Phases of Psychosis

Three Phases of a Psychotic Episode

The typical course of a psychotic episode can be thought of as having three phases: Prodrome Phase, Acute Phase, and Recovery Phase.

Phases of Psychosis

The first phase is called the Prodrome Phase.

Although a psychotic episode is viewed as occurring in three phases, not all people will experience clear symptoms of all three phases. Each person’s experience will differ.

Psychotic episodes rarely occur out of the blue. Almost always, a psychotic episode is preceded by gradual non-specific changes in the person’s thoughts, perceptions, behaviours, and functioning. The first phase is referred to as the prodrome (or prodromal) phase. During this period the person starts to experience changes in themselves, but have not yet started experiencing clear-cut psychotic symptoms.

Types of changes in feelings, thoughts, perceptions and behaviours include:

  • difficulty screening out distracting information and sensations.
  • difficulty focusing or understanding what they are hearing
  • changes in perceptual experiences – visual experiences may become brighter or sounds louder
  • feeling overloaded
  • finding t harder to keep track of what they are thinking and what others are saying.
  • feeling disconnected
  • desire or need to be alone
  • sleep disturbances
  • depressed mood
  • irritability
  • suspiciousness 
  • unexplained difficulty at/skipping school or work

The changes that have been observed in the prodromal phase are very general and could be signs of many different things, including ordinary adolescent behaviour. It is not possible to predict from these symptoms if a person is going on to develop psychosis. The “Warning Signs of Psychosis” section provides information on changes that are more characteristic of psychosis and suggest even greater concern and need for professional assessment.

Prodrome symptoms vary from person to person and some people may not experience any of the changes. This phase can last from several months to a year or more.

Just because somebody is experiencing all of these changes does not necessarily mean that they are likely to be in the prodrome phase of psychotic episode. The prodrome cannot be “diagnosed” until after psychosis has developed. Up until that point, even professionals can only have a hunch that the changes may be the start of psychosis. Although the symptoms described above are typical of the prodrome phase of psychosis, they may also be due to other causes. If you are concerned about similar types of changes in yourself or someone else, it’s important to seek help.

The second phase is the Acute Phase.

This is the stage when characteristic psychotic symptoms – such as hallucinations, delusions and very odd or disorganized speech or behaviours – emerge and are most noticeable. The experiences are often very distressing for the person. It is during this phase when appropriate treatment for psychosis needs to be started as soon as possible.

The third phase is Recovery.

Within a few weeks or months of starting treatment, most people begin to recover. Many of the symptoms get less intense or disappear, and people are generally better able to cope with daily life. Some of the symptoms that emerged in the Acute Phase may linger in the Recovery Phase, but with appropriate treatments, the vast majority of people successfully recover from their first episode of psychosis.