The 3 Phases of Psychosis & Warning Signs of Each

It's easier to get someone help when they're in that prodal phase than when someone's in a full-blown psychotic episode. Once someone reaches a full-blown psychotic episode, it's hard to talk them to getting into an appointment to see a psychiatrist to see their primary care doctor to get into the ER. So, it's important for supporters to know what a prodal phase looks like. — What are the phases of psychosis? So [snorts] what happens is we have a lot of different reasons for psychosis as we discussed right the medical the biological the psychiatric but we do see a trend in the way that psychosis manifests we do see a trend — and it's not 100%. But most of the time we can go back and identify three distinct phases of a psychotic presentation. The first phase is what we call a prodal phase. And prodal basically means like it didn't really manifest yet, but it's coming. And there are certain behaviors that people notice, usually outsiders, families, loved ones, supporters notice before the psychotic episode breaks and happens. That prodal phase is more of a social isolation. It's a change in their daily routines and behavior where they just become a little less interested in what's going on out here and more up there. They become more internally preoccupied. Internally preoccupied is just a way of saying right and less engaged with everyone else. So it's a social withdrawal. So all of a sudden they're not really spending time with anybody. They're in their room or they're on the couch and you can't really engage them in a conversation. They seem sort of internally preoccupied. They're not caring about how they look, the external stuff. — Mhm. — You start stop kind of caring about everything out here. Because this makes sense though if you think about it. If [snorts] all of a sudden, not but gradually your mind starts making things different. Maybe some voices, maybe some thoughts, paranoia, maybe there's a delusional content building. You're starting to be removed from reality. That reality becomes less prominent to you, but the internal reality becomes more prominent. — Yes. — Doesn't that make sense? Absolutely. — So, what we see as objective observers, as outsiders, is wow, you know, why haven't they showered in 3 days? — Mhm. — They're not really talking to anybody, you know? I mean, what's up? You like what's going on? They don't care about the way they look. Do you see that, B? What's going on? Right? — But they're not yet manifesting that delusional thought content or seeing things and now you see that as an outside observer. — So, that's the prodal phase. Now, can someone who has taken a substance go through a prodal phase? — Such a super question. You're so on. — All right. — You're so on. Now, usually you see these three distinct phases or the prodal phase. You usually see that in the psychiatric — and even the biological manifestations, but not so much the substances. is I mean substances are you know you take psilocybin you're flying high in 20 minutes or 30 minutes right you're woo you're out there so not really because it's a substance it's acting quick and it's going it's usually you know someone has lupus or MS or um you know a brain disorder of some sort and they just start withdrawing right because that it's that process that just starts to build that internal process of starting to remove themselves from reality it's more of a gradual onset — right now I'm not saying that people can't jump right into a psychotic episode like full-blown. That does happen. Of course, it happens. — But you do see this progression. So, that's the prodal phase. And that's important. And you know why it's important? Because you can catch it. — Mhm. — And you can say something's not right here. And I'll tell you why. If somebody it's easier to get someone help when they're in that prodal phase than when someone's in a full-blown psychotic episode. Once someone reaches a full-blown psychotic episode, we're going to talk about that next. It's hard to talk them to getting into an appointment to see a psychiatrist, to see their primary care doctor, to get into the ER, — to even get them to understand what that even means, — right? I mean, they're just so removed that now it's just like an emergency. It's like an e situation and you know, god forbid something bad happens, they can hurt themselves or someone else inadvertently or something, right? — So, it's important for supporters to know what a prodal phase looks like. — Yes. — Now, when people have schizophrenia or bipolar disorder or major depressive

disorder, you can actually become attuned to this and that's important again for the same reasons, right? Like, you know, I have a psychotic disorder. I know I have schizophrenia. bipolar mania. You could talk to your loved ones and say, "Look, if you see me starting to get this way, let me know. I mean, I got to adjust my meds. I got to call my doc. We have to do something. " So, it's important to identify these things, right? So, that's the prodal phase. Then, you have the acute episode. Now, an acute episode, you can't miss. I mean, you're not missing an acute psychotic episode. I see it probably every day at my job um with somebody. I see a high volume of patients throughout the hospital and I work emergency psychiatry and a lot of those patients have acute psychotic episodes. I mean, you can't miss it. I think it's pretty in-your-face. You have someone that is not making any sense, that is nonlinear in their presentation. Their speech is erratic and loose. They are actively responding to things that are not there. — I fundamentally understand this, but what does that look like? — All right. I um Okay, ready? So, uh, Kyle, seriously, uh, the the producer and the director before I came here, they planted that seed. They gave me a drink and they planted the seed and now it's going through my body and it's growing like a plant and it's in my brain and now I know. I know what you know and I know you've been in on this the whole time, too. I know it. I know that since I was a kid. So, I know you know. I don't even have to tell you this stuff, right? But just seriously, like I'm not sure what I want to do right now, but I um but I You're listening to my thoughts anyway, so it doesn't matter. Okay. But seriously, I think I just got to go. Um Right. Okay. So that's like a paranoid delusion. — Mhm. — And I believe it. — Mhm. — If [snorts] you like psychology and learning about mental health and want to learn more while meeting other people who are interested, explore your membership options using the link below this video or visit medcircle. com. Hallucinations are I can't act them out, but in my head as we're sitting here, there are voices and they're going um they're either commentating on what I'm doing. You're sitting in the chair right now. You're wearing white pants and your uh your shoes are brown and uh you know, this is what's going on and you're working for Med Circle right now and you know what? You look terrible. You're such a terrible person. You're I can't believe you said that. I can't believe you're doing it's a voice. A real voice, not thoughts. That's important because we all have thoughts. We all kind of talk to ourselves a little bit in our heads, right? So don't think you're psychotic. — This is no different than you hearing my voice right now, — right? — That's how prominent it is. — Okay. So that's an auditory hallucination, right? So that's what psychosis can look like. I mean, there's so many different ways. I could have played that a lot of different ways, but that's like one sort of — Yeah. — presentation of what psychosis looks like acutely. — Yeah. And it's clear to the person ex on the receiving end of that this person is not grounded to reality. — Right. — Yeah. — Right. Absolutely. So that's the active phase of psychosis where they call them the positive symptoms, right? The delusions and hallucinations and all that just kind of just in your face. — Then you have the recovery phase, right? And that is usually once you give them some medicine and you know this is where I am a firm you know this about me believer in psychotherapy and talk therapy. When someone is having an acute psychotic episode it's really hard to talk them out of it. So you have to resort to medicines in a lot of cases and those medicines are antiscychotics — and what they do is they reduce dopamine in the brain and they reduce those positive symptoms the delusions hallucinations you know — and again positive does not mean good in this case — classification positive being delusions hallucinations active things — negative meaning withdrawn — that's how I want people to understand those two terms yes — but usually we use medicine and then that can bring that acute episode whether it lasted days, weeks, months, hours. — Mhm. — Brings it down. — Okay. So, those are the three phases. — Got it. Now, during these phases, if they're in the prodal dramal phase, — uh supporters can — uh very be as proactive as they can ever be. This is your chance to act. Get them in to see a doctor. If they already have a doctor, do a med check. Uh that's your time to strike. If they're in an acute phase, it's an emergency situation. You yourself are not going to talk them out of it. It's time to get them to the ER so that they can be treated by professionals immediately. Now, during the recovery phase, what should supporters be doing or not doing? — I think during the recovery phase, you know, going through a psychotic episode is exhausting emotionally, physically

— for everyone. I mean, I was just speaking on the patient's behalf, but probably for everyone. You're right. For — [sighs] — But in order to sort of create an empathetic/sympathetic sort of environment for the patient, I mean, a psychotic episode is just stressful and scary sometimes and exhausting. And after they go through that, you know, you kind of want to just go easy. Make sure that you're supportive. There's no judgment. There's no criticism. Make sure that if they're given a medicine, make sure they're following up with that medicine to kind of keep things at bay for a little while. You can always talk about meds later and readjustment and stopping or restart, whatever, but make sure they're taking their medicines. care of themselves. — Make sure they're getting adequate rest and good nutrition. I mean, all the basics, the basic foundations of being healthy. Try and support them through that. Awesome.