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Your daughter Lisa calls you at 2:00 a.m. because she is scared. She hears voices coming from her closet telling her she is worthless. She has been depressed lately, and you wonder if her mind is playing tricks on her. You ask to speak with her roommate, who agrees to walk with her to the campus counseling center later that morning.
You get a call from campus police. Your son Adam has been taken to the emergency room after he ran into a classroom yelling that government spies were chasing him. He had used cocaine the night before and had been hiding around different parts of campus throughout the night.
Your daughter’s roommate calls you. Maria has not slept, showered, or eaten in four days, believing she is on the verge of discovering a new source of energy. “You need to take her home.”
Symptoms of psychosis, like hearing voices and feeling paranoid, occur more frequently than you might think in the college population. Every week or two at the college counseling center where I work as a psychiatrist, I see a student who has psychotic symptoms. In the last year, three in one thousand college students reported being diagnosed with schizophrenia, a chronic psychotic disorder. This number may underestimate the actual rate of psychosis, because many people have short-lived psychotic experiences connected to stress, trauma, depression, bipolar disorder, or substance abuse. In fact, three of one hundred people will have a psychotic episode in their lifetime.
When I speak with parents whose children are psychotic, they are often bewildered. How did this happen? Will my son recover? Will my daughter be able to stay in school? Here are the top 10 things you need to know about psychosis in the college years.
1. Psychosis means the presence of at least one of the following: hallucinations, delusions, disorganized speech, and disorganized behavior. Hallucinations could be hearing voices that are not there, or seeing people that are not present. Delusions are false beliefs, like school officials are watching you or you have superpowers. Disorganized speech could mean your child talks illogically, jumping from topic to topic or going off on tangents. Disorganized behavior could range from agitation to catatonic behavior.
2. College students can feel frightened by their psychotic experiences, believing they are “going crazy” or will never be “normal” again. Embarrassed by their symptoms, they will often hide them from you. They might finally seek help when they cannot concentrate on their classwork, or when a friend encourages them to visit the campus mental health service.
3. A psychotic episode does not have to mean the end your child’s academic career. In the initial example, Lisa is treated for psychotic depression with an antidepressant and antipsychotic medication, and she is able to finish the semester. She later tapers the antipsychotic but stays on the antidepressant long term. Adam completely recovers from his drug-induced psychosis after a few days and remains free of psychosis by avoiding drugs. Maria, diagnosed with bipolar disorder, takes the rest of the semester off while she begins treatment with a medication that is both an antipsychotic and mood stabilizer. She returns to college with a reduced workload. Lisa, Adam, Maria, and many people with psychotic episodes will graduate from college. Good treatment and lifestyle choices increase the likelihood they will remain in school.
4. Early and comprehensive treatment of first episode psychosis can reduce symptoms and improve school functioning. Coordinated Specialty Care (CSC), the gold standard for treatment, includes family education, individual therapy, low dose antipsychotic medication, and vocational and educational counseling. While there are a limited number of CSC programs throughout the country, many psychiatrists incorporate elements of this approach.
5. You need to be a strong advocate for your child’s treatment. Campuses often do not have enough therapists or psychiatrists to provide services for every student, so your child may need to obtain part or all of his care off campus. Contact a case manager or other representative at the college counseling center to identify local resources.
6. Psychosis could be one of the biggest challenges you face, especially if your child has ongoing difficulties in thinking or functioning that can occur in schizophrenia. Support groups offered by organizations like the National Alliance on Mental Illness will give you the tools to navigate through your child’s mental health journey.
7. Regular sleep is essential in preventing a recurrence of psychosis. College students can have wildly unpredictable sleep schedules, but if your child has a history of psychosis, she needs adequate sleep. Some students will take a reduced course load and take longer to graduate to maintain a regular sleep schedule.
8. Alcohol and drugs like cocaine, LSD and marijuana can increase psychotic symptoms in those who might be genetically vulnerable. Avoiding these substances will go a long way in preventing psychotic episodes.
9. Psychosis can increase the risk of suicidal thoughts or behaviors. If suicidal thoughts are escalating, the hospital might be the safest place for your child. Meet with the hospital social worker and your child to assess whether school or home is the best place for her to go after discharge.
10. Resilience. Hope. Recovery. Remember these words if your child has an episode of psychosis. The National Institute of Mental Health and National Alliance on Mental Illness provide up to date information on research and treatment programs. Create a support team for you and your child, and turn heartbreak into hope.
©2016 Marcia Morris, All Rights Reserved
Details have been altered to protect patient privacy.
