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First Episode Psychosis

Prof. David Roe, Clinical Psychologist, Department of Community Mental Health, Haifa University;  Dr. Gili Hoter Ishay, Occupational Therapist, Department of Community Mental Health, Haifa University ;  Dr. Aviv Segev, Specialist Psychiatrist, Director of the Center for Diagnosing and Treating Psychotic Disorders, Shalvata Mental Health Center
16 June 2025

First Episode Psychosis (FEP) is an event that provokes distress, and may be traumatic and difficult, during which the individual first experiences symptoms of psychosis. These symptoms manifest as changes in thinking, perception and behavior, seriously impairing the way the individual experiences and lives reality. In most cases, First Episode Psychosis occurs by the age of 25, frequently parallel to the transition between significant life functions, and may suddenly or gradually occur. 

  

Early warning signs of psychosis are not easy to identify. They may assume different forms based on the cause of the psychosis itself and may occasionally occur days or even weeks before other symptoms or not appear at all. What should be noted is changes, particularly changes in behavior, mood and social function. These changes may include: 

  • Mood swings.  
  • Anxiety. 
  • Suspicion and distrust of others. 
  • Increased interest in religion or mysticism. 
  • Hearing voices or seeing things that do not exist in reality.  

In addition, behavioral changes, such as social distancing and withdrawal, diminished function at work or in studies, as well as changes in sleeping and eating patterns may occur.  

The good news is that with proper treatment, the chances of recovery can significantly improve, and prevent recurrence of episodes. 

First Episode Psychosis (FEP) is an event that provokes distress, and may be traumatic and difficult, during which the individual first experiences symptoms of psychosis that manifests as changes in thinking, perception and behavior, seriously impairing the way the individual experiences and lives reality.  

According to the American Diagnostic and Statistical Manual of Mental Disorders, DSM-5, the First Episode Psychosis is associated with several mental health disabilities, known as the psychosis spectrum: from a brief psychotic episode to schizophreniform disorder, schizophrenia, schizoaffective disorder, delusional disorder or bipolar disorder. Having said that, it is important to note that a psychotic episode, or psychosis, is not considered a disease in and of itself but a symptom. Its presence does not necessarily indicate a chronic and ongoing disease. 

 

When First Episode Psychosis Occurs for the First Time 

First Episode Psychosis largely occurs in young adulthood (approximately half of cases occur by the age of 25), frequently parallel to the transition between significant life events, such as between high school and military service, or between work and studies. The dramatic transition is often experienced by the young person and their family as  “out of the blue," as a disturbance that disrupts the normal course of life, during the preparation for independence and adult life. This transition sometimes even leads to significant functional delay and disruption of personal, social, and professional development.  

Although psychotic disorders can significantly impact the quality of life of the young person and their family, as well as the person's ability to care for themselves and function, most conditions improve through medication, psychological, and social therapies. The earlier they are accessed, the higher the chances of recovery and return to functioning.  

Early signs of onset of a psychotic episode

It is not always easy to identify early warning signs of psychosis. They may assume different forms based on the cause of the psychosis itself and may occasionally occur days or even weeks before other symptoms or not appear at all.   

The nature of the onset of psychosis can be divided into two types:  

Sudden onset

the symptoms appear all at once, with no early signs.   

Prodromal onset

 The symptoms appear over a long and slow period of time and deteriorate.   

What should be noted is changes, particularly changes in behavior, mood and social function. These changes may include: 

  • Mood swings.  
  • Anxiety. 
  • Suspicion and distrust of others. 
  • Increased interest in religion or mysticism. 
  • Hearing voices or seeing things that do not exist in reality.

In addition, behavioral changes, such as social distancing and withdrawal, diminished function at work or in studies, as well as changes in sleeping and eating patterns may occur. It is also important to emphasize that these changes may indicate many different things, such as depression or post-traumatic stress disorder (PTSD), and not necessarily the development of a psychotic disorder, but the importance is the same - these changes constitute a red flag, and a professional evaluation is therefore recommended.  

Although dealing with First Episode Psychosis is challenging, it is important to remember that this is a medical condition that can be successfully treated. Early identification and receipt of adequate treatment significantly improves the chances of recovery and reduces the chances of recurring episodes. Today's advanced treatments combine medication with emotional, social, and occupational support. With the right holistic approach and support, it is possible to return to optimal functioning and live a full and fulfilling life.