What Are the 5 Stages of Psychosis? Progression, Timeline, and Symptoms

Psychosis is a mental health condition marked by distinct stages. A person’s journey through psychosis begins in the prodromal stage. It then follows the escalation of symptoms during the crisis stage, and subsequently leads to eventual recovery. Each of the stages presents a critical opportunity for treatment, making it essential to recognize the symptoms of each phase.

Disclaimer: 3 Phases of Psychosis vs. 5 Stages of Psychosis & Official Classifications

Clinically, there are only three phases of psychosis: Prodrome, Acute, and Recovery.[1] However, some providers extend this into five stages to expound on the patient experience during these three phases and include the “Crisis” and “Residual” phases that are largely anecdotal.

Many of the symptoms from the three phases can be identified in the five phases, but are only applicable to the three phases. While not clinically accurate, the five phases are a popular approach to psychosis and carry some merit in the treatment space. This resource will cover the five stages of psychosis as they are commonly understood, but ultimately, psychosis only has three phases.

What Is Psychosis?

Psychosis is a condition that affects as many as 3% of people at some point in their lifetime. [2] Psychosis is defined as experiencing thoughts, hallucinations, and delusions that make it difficult to discern what is based in reality.

The first symptoms or episode of psychosis typically manifests in a person’s early adult life; however, earlier and later onset are possible. Psychosis can exist on its own, but it is often a symptom of other mental health conditions.

Psychosis is not a set of symptoms that includes conditions like schizophrenia or bipolar disorder. Instead, psychosis is a symptom or feature that may occur within these disorders. Psychosis may be a symptom of severe depression, bipolar disorder, schizophrenia, or neurological disorders, especially in older adults. [3]

Understanding the Stages of Psychosis

A person living with psychosis may feel as though the condition will always define their life. It’s important to recognize that psychosis is a condition that progresses through five distinct stages, moving from the initial onset of the first psychotic episode through to recovery and beyond.

The five stages of psychosis adopted by some treatment providers include the prodromal stage, acute stage, crisis stage, recovery stage, and finally, the residual stage. Each step presents unique symptoms and treatment plans that help the person eventually achieve recovery.

Prodromal Phase

The prodromal phase is considered the early stage of psychosis. This is where the first signs of psychosis will first appear; however, they are often dismissed in the earliest stages.

For example, mood swings, depression, and social withdrawal may be attributed to stress, or a change in job, relationship, or even daily life routines.

The individual with early psychosis may begin to experience additional symptoms, such as paranoia, suspiciousness, or difficulty shaking off intrusive thoughts or feelings.

The prodromal stage of psychosis can last anywhere from a few weeks to several years. According to one study, the average duration of this stage of psychosis is 21.6 months. [4]

Early intervention through mental health treatment leads to the best long-term outcomes. This is especially true if a person seeks help from a mental health professional for their first time experiencing psychosis symptoms.

Acute Stage

The acute stage of psychosis is when a person begins to experience the full onset of symptoms. This is also the stage where the need for mental health care becomes most obvious.

The symptoms that previously could be dismissed as something less severe have escalated to the point of causing disruptions in the person’s life.

The emergence of telltale psychosis symptoms, such as hearing voices, visual hallucinations, and false beliefs, marks the acute phase. During the acute stage, a person’s thoughts are frequently preoccupied with psychotic symptoms.

At this stage, they may not be able to distinguish between their thoughts and reality. There may be a background awareness that their thoughts aren’t aligned with reality. Still, the intrusiveness of the symptoms is persistent.

At this stage, the person’s perceptions, hallucinations, and delusions begin to become their reality.

Now is the time to seek help from a healthcare professional, ideally a mental health provider. It’s at this stage that healthcare providers can identify psychotic symptoms accurately. This allows them to begin appropriate, timely treatment.

Crisis Stage

The crisis stage of psychosis is defined as the point where symptoms reach their peak. This is a scary, confusing time for the individual, as well as for their family and loved ones. During this time, symptoms are so severe that it becomes impossible to perform daily activities.

The intensity of delusions, hallucinations, paranoia, and confusion is extremely high during the crisis stage. While for some, this may be a brief psychotic disorder, the person must receive appropriate psychosis treatment.

Family and friends need to be aware that the risk of self-harm is extremely high during this stage.

Depending on the severity of the crisis stage, inpatient stay in a psychiatric hospital may be needed. Hospitalization is often the best place for someone during the crisis stage. They will receive the therapy and antipsychotic medications needed for appropriate care.

Recovery Stage

During the recovery phase, a person with psychosis begins to experience a gradual decrease in the number and severity of their symptoms.

For some, the recovery stage of psychosis is reached and traveled through relatively quickly. For others, the journey is much longer and requires significantly more treatment. Recovery from psychosis isn’t always linear, and it’s an individual process.

This stage centers on the continuation of effective treatment. According to the National Institute of Mental Health, the most common form of treatment is antipsychotic medications, which, combined with other forms of coordinated mental health care, lead to better outcomes. [5]

While the recovery timeline varies from person to person, it’s typical for the recovery stage to last three to twelve months.

Residual Stage & Lifelong Mental Health

Defined as the final stage of psychosis, the residual stage is focused on maintaining remission from severe symptoms and learning to live with the ones that persist.

At this stage, the severe symptoms of paranoia, delusions, hallucinations, and risk of self-harm have faded into the background. However, there may still be some remaining symptoms that include mild delusions, feeling unmotivated, social withdrawal, and issues with focus and maintaining daily activities.

This stage of psychosis can be a time of vulnerability. There might be fear of returning to the crisis stage, as well as navigating changes in relationships, jobs, and other areas of life. This is a time to focus on well-being and ensure that there are strong support systems in place.

Prioritizing self-care, mental health, and building supportive relationships are all key to protecting one’s mental health for the long term.

Warning Signs and Symptoms of Psychosis

According to the National Alliance on Mental Illness, several early warning signs occur before the onset of psychosis. These include: [6]

• Difficulty with thinking, focus, and concentration
• A decline in school or work performance
• Negative changes in personal hygiene and self-care
• Social withdrawal/spending more time alone
• Feelings of unease among others
• Growing feelings of suspicion
• Lack of emotion, or inappropriate emotions

Following this, a person may experience more severe and noticeable symptoms with the early onset of psychosis. These may include: [7]

• Sensory perceptions that aren’t experienced by others, including visual, auditory, and taste perceptions
• Persistent unusual thoughts or beliefs that can’t be changed, even when someone tries to reason with them
• Continued withdrawal from family, friends, and close acquaintances
• Continued decline in self-care and work or school performance
• Increased instances of inappropriate moods or behavior

As a person reaches the crisis stage of psychosis, their symptoms will escalate to include: [8

• Auditory hallucinations
• Visual hallucinations, including people or objects that are not there
• Unusual feelings that can’t be explained
• Severe paranoia

The Journey to Recovery from Psychosis

The phases of psychosis are an outline of the typical trajectory the condition takes. With early intervention and effective treatment, it’s possible to recover from psychosis and minimize its impact on your quality of life. Identifying each stage of psychosis and seeking help improves treatment outcomes and long-term recovery.

An episode of psychosis may last weeks, months, or longer. While some episodes may resolve without formal treatment, especially substance-induced psychosis, professional care greatly improves outcomes and reduces recurrence. Professional mental health care, including medications and psychotherapy, provides the best outcomes. Don’t wait for the symptoms to pass. Reach out and seek the help you need today.