Psychosis in Youth: Early Symptoms, Marijuana and Forgiveness Therapy

Numerous risk factors have been identified that predispose youth to a first psychotic episode (PFE), including bullying (Schreier, A., et al, 2009), marijuana use (Moore, T.H, et al. 2007), and sexual trauma, major social stressors and children of first-generation immigrants ((McGrath, J.J. & Lawlor, D.A., 2011).  The early, or what is referred to as the prodromal, phase of a PFE often involves negative symptoms of social withdrawal, depression/anxiety, speaking little, poor hygiene, excessive anger (which is often meant for bullies), inexpressive facies, reduced drive and motivation, lack of pleasure in everyday life, reduced concentration and attention, and sleep disturbance.   This prodromal phase can persist for several years before the development of a first psychotic episode.  

The treatment of youth with the negative symptoms is important in order to try to prevent the progression to a first psychotic episode.   Often parents feel overwhelmed by the youth’s symptoms and have no idea how to respond to them, especially when their child is uncooperative.   It is essential that these symptoms be addressed because approximately, 35% of such youth will go on to have a PFE (Nelson, B, et al, 2013).  However, those develop who do not progress to a PFE often continue to have troubling negative symptoms.

Treatment protocols for such youth that have included second generation anti-psychotics, SGA, such as risperdol and zyprexa, and cognitive behavioral therapy delay the onset of psychosis but do not prevent psychosis during the follow up.   One hopeful study has shown that the use of omega-3 decreased the transition rate markedly to a PFE (Amminger GP, et al. 2010).   

The evaluation of anger and the use of forgiveness therapy should be considered during the prodromal period with youth who harbor intense anger because of sexual trauma, major life stresses and the pressures and prejudices often experienced as the child of first-generation immigrants.  We have found forgiveness therapy (FT) to be helpful in diminishing the intense anger many of these youth have with bullies and with others who have traumatized them, while at the same time, an SGA is used to diminish negative symptoms such as severe anxiety, mistrust and excessive anger.  

The use of forgiveness therapy in these youth decreases not only their anger but also their anxiety, sadness and insecurity.  A major focus of treatment is also to build up the youth’s ability to trust others and to feel safe in friendships and in school settings, where much of bullying occurred.  The anger in these youth is often so intense because of the injustice of the trauma they have experienced that they are unable to forgive cognitively or emotionally.  Those with a faith dimension to their lives can then helped in the resolution of their anger by giving it to God or thinking revenge belongs to God several times daily.

Parents need to take steps to protect such children by not permitting violent video gaming because it can result in a strong sense of pleasure the expression of anger (See Lessons from Sandy Hook).  Also, it can interfere with the major goal of mastery over anger by forgiveness rather than by its expression.  Finally, engaging in fantasy games in which youth imagine giving vent to violent fantasies can increase the likelihood of the expression of severe anger toward family members and others through texting or verbal or physical aggression.

The other activity these youth to be warned against is the use of marijuana.   Three meta-analyses have concluded marijuana/cannabis use is associated with a three fold increased risk of developing psychosis. (Moore T.H.,  et al., 2007)
Youth with prodromal symptoms identified earlier should never use marijuana.

There is reason to be hopeful that the recognition and early intervention into negative symptoms in youth can prevent their progress to a serious, lifelong, debilitating mental illness.


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