What is Psychosis?
The word psychosis used to describe conditions which affect the mind, where there has been some loss of contact with reality. When someone becomes ill in this way it is called a psychotic episode.
Psychosis is most likely to occur in young adults and is quite common. Around 3 out of every 100 young people will experience a psychotic episode - making psychosis more common than diabetes in young people. Most make a full recovery from the experience.
Psychosis can happen to anyone. Like any other illness it can be treated.
What are the Symptoms?
Psychosis can lead to changes in mood and thinking and to abnormal ideas, making it hard to understand how the person feels. In order to try to understand the experience of psychosis it is useful to group together some of the more characteristic symptoms.
Confused Thinking
Everyday thoughts become confused or don't join up properly. Sentences are unclear or don't make sense. A person may have difficulty concentrating, following a conversation or remembering things. Thoughts seem to speed up or slow down.
False Beliefs
It is common for a person experiencing a psychotic episode to hold false beliefs, known as delusions. The person is so convinced of their delusion, that the most logical argument cannot make them change their mind. For example, someone may be convinced from the way cars are parked out side their house that they are being watched by the police.
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.
Changed Feelings
How someone feels may change for no apparent reason. They may feel strange and cut off from the world with everything moving in slow motion. Mood swings are common and they may feel unusually excited or depressed. People's emotions seem dampened . . . they feel less than they used to, or show less emotion to those around them.
Changed Behaviour
People with psychosis behave differently from the way they usually do. They may be extremely active or lethargic, sitting around all day. They may laugh inappropriately or become angry or upset without apparent cause. Often, changes in behaviour are associated with the symptoms already described above. For example, a person believing they are in danger may call the police. Someone who believes he is Jesus Christ may spend the day preaching in the streets. People may stop eating because they are concerned that the food is poisoned, or have trouble sleeping because they are scared of something.
Symptoms vary from person to person and may change over time.
What is First Episode Psychosis?
First-episode psychosis simply refers to the first time someone experiences psychotic symptoms or a psychotic episode. People experiencing a first episode psychosis may not understand what is happening. The symptoms can be highly disturbing and completely unfamiliar, leaving the person confused and distressed. This distress is increased by negative myths and stereotypes about mental illness which are still common in the community.
The word psychosis used to describe conditions which affect the mind, where there has been some loss of contact with reality. When someone becomes ill in this way it is called a psychotic episode.
Psychosis is most likely to occur in young adults and is quite common. Around 3 out of every 100 young people will experience a psychotic episode - making psychosis more common than diabetes in young people. Most make a full recovery from the experience.
Psychosis can happen to anyone. Like any other illness it can be treated.
What are the Symptoms?
Psychosis can lead to changes in mood and thinking and to abnormal ideas, making it hard to understand how the person feels. In order to try to understand the experience of psychosis it is useful to group together some of the more characteristic symptoms.
Confused Thinking
Everyday thoughts become confused or don't join up properly. Sentences are unclear or don't make sense. A person may have difficulty concentrating, following a conversation or remembering things. Thoughts seem to speed up or slow down.
False Beliefs
It is common for a person experiencing a psychotic episode to hold false beliefs, known as delusions. The person is so convinced of their delusion, that the most logical argument cannot make them change their mind. For example, someone may be convinced from the way cars are parked out side their house that they are being watched by the police.
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.
Changed Feelings
How someone feels may change for no apparent reason. They may feel strange and cut off from the world with everything moving in slow motion. Mood swings are common and they may feel unusually excited or depressed. People's emotions seem dampened . . . they feel less than they used to, or show less emotion to those around them.
Changed Behaviour
People with psychosis behave differently from the way they usually do. They may be extremely active or lethargic, sitting around all day. They may laugh inappropriately or become angry or upset without apparent cause. Often, changes in behaviour are associated with the symptoms already described above. For example, a person believing they are in danger may call the police. Someone who believes he is Jesus Christ may spend the day preaching in the streets. People may stop eating because they are concerned that the food is poisoned, or have trouble sleeping because they are scared of something.
Symptoms vary from person to person and may change over time.
What is First Episode Psychosis?
First-episode psychosis simply refers to the first time someone experiences psychotic symptoms or a psychotic episode. People experiencing a first episode psychosis may not understand what is happening. The symptoms can be highly disturbing and completely unfamiliar, leaving the person confused and distressed. This distress is increased by negative myths and stereotypes about mental illness which are still common in the community.
A psychotic episode occurs in three phases. The length of each phase varies from person to person.- Phase 1: Prodrome
The early signs are vague and hardly noticeable. There may be changes in the way some people describe their feelings, thoughts and perceptions. - Phase 2: Acute
Clear psychotic symptoms are experienced, such as hallucinations, delusions or confused thinking. - Phase 3: Recovery
Psychosis is treatable and most people recover. The pattern of recovery varies from person to person. The important thing to remember is that people recover from first-episode psychosis, and many never experience another psychotic episode.
What are the Types of Psychosis?
Everyone's experience of psychosis is different and attaching a specific name or label to the psychotic illness is not always useful in the early stages.
However, when someone has a psychosis, a diagnosis of a particular psychotic illness is usually given. Diagnosis means identification of an illness by a person's symptoms and the diagnosis will depend on what brought on the illness and how long the symptoms last.
When someone is experiencing a psychotic episode for the first time, it is particularly difficult to diagnose the exact type of psychosis, because many of the factors which determine the label remain unclear. Nevertheless, it is useful to be familiar with some of the labels which you might hear. - Drug-lnduced Psychosis
Use of, or withdrawal from, alcohol and drugs can be associated with the appearance of psychotic symptoms. Sometimes these symptoms will rapidly resolve as the effects of the substances wear off. In other cases, the illness may last longer, but begin with drug-induced psychosis.
Organic Psychosis
Sometimes psychotic symptoms may appear as part of a head injury or a physical illness which disrupts brain functioning, such as encephalitis, AIDS or a tumour. There are usually other symptoms present, such as memory problems or confusion.
Brief Reactive Psychosis
Psychotic symptoms arise suddenly in response to a major stress in the person's life, such as a death in the family or change of living circumstance. Symptoms can be severe, but the person makes a quick recovery in only a few days.
Delusional Disorder
The main problem is strong beliefs in things that are not true.
Schizophrenia
Schizophrenia refers to a psychotic illness in which the changes in behaviour or symptoms have been continuing for a period of at least six months. The symptoms and length of the illness vary from person to person. Contrary to previous beliefs, many people with schizophrenia lead happy and fulfilling lives, with many making a full recovery.
Schizophreniform Disorder
This is just like schizophrenia except that the symptoms have lasted for less than six months.
Bipolar (Manic-depressive) Disorder
In bipolar disorder, psychosis appears as part of a more general disturbance in mood, in which mood is characterised by extreme highs (mania) or lows (depression). When psychotic symptoms are present, they tend to fit in with the person's mood. For example, people who are depressed may hear voices telling them they should commit suicide. Someone who is unusually excited or happy may believe they are special and can perform amazing feats.
Schizoaffective Disorder
This diagnosis is made when the person has concurrent or consecutive symptoms of both a mood disorder (such as depression or mania) and psychosis. In other words the picture is not typical of a mood disorder or schizophrenia.
Psychotic Depression
This is severe depression with psychotic symptoms mixed in, but without periods of mania or highs occurring at any point during the illness. This distinguishes the illness from bipolar disorder. - What Causes Psychosis?
A number of theories have been suggested as to what causes psychosis, but there is still much research to be done.
There is some indication that psychosis is caused by a poorly understood combination of biological factors which create a vulnerability to experiencing psychotic symptoms during adolescence or early adult life. These symptoms often emerge in response to stress, drug abuse or social changes in such vulnerable individuals. Some factors may be more or less important in one person than in another
In first-episode psychosis, the cause is particularly unclear. It is, therefore, necessary for the person to have a thorough examination to rule out known medical causes and make the diagnosis as clear as possible. This usually involves medical tests, as well as a detailed interview with a mental health specialist.
Psychosis has many forms. Course and outcome vary from person to person. - Recovering From Psychosis
Sometimes people with psychotic symptoms are reluctant to seek treatment. Perhaps they believe there is nothing wrong, or hope the symptoms will go away without help. They may be concerned about the actual treatment or worried about what people may think.
An increased understanding of psychosis has led to new drugs and therapies being developed. People with psychosis are likely to be treated at home, usually visiting a local mental health clinic an a regular basis. Home visits by local mental health services can be arranged and if hospitalisation is required, this is usually only for a brief period.
Psychosis, like other illnesses, can be treated. Most people make a good recovery.
What Will Treatment Involve?
The first phase of treatment involves assessment. This means having a series of interviews with a mental health specialist, such as a psychiatrist, clinical psychologist or community psychiatric nurse. The specialist will spend time getting to know the person, as well as speaking with family and friends. Blood tests and x-rays will probably be organised to exclude a physical cause for the symptoms. This is a frightening and confusing time for everyone concerned and a great deal of reassurance and tolerance is needed. It is important to establish a good trusting relationship wherever possible.
Information obtained from the person with the psychosis and their family and friends, together with the test results, will provide some idea about the type of psychosis being experienced, the cause, and how the person can best be helped.
Sometimes psychotic symptoms go away rapidly and people resume a normal life immediately. Other people take several weeks or even months to recover. Like after any illness, they may want to spend some time convalescing or they may wish to use a variety of different treatment options. Determining the best treatment will depend on factors such as personal preference, how severe the psychotic symptoms are, how long they have been present, and what the apparent cause is.
Medication
Medication can be a crucial treatment for psychosis. Along with other forms of treatment, it plays a fundamental role in recovery from a psychotic episode and in prevention of further episodes.
There are a number of different types of meditation which are very effective in reducing the symptoms of psychosis and the anxiety and distress these symptoms ran cause. Treatment commences with a low dose of medication and details about how much to take and when to take it will be worked out with a doctor. Medication will be monitored and if side-effects develop the type of meditation or the amount taken may be changed. This is critical in order to avoid distressing side effects which can lead to a per son being unwilling to accept medication which is central to their recovery.
Counselling and Psychological Therapy
Having someone to talk to is an important part of treatment. The exact method may vary to suit the individual and the phase of the psychotic episode. A person with acute psychotic symptoms may simply want to know there is someone who can understand their experience and provide reassurance that they will recover. As the recovery phase progresses, people may ask why me and learn practical ways to prevent further episodes, such as stress management and early recognition of warning signs. Counselling or therapy can take plate on an individual basis or in groups.
Practical Assistance
Treatment can also involve assistance with day-to-day things, such as getting back to school or work, arranging accommodation or obtaining finances.
When Should Hospital Be Considered?
Most people with psychosis can be supported at home by relatives or friends as long as they are provided with skilled and regular support from mental health professionals. First episode patients should be treated at home, if possible, to minimise distress and disruption to the young person.
Home-based care can be provided by your local community mental health service. crisis assessment and treatment (CAT) services, who provide intensive 24-hour support to the person and their family, are often a part of community mental health services.
Sometimes, however, there are benefits in spending a period of time in hospital before continuing with home treatment. Hospitalisation allows symptoms to be observed more fully, assists investigations and helps with the start of treatment. Sometimes people request hospitalisation so they can rest and feel safe.
Today, hospitalisation is more commonly reserved for situations where psychotic symptoms are placing the person or other people at risk. For example, the person may be seriously considering suicide. In such cases, hospitalisation allows assessment and treatment to be continued and ensures that the person is safe.
In some cases, admission may need to be arranged against the person's will or on an involuntary basis, at least at the beginning. However, treatment at home is resumed as soon as possible.
How Can the Person Be Involved?
People with early psychosis are encouraged to be actively involved in their own treatment. There is a need to learn about psychosis, about the recovery process, and what the individual can do to promote and maintain recovery. Sometimes there are secondary problems to be dealt with, like how to catch up with missed school or work, or how to tope with feelings of depression and stress related to the experience. It is important for the person to know their rights and to ask questions when something is not clear.
What About Recovery?
The pattern of recovery from psychosis varies from person to person. Some people recover quickly with very little intervention. Others may benefit from support over a longer period.
Recovery from the first episode usually takes a number of months. If symptoms remain or return, the recovery process may be prolonged. Some people experience a difficult period lasting months or even years before things really settle down. The important thing to remember is that psychosis is treatable.
Most people recover from Psychosis to lead satisfying and productive lives.
Getting Help Early
Getting help early involves recognising psychosis at the earliest possible time and finding appropriate specialist treatment.
Don't Delay
The initial episode of psychosis can be a particularly confusing and traumatic experience. The change in the person's behaviour causes concern and distress because no-one really understands what is happening.
This lack of awareness often leads to delays seeking help. As a result, these treatable illnesses are left unrecognised and untreated. Even when help is sought, further delays may occur before the right diagnosis is made because recognition of these disorders can be difficult.
Why is it Important to Get Help Early?
Often there is a long delay before treatment begins for the first episode of psychosis. The longer the illness is left untreated the greater the disruption to a person's family, friends, study and work. The way they feel about themselves can be affected, particularly if treatment is prolonged. Other problems may occur or intensify, such as unemployment, depression, substance abuse, breaking the law and causing injury to themselves may occur or intensify.
In addition, delays in treatment may lead to slower and less complete recovery.
Disruption need not occur. If psychosis is detected early, many problems can be prevented.
What are the Early Signs?
Usually there are some changes in a person before the obvious symptoms of psychosis develop. These changes are called early signs and this phase just before the psychosis is called the prodrome. The early signs are vague and hardly noticeable. The important thing to look for is if these changes get worse or simply do not go away.
Early signs vary from person to person. In the prodromal phase, there may be changes in the way some people describe their feelings, thoughts and perceptions. However, they have not started experiencing clear psychotic symptoms such as hallucinations, delusions or confused thinking.
Early Signs
A person may becomne - suspicious
- depressed
- anxious
- tense
- irritable
- angry
A person may experience - mood swings
- sleep disturbances
- appetite changes
- loss of energy or motivation
A person may feel - their thoughts are speeded up or slowed down
- things are somehow different
- things around them seem changed
- Often family and friends are the first to notice the changes.
Family and friends may notice when - a person's behaviour changes
- a person's studies or work deteriorate
- a person becomes more withdrawn or isolated
- a person is no longer interested in socialising
- a person becomes less active
Families often sense that something is not quite right even though they don't know exactly what the problem is. These behaviours might be a brief reaction to stressful events like hassles at school or work or trouble with relationships. On the other hand they may be early warning signs of a developing psychosis. It is important that these behaviours are checked out.
The First Step
When these prodromal or psychotic symptoms appear it is important that the young person gets help. A good place to start is with a local doctor community health centre or community mental health service. School counsellors might also be available. Remember these changes in behaviour may not be early signs but it is a good idea to get them checked out. If a psychotic disorder is developing the sooner the young person gets help the better.
The earlier psychosis is recognised and treatment commences, the better the outlook.
How Can I Help Someone With Psychosis?
It can be very distressing to realise that someone close to you is experiencing psychosis. You may feel shocked, confused, bewildered and guilty. There is no right or wrong way to feel.
Recognising the problem may have been difficult, as it is easy to mistake early psychosis for the normal ups and downs of young people. You have lots of questions and may not know what to do next. You want to help, but are not sure how.
Where Can I Get Help?
It con be very confusing to know where to get help. Families, partners or friends find it hard to make the decision to obtain help for lots of reasons. The person experiencing a psychotic episode may not wish to get help or even acknowledge that they are unwell. It can be extremely hard to cope alone with a person who is in a psychotic state.
Help is needed far the unwell person to find out exactly what is happening and what type of treatment is required. Help is also needed for families, partners and friends so they can understand what is happening and find out how to be involved in the assessment, treatment and recovery process.
A good place to start is with your local doctor, community health centre or mental health service. They will tell you what to do next and where treatment can be obtained. Initially, your biggest concern will be understanding what is happening and getting the right sort of help.
If you have difficulty getting advice or help, or feel you are getting nowhere, you may need to shop around. Talk to your local doctor about the possibility of psychosis or contact advocacy and support agencies, such as Schizophrenia Fellowship or the Association of Relatives and Friends of the Mentally Ill (ARAFMI).
How Can I Help During Treatment?
Once you have found a professional or service experienced in dealing with psychosis you may find it useful to:
Try to think of yourself and the professional as having the same goal to help the person with psychosis and work towards recovery. It is like a partnership between yourself and the treating person or team.
Find out who else is in the treating team--ask for their names and contact numbers. Ask the staff specifically what their role is now and what it will be in the future.
Ask who is the best person to contact and make a note of all this information.
Ask for a meeting with the key people in the team and prepare a list of questions to take with you. Feel free to write the answers down at the meeting. Ask for regular meetings and obtain an appointment time for your next meeting.
Ask for specific information. If you don't understand what you are being told, say so and ask for a clearer explanation.
Ask where you can obtain additional information. For instance, are there specific education sessions you can attend or is there material available to read?
Further Reading
There is a lot to learn about psychosis, treatment and recovery. You may find some of the following useful. - Alexander, K. (1991), Understanding and coping with Schizophrenia.
Schizophrenia Fellowship of Victoria (1993) - Something is not quite right. Schizophrenia Fellowship of Victoria (1994)
- Psychosis--What is it? Watkins, J. (1992), Psychosis and Schizophrenia.
ARAFENI
