What does it mean to be at risk?

Certain changes in thoughts and feelings have been identified as indications of an at-risk mental state that may be experienced before the onset of a psychiatric illness. For some, the symptoms of the at-risk mental state may indicate the early stages of a psychotic disorder that will develop over time. For others, the symptoms seem to fade with time or remain mild, and no psychiatric illness develops. Only about 30% of people who experience at-risk mental state go on to develop a psychotic disorder.

Signs of psychosis risk​

  • Becoming more socially isolated
  • Difficulty in functioning in school, work or home
  • Worsening personal hygiene and grooming
  • Requiring prodding to complete basic activities
  • Loss of usual interest in activities
  • Reduction in emotional expression
  • Loss of motivation and energy
  • Increased difficulty with conversation
  • Odd appearance

Signs are indicators of risk that are noticed by others. Young people at risk might begin to appear withdrawn and to lack interest in social contact. They often lose interest in activities that were formerly a source of pleasure. They may require prodding to engage in daily activities such as showering and changing clothes. They may also begin to appear less emotional or to be confused by their emotions. Sometimes a relative, friend, or teacher will notice that their appearance is odd, that they have become focused on unusual ideas, or that they have developed a sense of self-importance. These changes often accompany a decline in school or work performance.

Symptoms of psychosis risk

  • Difficulty organizing thoughts or speech
  • Difficulty following conversation
  • Lack of pleasure in formerly enjoyed activities
  • Increasing desire to be alone
  • Heightened sensitivity to light and sound
  • Hearing things such as voices others do not hear
  • Seeing, smelling, or tasting things others don’t
  • Suspicion of others
  • Feeling a loss of control over thoughts
  • Preoccupation with the supernatural
  • Confusion about what is real and imaginary
  • Unrealistically inflated sense of self-importance

Young people who are at risk can experience a variety of symptoms. It is common for people at risk to have some difficulty staying focused and getting their point across in conversation. They might find themselves feeling as if they are often the center of attention, or they may even worry that other people are out to harm them. They might start to feel confused about what is real, imaginary, or dreamed. Some participants report that they have less control over their thoughts. Others say that their eyes and ears are playing tricks on them, and that they sometimes hear, see, or smell things that others do not. People who are at risk might have only one or two of these symptoms, but it is also possible to have several of them at once. 

What if I am at risk?

Experiencing these signs and symptoms does not mean that a psychotic disorder is certain to develop. Only about 30% of people who are identified as being at risk for psychosis go on to develop a psychotic disorder. In other words, about 70% of participants identified as being at risk either do not progress to full psychosis or experience an improvement in symptoms. It is very important to get help as early as possible so that the symptoms can be evaluated and addressed before they intensify. 

If such experiences do intensify, the COPE clinic supports every person it treats and will offer state-of-the art treatment as the clinical situation requires. Importantly, even if a person has more intense symptoms and progresses to what would be considered full psychosis, recovery is most easily accomplished at the earliest stage of developing problems. We are proud of the clinical outcomes of many individuals who have been a part of our clinic who have, despite developing full psychosis for a time, been able to recover with a combination of counseling and medication treatment and resume many of their previous activities at work or school, and with friends and family. 

What is psychosis?

Psychosis affects about 3% of the population at some point in their lives. While its causes are not yet fully understood, studies suggest that psychosis usually results from a combination of genetic (inherited) risk and environmental exposures such as head injury, stress and drug use. Psychosis is known to result from a chemical imbalance in the brain, and the new medications that have been developed to address this imbalance are often very effective. 

“Psychotic” is a word that has a precise meaning in psychiatry but carries many inaccurate connotations in popular culture. It does not mean “homicidal” or “mad,” and it does not describe the entirety of a person’s character or experience. While television and movies often portray psychotic people as dangerous, the vast majority of people suffering from psychosis are in fact withdrawn and socially isolated. People who suffer from psychosis can be successfully treated and live fulfilling lives. 

The term “psychosis” refers to delusions, hallucinations, and thought disorder that occur in schizophrenia and mood disorders. These all take many forms. For example, delusions, or erroneous beliefs, may involve the idea that one is being controlled from the outside, that one is being persecuted, or that one has been given magical powers. Hallucinations are usually auditory and often involve hearing voices, though they can sometimes affect vision, taste, and smell as well. It is common in psychosis to hear one or more voices speaking or to hear one’s thoughts spoken aloud. Thought disorder refers to the disorganized thinking that makes it hard for someone to formulate basic thoughts and communicate them in a way that is easily understood. Difficulty thinking clearly is usually detected when someone is consistently difficult to follow in conversation. 

People who are at risk for psychosis may experience these types of thoughts and perceptions for a very short time, or else they may experience them in a limited way, retaining the ability to see that the delusions and hallucinations are unlikely. In contrast, people are considered to have developed a psychotic disorder when they lose perspective on their symptoms and can no longer dismiss delusions or recognize hallucinations as unreal. 

What does COPE offer?

Brief clinical therapy, evaluations, and medical consultations are provided free of charge for participants in research.