WHAT IS PSYCOSIS?
The word "psychosis" is used to describe conditions that affect the mind, in which there has been some loss of contact with reality. The terms "early psychosis" or "first episode psychosis" mean that an individual is experiencing psychosis for the first time. Hallucinations, delusions (false beliefs), paranoia and disorganized thoughts and speech are symptoms of psychosis. These symptoms can seem so real that often the person does not realize that they are experiencing psychosis. Psychosis also affects feelings and behaviour.
Psychotic episodes are periods of time when symptoms of psychosis are strong and interfere with regular life. Although the lengths of these episodes vary from person to person and may only last a few hours or days, psychosis is most likely to continue for weeks, months or even years unless the person is given proper treatment.
The experience of psychosis varies greatly from person to person and individuals experiencing psychosis may have very different symptoms.
Approximately 3% of people will experience a psychotic episode at some stage in their life, although a first episode usually occurs in adolescence or early adult life. Psychosis occurs across all cultures and levels of socioeconomic status and affects males and females equally.
Being able to treat psychosis early is very important, since it usually starts during a very critical stage of a young person's life. Adolescents and young adults are just starting to develop their own identity, form lasting relationships, and make serious plans for their careers and future. A successful recovery leads to a healthy, productive future.
There are three phases to psychosis; however, not all people having a psychotic episode will experience clear symptoms of all three phases. Each person's experience will differ.
The first phase is called the Prodromal Phase.
This is the period before the psychosis becomes more obvious. There are often changes in feelings, thoughts, perceptions and behaviours. Prodromal symptoms vary from person to person and some people may not experience a prodrome. The duration of this phase is quite variable, although it usually spans several months.
The second phase is the Acute Phase.
This is the stage when the typical psychotic symptoms emerge. It is also the stage that is easiest to recognize and diagnose. Therefore the acute phase is when most people begin receiving treatment.
The third phase is Recovery.
Some of the symptoms that are apparent in the Acute Phase may linger in Recovery. With appropriate treatments, the great majority of people successfully recover from their first episode of psychosis.
Early Signs (Prodromal Phase)
Prior to the onset of acute psychosis people may have symptoms that are characterized as Prodromal symptoms. Some of the more common Prodromal symptoms include:
- social withdrawal
- reduced concentration, attention
- depressed mood
- sleep disturbance
- anxiety
- suspiciousness
- skipping school or work
- irritability
These symptoms are very general and could be signs of many different things, including normal adolescent behaviour. It is always important to be on the alert for such changes in thoughts, feelings, perceptions and behaviour especially when they are continuous over a period of time. The earlier the treatment starts, the greater the chance of a successful recovery.
Definite Psychotic Symptoms
It is in the Acute Phase that typical psychotic symptoms emerge. These are the symptoms that are hard to miss. They are intense, active and continuous. They interfere with normal life functioning. These symptoms are frequently separated into "positive" and "negative" categories.
Positive symptoms are referred to as "positive" because they are viewed as an excess or distortion of the person's normal functioning.
Some of the positive symptoms include:
Delusions (Fixed false beliefs)
Such as:
- being followed or monitored
- being plotted against
- having special abilities or "powers"
- certain songs or comments are specifically directed toward oneself or communicating a hidden message
- being controlled by forces or other individuals
- having one's thoughts broadcast so others can hear them
Hallucinations
Hallucinations involve seeing, hearing, feeling, smelling or tasting something that is not actually there. The most common type of hallucination involves hearing things - such as voices or particular sounds. These hallucinations can be so real that the individual may not realize that what they are hearing is false. It is often the odd behaviour that happens as a result of the hallucinations that gets recognized as a problem.
Disorganized Speech or Behaviour
The speech of individuals with psychosis may be disorganized in such a way that the person moves quickly from one topic to the next, or to the point where the person's speech may not be understandable.
The behaviour of individuals with psychosis also may be disorganized. The person may have difficulties performing activities of daily living (e.g., cooking, self-care) or display inappropriate behaviours or responses (e.g., laughing while describing a personal tragedy).
Negative symptoms reflect a decrease in, or loss of, normal functions. These symptoms are often less evident than positive symptoms and require careful assessment.
Some examples of negative symptoms include:
- little display of emotions
- not speaking very much
- difficulties in thinking or coming up with ideas
- decreased ability to initiate tasks
- lowered levels of motivation or drive
It is also common for other symptoms or problems to occur along with the psychotic symptoms.
Some examples of other problems include:
- depression
- anxiety
- suicidal thoughts or behaviours
- substance abuse
- difficulties functioning
- sleep disturbance
Recovery Stage
In the recovery stage, the acute symptoms mentioned above will lessen and start to fade; however, some symptoms may linger. Even after the psychosis has responded to treatment, problems such as depression, anxiety, decreased self esteem, social problems and difficulties with work or school may occur.
- What causes psychosis?
Biology
Neurotransmitters. There is strong evidence that some psychoses involve a dysfunction in neurotransmitters in the brain. Neurotransmitters are the "chemical messengers" of the brain. They transmit impulses throughout the brain and the central nervous system. Of particular importance is the neurotransmitter dopamine. Most antipsychotic drugs that control the positive symptoms of psychosis also block the transmission of dopamine.
Genetics. Individuals whose close relatives experience psychosis are themselves at increased risk. For example, the risk of developing psychosis associated with schizophrenia in the general population is approximately 1%, yet the children and siblings of those with schizophrenia have respective lifetime risks of 13% and 9%.
Brain Changes. Changes have been found in the brains of some individuals with schizophrenia, which appear to have been present since birth or early childhood. Possible causes of the changes include: genetic transmission, abnormal neurodevelopment and pregnancy or birth complications (e.g. exposure of mother to a virus during the second trimester of pregnancy).
Stress
Some psychoses appear to occur primarily in response to stress. In most cases, it is believed that a vulnerability to psychosis combined with stress will lead to psychosis.
Drugs
Psychosis can be induced by drugs or can be drug assisted. For example, it appears that amphetamines can cause a psychotic episode, while other drugs, including marijuana, can increase a person's natural vulnerability to psychosis resulting in a psychotic episode.
Vulnerability and Stress
Stresses can be such things as significant life events (e.g. death of a loved one, moving to a new city, etc.), abuse of alcohol and drugs or stressful living conditions (e.g. high levels of family conflict or financial problems).
The degree of vulnerability varies from person to person. Likewise, the amount of stress that may trigger psychosis likely differs for each individual. For example, a person with a low vulnerability might withstand a large amount of stress without experiencing psychosis, whereas, a person with a high vulnerability might only withstand a minimal amount of stress without experiencing psychosis.
Although some individuals with psychosis may experience mood swings and increased feelings of agitation, they are more likely to present emotional dampening and social withdrawal. While strong delusions and hallucinations may cause a person to react unpredictably or even aggressively, individuals with psychosis are rarely violent and, in fact, they are at much greater risk of causing harm to thems
- TREATMENTS
Treating psychosis involves education, medication, close monitoring of symptoms, stress management and creating a strong, supportive environment.
These treatments all help to speed up the recovery process and promote good quality of life for both the person and the family.
Becoming educated about psychosis is an important part of treatment because it allows the person and family to understand the experience of psychosis and what to expect with the treatments that are recommended.
Medication is an important part of the treatment of psychosis. It relieves symptoms of psychosis and is critical in preventing relapse. There are many different medications available to treat psychosis. These medications are called antipsychotics (or sometimes neuroleptics).
The antipsychotic medications are usually divided into two categories:
- Typical antipsychotics which include haloperidol, loxapine and many others
- Atypical antipsychotics which include risperidone, olanzapine, quetiapine, ziprasidone and clozapine
There are also other medications that are sometimes used along with antipsychotics, depending on the symptoms. For example, antidepressants or mood stabilizers may be used for problems with mood.
Antipsychotics differ in terms of side effects. Many side effects diminish over time and some people do not experience any side effects. Atypical antipsychotics are usually tried first, as they have fewer side effects.
Some common side effects of the atypical antipsychotics include tiredness, dry mouth, blurred vision and weight gain.
Mental health professionals need to closely monitor for side effects, and if bothersome side effects develop, they may recommend a lower dose, or add a medication to reduce them, or try an alternative medication. Mental health professionals may also work with a person by helping cope better (eg. chewing gum for dry mouth; walking more to avoid weight gain).
Stress management and coping skills
Stress can worsen a person's symptoms and ability to function. Managing stress starts with learning to recognize stress. Stress symptoms include many mental, social and physical changes. Common symptoms of stress include feelings of exhaustion and fatigue, irritability or anxiety, changes in appetite or sleep patterns, headaches and/or muscle tension in the back and neck. Increased use of alcohol and/or drugs may also be a sign of poor coping. Each person's response to stress is unique.
By anticipating stress, a person can prepare for it and work out how to control it when it happens. Some ways to reduce stress include:
- Relaxation
- Realistic thinking
- Time management and organization
- Reducing responsibilities and obligations
Other strategies include regular exercise, eating and sleeping well and goal-setting. Different stress strategies work better for some people than others. Therefore, trying out a number will help to figure out what works best.
Having the support of groups can be very beneficial. Groups provide a safe environment to meet with others who have been through similar experiences. Groups offer education about psychosis through videos, presentations, written material and discussion. They are also a great way to learn and be positive about recovery.
What about counselling/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 want to learn practical ways to prevent further episodes, such as stress management and early recognition of warning signs. Counselling or therapy can take place on an individual basis or in groups.
Many of the treatments offered are important to help prevent a reoccurrence of psychosis (called a "relapse"). Taking medication as prescribed, education and learning how to manage stress will all help prevent relapse.
In addition, becoming educated about the early warning signs of relapse and developing a plan of action if these occur, can help thwart or reduce the severity of relapse.
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