The 5 stages of psychosis can be difficult to understand, especially when you or someone you care about is going through it. 

Knowing what happens during each stage can make the experience less frightening and more manageable. With the right information and professional support, recovery is possible. 

Understanding Psychosis and Its Impact

Psychosis happens when a person loses touch with reality. It affects how they think, feel, and understand the world around them. Someone going through psychosis might see or hear things that aren’t there, believe things that aren’t true, or have trouble thinking clearly.

Doctors describe psychosis as a group of symptoms that can appear in many different conditions. It’s common in disorders like schizophrenia, but it can also happen with mood disorders such as depression or bipolar disorder, or as a result of substance use or certain medical and neurological illnesses.

Researchers estimate that between 15 and 100 people out of every 100,000 experience psychosis each year. While it often starts in late adolescence or early adulthood, it can happen at any age. Older adults with neurological conditions, such as Parkinson’s or Alzheimer’s disease, are also more likely to develop psychotic symptoms.

Psychosis usually develops through a series of changes that unfold over time. Mental health professionals often describe this process in five stages, each with its own signs and challenges that help guide treatment and recovery.

Stage One: Early Warning Signs (Prodromal Phase)

In this first stage, changes are small and subtle. Many people go through this phase, though not everyone progresses to a full psychotic episode.

What Happens During the Prodromal Phase

• Gradual changes in mood or thoughts – People may feel more anxious, depressed, or uneasy than before. Sleep may become disturbed. Thoughts may feel vague or scattered. Attention and concentration may suffer.¹
  
• Behavior and daily life begin to shift – Someone might pull away from friends or family. Their school or work performance could drop. They might lose interest in once-enjoyed activities or feel fatigued.
  
• Milder experiences of “psychotic-like” symptoms – Before full delusions or hallucinations appear, people may notice subtle changes, like sounds seeming louder or shadows looking odd. These mild experiences, called attenuated positive symptoms, are often recognized as unusual or confusing.¹

How Common Is This Phase?

• Most people who later develop a psychotic disorder report having had a prodromal period first, around 78% do.²
  
• The highest risk of developing psychosis was within the first two years after entering treatment or being identified as at risk. However, some people still developed psychosis up to 10 years later, meaning the risk doesn’t disappear quickly.³

Stage Two: Acute Episode (Active Psychosis)

In this stage, symptoms become much stronger and more obvious. People move from subtle warning signs into full-blown psychosis. The shift is sudden and carries great urgency for treatment and safety.

What Happens During an Acute Episode

During active psychosis, a person may experience:

• Hallucinations – sensing things that aren’t there (e.g., hearing voices, seeing shadows).
• Delusions – firm beliefs that conflict with reality (for example, believing someone is following them, or that they have special powers). 
• Disorganized thinking or speech – jumping between topics, speaking in unclear or jumbled sentences.
• Disorganized or abnormal behavior – agitation, odd movements, or performance problems in daily tasks.
• Cognitive changes – difficulty focusing, memory problems, slower thinking.
• Emotional and internal turmoil – people often feel anxious, frightened, or emotionally unsettled.

Because these experiences are sudden and intense, the person may not realize they are ill (lack of insight). They may resist help or refuse treatment.

What Triggers or Causes an Acute Episode

Acute psychosis doesn’t always have one clear cause. It can arise under different conditions:

• Primary psychiatric disorders – e.g., schizophrenia, bipolar disorder, major depression with psychotic features.
  
• Medical or neurological conditions – such as infections, autoimmune diseases, or brain disorders.
  
• Drug-related causes – intoxication with or withdrawal from substances (e.g. stimulants, hallucinogens) can provoke psychosis.
  
• Stress or trauma – major life changes or psychological stress often play a role in triggering acute psychosis in vulnerable people.

Stage Three: Crisis and Stabilization

In this stage, people need immediate help and support to get safe and stable. The goal is to reduce distress and stop harm, then stabilize symptoms so recovery can begin.

What Happens During the Crisis Phase

• Severe symptoms flare up – Hallucinations, delusions, confusion, agitation, and disorganized behavior become strong. The person may act in a way that is unsafe to themselves or others.
  
• Loss of insight or self-control – The person may not realize they are ill or needing help. They may resist help or deny they need treatment.
  
• Risk of harm or danger – Because thinking is disturbed, there is a risk of self-injury, neglect, or conflict with others. Family and caregivers often feel helpless, frightened, and overwhelmed.

What Stabilization Is About

• Safety first – The immediate priority is ensuring a safe environment. This may involve hospitalization or crisis units.
  
• Crisis intervention models – Specialized crisis teams respond quickly to psychiatric emergencies, offering support through mobile units or stabilization centers. Research shows these services can lower hospital readmissions and reduce stress on families.⁴
  
• Crisis Stabilization Centers – These are short-stay, often community-based places where people in crisis can stay for a short period (1–10 days). They provide short-term care and assessment, guide next steps, and reduce costs and hospital strain.⁵
• Inpatient care and therapies – For those whose crisis is severe, inpatient psychiatric units may be needed. During this time, therapeutic interventions like brief cognitive behavioral therapy or mindfulness practices may start to help reduce the chance of relapse.
• Multidisciplinary teams – A team approach involving psychiatrists, psychologists, nurses, social workers, and case managers is more effective. They monitor symptoms, manage medications, assess risk, connect to supports, and plan for what comes next.

Stage Four: Recovery and Rehabilitation

Recovery is personal and nonlinear. Around 20% of people with psychosis may develop long-term or treatment-resistant symptoms, or additional challenges like substance use or medical issues. In such cases, rehabilitation needs to be more intensive and coordinated.⁶

What Recovery and Rehabilitation Look Like

• Functional recovery – This means regaining the ability to work, go to school, maintain relationships, and care for one’s self. Recovery aims to improve daily tasks and social life.
  
• Cognitive recovery – Thinking, memory, attention, and decision-making often suffer during psychosis. Rehabilitation includes training and exercises to improve these abilities.
  
• Social recovery – Reconnecting with family, friends, and community is key. Support groups, peer work, and community programs help the person feel less isolated.
  
• Personal or subjective recovery – This involves changing how one sees oneself after psychosis, to rebuild identity, hope, purpose, and confidence. Many people describe it as finding meaning after the illness. 

Stage Five: Residual Phase

The intense symptoms of psychosis have lessened or disappeared. The person is no longer in crisis and has usually gone through treatment and early recovery. However, some mild or lingering symptoms may remain, and ongoing care is still important to prevent relapse.

What Happens During the Residual Phase

• Milder symptoms remain – Some people may still feel slightly confused, unmotivated, or withdrawn. They hear faint sounds or have unusual thoughts, but these are less distressing and easier to manage.
  
• Emotional and social recovery continues – The person may still be rebuilding confidence, self-esteem, and social connections. Fatigue, low energy, or anxiety about relapse are common during this stage.
  
• Cognitive effects may linger – Some people continue to struggle with concentration, memory, or decision-making. Cognitive training and therapy can help improve these skills over time.

Trusted Care for Navigating Psychosis

Reaching the end of a psychotic episode doesn’t mean the journey is over. It means a new one begins. 

Support and recovery programs provide care that goes beyond symptom management. With a team of professionals, they understand that healing takes time, patience, and compassion for the person recovering and for their loved ones.

• Personalized care plans help each move forward at their own pace. Therapists, doctors, and counselors work together to find the right mix of medication, therapy, and lifestyle support.
  
• Family support programs guide loved ones through understanding psychosis, learning communication skills, and rebuilding trust and connection.
  
• Therapeutic communities create safe, welcoming spaces where people can share experiences, gain confidence, and rediscover purpose.

Oceanrock Health and South Coast Counseling actively guide individuals and families through recovery from psychosis, offering understanding, personalized support, and a clear path toward lasting stability and hope.

Sources:

1. Woodberry, K. A., Shapiro, D. I., Bryant, C., & Seidman, L. J. (2016). Progress and Future Directions in Research on the Psychosis Prodrome. Harvard Review of Psychiatry, 24(2), 87–103. Link
2. Benrimoh, D., Dlugunovych, V., Wright, A. C., Phalen, P., Funaro, M. C., Ferrara, M., Powers, A. R., Woods, S. W., Guloksuz, S., Yung, A. R., Srihari, V., & Shah, J. (2024). Proportion of Patients Who Experience a Prodrome Prior to Psychosis Onset: A Systematic Review and Meta-Analysis. Molecular Psychiatry. Link
3. Nelson, B., Yuen, H. P., Wood, S. J., Lin, A., Spiliotacopoulos, D., Bruxner, A., Broussard, C., Simmons, M., Foley, D. L., Brewer, W. J., Francey, S. M., Amminger, G. P., Thompson, A., McGorry, P. D., & Yung, A. R. (2013). Long-term Follow-up of a Group at Ultra High Risk (“Prodromal”) for Psychosis. JAMA Psychiatry, 70(8), 793. Link
4. Murphy, S. M., Irving, C. B., Adams, C. E., & Waqar, M. (2015). Crisis Intervention for People with Severe Mental Illnesses. Cochrane Database of Systematic Reviews, 12(12). Link
5. Saxon, V., Mukherjee, D., & Thomas, D. (2018, June 8). Behavioral Health Crisis Stabilization Centers: A New Normal. Journal of Mental Health and Clinical Psychology. Link
6. Killaspy, H., Craig, T., Dark, F., Harvey, C., & Medalia, A. (2021). Design and Implementation of Rehabilitation Interventions for People with Complex Psychosis. Frontiers in Psychiatry, 12. Link