provide the best outcomes for individuals with psychosis.

Please refer to the SAHPRA (South African Health Products Regulatory Authority) for up-to-date professional and patient information leaflets on psychiatric or other medication.

Where to find more information

For more details on psychosis and related concerns, visit our guides for caregivers, educators and adolescents.

To learn more about the technical work behind this guide, please see our reference below.

References

Clinical description, symptoms, and diagnostic information

Facts

  • American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders: Fifth edition text revision DSM-5-TR. American Psychiatric Association Publishing.
  • Cascio, M. T., Cella, M., Preti, A., Meneghelli, A., & Cocchi, A. (2012). Gender and duration of untreated psychosis: A systematic review and meta‐analysis. Early Intervention in Psychiatry, 6(2), 115–127. https://doi.org/10.1111/j.1751-7893.2012.00351.x
  • Castillejos, M. C., Martín-Pérez, C., & Moreno-Küstner, B. (2018). A systematic review and meta-analysis of the incidence of psychotic disorders: The distribution of rates and the influence of gender, urbanicity, immigration and socio-economic level. Psychological Medicine, 48(13), 2101–2115. https://doi.org/10.1017/S0033291718000235
  • Healy, C., Brannigan, R., Dooley, N., Coughlan, H., Clarke, M., Kelleher, I., & Cannon, M. (2019). Childhood and adolescent psychotic experiences and risk of mental disorder: A systematic review and meta-analysis. Psychological Medicine, 49(10), 1589–1599. https://doi.org/10.1017/S0033291719000485
  • Institute for Health Metrics and Evaluation (IHME). (2019). GBD compare data visualization. Seattle, WA: IHME, University of Washington. Available from http://vizhub.healthdata.org/gbd-compare. (Accessed 11/15/2022)
  • Jongsma, H. E., Turner, C., Kirkbride, J. B., & Jones, P. B. (2019). International incidence of psychotic disorders, 2002–17: A systematic review and meta-analysis. The Lancet Public Health, 4(5), e229–e244. https://doi.org/10.1016/S2468-2667(19)30056-8
  • Kelleher, I., Connor, D., Clarke, M. C., Devlin, N., Harley, M., & Cannon, M. (2012). Prevalence of psychotic symptoms in childhood and adolescence: A systematic review and meta-analysis of population-based studies. Psychological Medicine, 42(9), 1857–1863. https://doi.org/10.1017/S0033291711002960
  • Solmi, M., Radua, J., Olivola, M., Croce, E., Soardo, L., Salazar de Pablo, G., Il Shin, J., Kirkbride, J. B., Jones, P., Kim, J. H., Kim, J. Y., Carvalho, A. F., Seeman, M. V., Correll, C. U., & Fusar-Poli, P. (2022). Age at onset of mental disorders worldwide: Large-scale meta-analysis of 192 epidemiological studies. Molecular Psychiatry, 27(1), 281–295. https://doi.org/10.1038/s41380-021-01161-7

Associated factors

  • American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders: Fifth edition text revision DSM-5-TR. American Psychiatric Association Publishing.
  • Castillejos, M. C., Martín-Pérez, C., & Moreno-Küstner, B. (2018). A systematic review and meta-analysis of the incidence of psychotic disorders: The distribution of rates and the influence of gender, urbanicity, immigration and socio-economic level. Psychological Medicine, 48(13), 2101–2115. https://doi.org/10.1017/S0033291718000235
  • Davies, C., Segre, G., Estradé, A., Radua, J., De Micheli, A., Provenzani, U., Oliver, D., Salazar De Pablo, G., Ramella-Cravaro, V., Besozzi, M., Dazzan, P., Miele, M., Caputo, G., Spallarossa, C., Crossland, G., Ilyas, A., Spada, G., Politi, P., Murray, R. M., … Fusar-Poli, P. (2020). Prenatal and perinatal risk and protective factors for psychosis: A systematic review and meta-analysis. The Lancet Psychiatry, 7(5), 399–410. https://doi.org/10.1016/S2215-0366(20)30057-2
  • Giannitelli, M., Consoli, A., Raffin, M., Jardri, R., Levinson, D. F., Cohen, D., & Laurent-Levinson, C. (2018). An overview of medical risk factors for childhood psychosis: Implications for research and treatment. Schizophrenia Research, 192, 39–49. https://doi.org/10.1016/j.schres.2017.05.011
  • Jongsma, H. E., Turner, C., Kirkbride, J. B., & Jones, P. B. (2019). International incidence of psychotic disorders, 2002–17: A systematic review and meta-analysis. The Lancet Public Health, 4(5), e229–e244. https://doi.org/10.1016/S2468-2667(19)30056-8
  • Laurens, K. R., Luo, L., Matheson, S. L., Carr, V. J., Raudino, A., Harris, F., & Green, M. J. (2015). Common or distinct pathways to psychosis? A systematic review of evidence from prospective studies for developmental risk factors and antecedents of the schizophrenia spectrum disorders and affective psychoses. BMC Psychiatry, 15(1), 205. https://doi.org/10.1186/s12888-015-0562-2
  • Pastore, A., De Girolamo, G., Tafuri, S., Tomasicchio, A., & Margari, F. (2022). Traumatic experiences in childhood and adolescence: A meta-analysis of prospective studies assessing risk for psychosis. European Child & Adolescent Psychiatry, 31(2), 215–228. https://doi.org/10.1007/s00787-020-01574-9
  • Radua, J., Ramella‐Cravaro, V., Ioannidis, J. P. A., Reichenberg, A., Phiphopthatsanee, N., Amir, T., Yenn Thoo, H., Oliver, D., Davies, C., Morgan, C., McGuire, P., Murray, R. M., & Fusar‐Poli, P. (2018). What causes psychosis? An umbrella review of risk and protective factors. World Psychiatry, 17(1), 49–66. https://doi.org/10.1002/wps.20490
  • Varese, F., Smeets, F., Drukker, M., Lieverse, R., Lataster, T., Viechtbauer, W., Read, J., Van Os, J., & Bentall, R. P. (2012). Childhood adversities increase the risk of psychosis: A meta-analysis of patient-control, prospective- and cross-sectional cohort studies. Schizophrenia Bulletin, 38(4), 661–671. https://doi.org/10.1093/schbul/sbs050

Co-occurring disorders

  • American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders: Fifth edition text revision DSM-5-TR. American Psychiatric Association Publishing.
  • Etchecopar-Etchart, D., Korchia, T., Loundou, A., Llorca, P.-M., Auquier, P., Lançon, C., Boyer, L., & Fond, G. (2021). Comorbid major depressive disorder in schizophrenia: A systematic review and meta-analysis. Schizophrenia Bulletin, 47(2), 298–308. https://doi.org/10.1093/schbul/sbaa153
  • Hunt, G. E., Large, M. M., Cleary, M., Lai, H. M. X., & Saunders, J. B. (2018). Prevalence of comorbid substance use in schizophrenia spectrum disorders in community and clinical settings, 1990–2017: Systematic review and meta-analysis. Drug and Alcohol Dependence, 191, 234–258. https://doi.org/10.1016/j.drugalcdep.2018.07.011
  • Seow, L. S. E., Ong, C., Mahesh, M. V., Sagayadevan, V., Shafie, S., Chong, S. A., & Subramaniam, M. (2016). A systematic review on comorbid post-traumatic stress disorder in schizophrenia. Schizophrenia Research, 176(2–3), 441–451. https://doi.org/10.1016/j.schres.2016.05.004
  • Veras, A. B., Ribeiro, K. M., Peixoto, C., Horato, N., Kahn, J. P., & Nardi, A. E. (2025). Schizophrenia spectrum disorders with comorbid panic: A systematic review. Schizophrenia Research, 277, 33–41. https://doi.org/10.1016/j.schres.2025.02.005

Interventions

  • Anagnostopoulou, N., Kyriakopoulos, M., & Alba, A. (2019). Psychological interventions in psychosis in children and adolescents: A systematic review. European Child & Adolescent Psychiatry, 28(6), 735–746. https://doi.org/10.1007/s00787-018-1159-3
  • Carl, E., Witcraft, S. M., Kauffman, B. Y., et al. (2020). Psychological and pharmacological treatments for generalized anxiety disorder (GAD): A meta-analysis of randomized controlled trials. Cognitive Behaviour Therapy, 49(1), 1-21. https://doi.org/10.1080/16506073.2018.1560358
  • Catalan, A., Salazar De Pablo, G., Vaquerizo Serrano, J., Mosillo, P., Baldwin, H., Fernández‐Rivas, A., Moreno, C., Arango, C., Correll, C. U., Bonoldi, I., & Fusar‐Poli, P. (2021). Annual research review: Prevention of psychosis in adolescents – systematic review and meta‐analysis of advances in detection, prognosis and intervention. Journal of Child Psychology and Psychiatry, 62(5), 657–673. https://doi.org/10.1111/jcpp.13322
  • Garey, J. (2024). Watching for signs of psychosis in teens. Child Mind Institute. https://childmind.org/article/watching-for-signs-of-psychosis-in-teens/
  • Miller, C. (2023). Psychosis in teenagers. Child Mind Institute. https://childmind.org/give/newsletters/psychosis-in-teenagers/
  • Pagsberg, A. K., Tarp, S., Glintborg, D., Stenstrøm, A. D., Fink-Jensen, A., Correll, C. U., & Christensen, R. (2017). Acute antipsychotic treatment of children and adolescents with schizophrenia-spectrum disorders: A systematic review and network meta-analysis. Journal of the American Academy of Child & Adolescent Psychiatry, 56(3), 191–202. https://doi.org/10.1016/j.jaac.2016.12.013
  • Stafford, M. R., Mayo-Wilson, E., Loucas, C. E., James, A., Hollis, C., Birchwood, M., & Kendall, T. (2015). Efficacy and safety of pharmacological and psychological interventions for the treatment of psychosis and schizophrenia in children, adolescents and young adults: A systematic review and meta-analysis. PLOS ONE, 10(2), e0117166. https://doi.org/10.1371/journal.pone.0117166
On this page

Let’s hear from you

Connect with us to learn more about CAMHI’s programs and initiatives.
Contact us

Don't forget to share this guide