What is Psychosis

A person who is suffering from an episode of psychosis can experience alteration in their perceptions of reality and can have difficulty thinking clearly as they normally would. When someone is affected in this way they may have unusual or strange ideas, they may hear or see things which are not there and they may have problems managing their emotions.

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. Most make a full recovery from the experience. Psychosis can happen to anyone. An episode of psychosis is treatable, and it is possible to recover. It is widely accepted that the earlier people get help the better the outcome. 25% of people who develop psychosis will never have another episode, another 50% may have more than one episode but will be able to live normal lives. Some people who develop psychosis may need ongoing support and treatment throughout their lives.

First episode psychosis simply refers to the first time someone experiences psychotic symptoms or a psychotic episode. People experiencing a first episode may not understand what is happening. The symptoms can be highly disturbing and unfamiliar, leaving the person confused and distressed. Unfortunately, negative myths and stereotypes about mental illness and psychosis in particular are still common in the community.

A psychotic episode occurs in three phases. The length of each phase varies from person to person.

A psychotic episode occurs in three phases, with the length of each varying from person to person.

The early signs may be vague and hardly noticeable. There may be changes in the way some people describe their feelings, thoughts and perceptions, which may become more difficult over time. Each person’s experience will differ and not everyone will experience all of the following "common signs":

• Reduced concentration
• Decreased motivation
• Depressed mood
• Sleep disturbance
• Anxiety
• Social withdrawal
• Suspiciousness
• Deterioration in functioning
• Withdrawal from family and friends
• Odd beliefs/magical thinking

The acute phase is when the symptoms of psychosis begin to emerge. It is also known as the "critical period." Clear psychotic symptoms are experienced, such as hallucinations, delusions or confused thinking. During this phase, the person experiencing psychosis can become extremely distressed by what is happening to them or behave in a manner that is so out of character that family members can become extremely concerned and may start to seek help. Before this stage the individual may have been experiencing a more gradual decline.

With effective treatment most people will recover from their first episode of psychosis and may never have another episode. It is important to remember that psychosis is a treatable condition and if help is sought early, an individual may never suffer another episode. Initially, some of the symptoms that are apparent in the acute phase may linger in the recovery phase but with appropriate treatment most people successfully recover and return to their normal, everyday lives.

Psychotic symptoms typically include changes in thinking, mood and behavior. Symptoms vary from person to person and may change over time. Some of the more characteristic symptoms can be grouped into five categories:

• Confused Thinking: Thoughts become muddled or confused. The person may not make sense when speaking. The person may have difficulty concentrating, following a conversation or remembering things. His or her mind may race or appear to be processing information in slow motion.
• False Beliefs: False beliefs, known as delusions, are common. The person can be so convinced of the reality of their delusion that no amount of logical argument can dissuade them. For example, they may believe the police are watching them, or they might think they are receiving special messages from the television, radio or newspaper.
• 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. Mood swings are common and they may feel unusually excited or depressed. A person’s emotions feel dampened and they may show less emotion to those around them.
• Changed behavior: People with psychosis may behave differently from the way they usually do. They may be extremely active or lethargic. They may laugh inappropriately or become angry or upset without apparent cause. Often, changes in behavior 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. A person may stop eating because they are concerned that the food is poisoned, or have trouble sleeping because they are scared.

Often there is a long delay before treatment begins for the first episode. The longer the illness is left untreated the greater the disruption to the person’s family, friends, studies, and work.

The way that individuals feel about themselves can be adversely affected particularly if treatment is prolonged. Other problems may occur or intensify, such as unemployment, depression, substance misuse. Breaking the law and self-injury may occur or intensify. In addition, delays in treatment may lead to slower and less complete recovery

If psychosis is detected and treated early, many problems can be prevented.

Research has found that early intervention is beneficial for patients and loved ones for the following reasons:

• Less treatment resistance and lower risk of relapse
• Reduced risk for suicide
• Reduced disruptions to work or school attendance
• Retention of social skills and support
• Decreased need for hospitalization
• More rapid recovery and better prognosis
• Reduced family disruption and distress