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Healthy Outlook

Intervene Early to Prevent Psychosis

By Nancy Ebbert, MD

Wednesday, March 6, 2013

Megan was a lively 14-year-old from a loving family when she began having disturbing symptoms. She was up at night with irrational fears. Usually outgoing, she hardly spoke any more. Her parents became increasing worried about her progressively withdrawn and unusual behavior.

Fortunately for Megan and her family, initial warning signs of psychosis were detected early enough to begin treatment at the groundbreaking PIER Institute in Portland, Maine. Through early intervention PIER is able to prevent many severe cases of mental illness. The PIER program is one of the first programs of its kind and is catching on across the United States. Over the past 10 years, the Portland program has been able to reduce the number of cases that progress from early psychotic symptoms to psychotic episodes to less than 10%.

Psychotic disorders are mental illnesses with the symptoms of psychosis (delusions, hallucinations, disordered speech and behavior) occurring in episodes or continuously, often over the course of a lifetime. The most serious and disabling psychotic disorder is Schizophrenia, affecting 1% of the population worldwide. Usually people develop symptoms in their early to mid-teens, becoming dramatically worse around the late teens and early 20s. For young people with an emerging psychotic disorder their education, vocational path, independent functioning and establishment of adult identity are seriously derailed. And this occurs in a way that is often gradual and difficult for everyone involved to understand.

The success of the PIER program can be replicated by encouraging early intervention. Many people believe a problematic upbringing is the greatest risk factor for mental illness. This is not true. While genetic inheritance does play some role, emerging evidence suggests that ignoring the early warning signs of psychosis may be the single most important factor.

Most young people are symptomatic for an average of two years before becoming fully psychotic. At this stage, stigma supports denial "not me/my child/my family," yet it is the most critical time to seek help. We now believe that early specialized intervention during this "clinical high risk" period can reduce — and possibly prevent — many young people from ever becoming mentally ill.

When symptoms are extremely severe, it is often easy to recognize that someone is suffering from a mental illness. However, symptoms can be fairly subtle at first. Sights and sounds are brighter and louder. Filtering out extraneous noise becomes difficult and the person is easily overwhelmed by sensory input. Other people may seem malicious, ill-intentioned or threatening. The young person may withdraw to protect themselves, staying in bed or alone much of the time. The world may seem alien or unreal. Odd ideas, behaviors or preoccupations may emerge. Neglect of self-care may set in. There is often a decrease in functioning. Grades may fall without apparent explanation. Getting anything done becomes a chore. Motivation is lost. Young people drop out of school, sports, employment.

If you or a family member begins experiencing these symptoms, take notes and share them with your health care provider.

To learn more about psychosis, warning signs, early intervention, or to watch a video about Megan and her family, visit the website of Contra Costa County's PIER Model program, First Hope, at

Healthy Outlook is written by the professional staff of Contra Costa Health Services, the county health department. Send questions to series coordinator Dr. David Pepper at For more health information, go to
About the Author

Dr. Ebbert is the Lead Psychiatrist for First Hope.