Before Psychosis Strikes

From left to right, Jason Schiffman, professor of psychology and associate dean for research and faculty welfare at the UC Irvine School of Social Ecology, who is co-leading the effort with Cameron S. Carter, MD, Distinguished Professor and chair of the Department of Psychiatry & Human Behavior. Photos by Steve Zylius / UC Irvine 

Before a first episode of psychosis fully takes hold, there is a window — narrow, easy to miss and for some teenagers and young adults, an extremely consequential moment in their lives. 

UC Irvine researchers are determined to engage and partner with some of these youth before that window closes.  

Backed by a $2.6 million grant from the Substance Abuse and Mental Health Services Administration, UCI this month will launch a countywide system of care designed to do exactly that.  

The four-year initiative brings together UCI faculty, clinicians, students, researchers and community partners to identify youth and young adults — ages 15 to 25 — who are showing early warning signs of psychosis, connect them with support and intervene before a first episode ever occurs.

“Research suggests that approximately 2-4% of young people meet criteria for clinical high risk for psychosis,” said Jason Schiffman, PhD, professor of psychology and associate dean for research and faculty welfare for the UC Irvine School of Social Ecology, who is co-leading the effort with Cameron S. Carter, PhD, Distinguished Professor and chair of psychiatry and human behavior in the School of Medicine. “Applied broadly to a county our size, that suggests thousands of young people could benefit from specialized assessment and support.” 

Over the four-year grant period, the program aims to provide treatment and coordinated care to more than 150 young people. An additional 500 to 600 brief screenings are expected each year, with outreach extending to families, schools, healthcare providers and community organizations. 

Disorders involving psychosis, which can include hallucinations, delusions and disorganized thinking, often first emerge during adolescence and young adulthood, Schiffman noted, adding that researchers have more recently recognized that a critical period exists before a first full episode, when symptoms are developing but haven’t yet crossed a clinical threshold.  

Reaching young people during that window has historically been the hard part. 

“Early signs can be subtle and overlap with concerns such as anxiety, depression, trauma or sleep problems,” Schiffman said. “A young person may recognize that something feels different but have trouble explaining it, or worry about how people will react. Even when someone recognizes the concern, stigma runs deep and available services have often been fragmented.” 

What’s at stake is more than symptom management, he said. Adolescence is when friendships form, degrees are earned and careers begin, and psychosis risk can quietly erode those milestones long before a formal episode. 

“We have an opportunity to address distress, support families and help young people stay engaged in their lives in ways that are consistent with their own values and passions,” Schiffman said. “If psychosis does develop, we want specialized treatment to begin promptly.” 

Carter agreed. 

“This is a unique collaboration between experts in the psychological assessment and management of youth in a risk state and psychiatrists and psychologists with expertise in treating more intense and potentially progressive symptoms, including the full onset of serious mental illness,” Carter said. “It is a unique new program that ensures that youth identified in the community can be linked to the right level and intensity of care.” 

Read the full feature article by the UC Irvine School of Social Ecology.