You can't see psychosis just by looking at someone's eyes, but research shows subtle physical differences, like wider retinal veins or altered eye movements (saccades), linked to schizophrenia and other psychotic disorders, with the retina acting as a window to brain health, potentially indicating early signs or risk, though these require professional eye exams, not just observation.
Eye movement dysfunctions are noted in the tracking movements, which, in many psychotic patients, consist either in the complete replacement of smooth pursuit by a large saccade, or much more frequently, by smaller, persistent interruptions of smooth pursuit by rapid eye movements.
Individuals with schizophrenia, as well as those with bipolar disorder or depression, have unique eye movements, and related biomarkers could someday help diagnose these disorders.
However, a person will often show changes in their behavior before psychosis develops. Behavioral warning signs for psychosis include: Suspiciousness, paranoid ideas, or uneasiness with others. Trouble thinking clearly and logically.
Visual hallucinations in psychosis are reported to have physical properties similar to real perceptions. They are often life-sized, detailed, and solid, and are projected into the external world.
But in general, 3 main symptoms are associated with a psychotic episode:
Schizophrenia changes how a person thinks and behaves.
The first signs can be hard to identify as they often develop during the teenage years. Symptoms such as becoming socially withdrawn and unresponsive or changes in sleeping patterns can be mistaken for an adolescent "phase".
The "25 rule" (or "rule of quarters") in schizophrenia suggests that outcomes fall into four roughly equal groups: 25% recover fully, 25% improve significantly with some ongoing support, 25% improve somewhat but need considerable help, and 25% have a poor outcome with chronic illness or suicide risk, highlighting the varied nature of schizophrenia's long-term course, though some sources use a "rule of thirds" with similar proportions for different outcomes.
We have suggested that those with a bipolar disorder may, during manic/hypomanic states, evidence sparkling eyes, have dilated pupils and, albeit rarely, evidence iris colour changes – especially blackening.
Schizophrenia is a mental illness that causes psychosis, but schizophrenia also has other symptoms. And it isn't the only cause of psychosis. In some cases, other mental illnesses cause psychosis, including depression, bipolar disorder, dementia and borderline personality disorder.
Studies have suggested that different types of negative mental health status have different facial movements (54, 55) and the facial expressions associated with mental illness are also different from physical illness (56, 57).
Hallucinations: In psychosis, the person sees, hears, feels, smells or tastes something that is not actually there. For example, they may hear voices which no one else can hear, or see things which aren't there. Things may taste or smell as if they are bad or even poisoned.
While bigger pupils usually mean you're alert or excited, some studies have found a link between dilated pupils and anxiety or mania in people with bipolar disorder. Droopy Eyelids (Ptosis): This condition, where one or both eyelids droop partially or completely, can sometimes be a symptom of depression or fatigue.
Antipsychotics and SSRIs may lead to an added risk of developing angle-closure glaucoma, but only in predisposed eyes. Topiramate can lead to an allergic-type reaction whereby structures of the lens and ciliary body are displaced, which results in angle-closure glaucoma.
Speech may be mildly disorganized or completely incoherent and incomprehensible. Disorganized (bizarre) behavior may take the form of childlike silliness, agitation, or inappropriate appearance, hygiene, or conduct.
Many people experiencing psychosis lack awareness of their condition, a phenomenon called anosognosia that affects up to 98% of those with schizophrenia. Self-awareness during psychosis exists on a spectrum—some people have partial insight, others recognize symptoms only after episodes end.
There's no single test for schizophrenia and the condition is usually diagnosed after assessment by a specialist in mental health. If you're concerned you may be developing symptoms of schizophrenia, see a GP as soon as possible. The earlier schizophrenia is treated, the better.
That's because some early symptoms of schizophrenia — those that occur before hallucinations, delusions and disorganization — are commonly seen in many teens, such as:
Many of schizophrenia's better-known symptoms are in the positive symptom category, including: Hallucinations. These occur when a person's senses — vision, hearing, touch or smell — experience things that do not exist. Hallucinations and delusions may be referred to as psychotic symptoms or psychosis.
Patient may also present with spectrum of conditions including obsessive-compulsive phenomenon and dissociative disorders. Even subtle changes such as social withdrawal, school refusal, deterioration in school work may be considered as part of prodrome and may require intervention if the person is under UHR category.
Almost always, a psychotic episode is preceded by gradual non-specific changes in the person's thoughts, perceptions, behaviours, and functioning. The first phase is referred to as the prodrome (or prodromal) phase.
Common symptoms of schizophrenia in females include hallucinations, delusions, and cognitive disruptions. However, females are more likely to experience affective symptoms, such as depression and anxiety, alongside the primary symptoms of schizophrenia.
Schizophrenia tends to run in families, but no single gene is thought to be responsible. It's more likely that different combinations of genes make people more vulnerable to the condition. However, having these genes does not necessarily mean you'll develop schizophrenia.