“It was like I was having a million thoughts all at once and yet I was so disorganized, nothing was getting done. I was frightened and anxious because I felt someone was trying to harm me. Increasingly, I spent most of my time alone in my room doing nothing. I didn’t want to be bothered with friends or family. The television started having special messages meant only for me and I was hearing voices commenting on what I was doing. Looking back, I realize things just weren’t making sense anymore. At the time though, it seemed normal and I didn’t mention what was happening with me to anyone. Since getting treatment, I understand that I was experiencing a health problem called psychosis.”
Psychosis is a serious but treatable medical condition that reflects a disturbance in brain functioning. A person with psychosis experiences some loss of contact with reality, characterized by changes in their way of thinking, believing, perceiving and/or behaving. For the person experiencing psychosis, the condition can be very disorienting and distressing. Without effective treatment, psychosis can overwhelm the lives of individuals and families.
Psychosis is a common medical condition affecting three per cent of the population. Psychosis can happen to anyone. Symptoms of psychosis most often begin between 16 and 30 years of age. Both males and females can be affected. Males tend to experience symptoms a few years earlier than females. Persons with a family history of serious mental illness are at increased risk of developing psychosis.
Psychosis tends to emerge during adolescence and young adulthood and is more likely to occur in families with a history of serious mental illness. When psychosis occurs for the first time it is difficult to know the cause. Sometimes psychosis emerges gradually over time, so that in the early stages symptoms might be dismissed or ignored. Other times, symptoms appear suddenly and are very obvious to the individual and those around them. Psychosis is associated with a number of medical conditions including schizophrenia, depression, bipolar (manic-depressive) disorder and substance abuse, among others. The initial experience of psychotic symptoms is known as the ‘first episode’ of psychosis. Because the first episode of psychosis can signal a variety of conditions, it is important to seek a thorough medical assessment.
A person with psychosis may:
- Experience confused thoughts;
- Feel their thoughts have sped up or slowed down;
- Feel preoccupied with unusual ideas;
- Believe that others can manipulate their thoughts; or that they can manipulate the thoughts of others;
- Perceive voices or visions that no one else can hear or see;
- Feel ‘changed’ in some way;
- Act differently than they usually would.
The early stage prior to a full-blown episode of psychosis is known as the prodromal stage. Symptoms of this phase are often subtle; they develop gradually and can be mistaken as “normal” behaviour, particularly in adolescents.
The duration of the prodromal stage can vary from person to person, however it commonly lasts for several months.
Prodromal symptoms can include:
- Withdrawal from friends and family
- Sleep disturbances
- Anxiety and/or suspiciousness
- Mood swings (extreme happiness to anger)
- Reduced ability to focus and feelings of disorientation
- A dislike to being touched by anyone
- An extreme sensitivity to noise, light, colours, textures
If the prodromal stage is not recognized (or in some cases, does not occur) and treatment is not initiated, an individual’s condition will develop into an acute episode of psychosis. In this phase, a person will exhibit symptoms that are severe enough to impair day to day function. They may include symptoms such as:
- Increased confusion– The person feels like their thoughts are racing around, speeding up or slowing down uncontrollably;
- Delusions– Otherwise called false beliefs, delusions range from paranoia to feelings of grandeur. For example, an individual believes he is being followed, his thoughts are being manipulated, or that he is able to control other peoples’ minds;
- Hallucinations– The individual sees, hears, smells or tastes things that are not present;
- Altered emotions– A person experiences greatly enhanced mood swings, “flat” mood or feelings of being disengaged;
- Behavioural changes– The individual acts differently than usual, exhibiting bouts of high and low energy, inappropriate laughter and sudden, unexpected bouts of anger.
An acute episode of psychosis is frightening for both the person suffering from the condition and for the people around them. It is a confusing, disruptive and potentially devastating time, particularly for young people who are just developing their self-image, their relationships and their view of a positive, productive future. In most cases, psychosis will not go away on its own – detection and treatment are required before recovery can occur.
Research has discovered that the sooner an intervention begins (in other words, the earlier identification, assessment and treatment start), the better the results. Once a psychotic episode is identified, the professionals who make up a treatment team can organize medications, education and support for the individual, as well as friends and family.
We refer to this as early psychosis intervention or EPI. EPI has been found to be so effective that the seriousness of a psychotic episode can be greatly reduced, and possibly even avoided, if treatment is started quickly and appropriately.
EPI reduces the impact of psychosis on a person’s activities, relationships and self-esteem. It reduces the risk of depression, suicide, substance use problems, hospitalization and relapses as well as helps with a faster, more complete recovery. All in all, EPI assists individuals in maintaining the life they have planned for themselves and reducing the effects of the illness.
With all the benefits of EPI, why isn’t it used all the time? Early detection is the key; if early identification is not made, then treatment is delayed and the benefits of EPI are decreased. The prodromal symptoms of psychosis are often not recognized as early warning signs. Sometimes people – including the person afflicted, family friends, and even the support professionals – do not identify behavioural changes as red flags to an impending psychotic episode. The individual who is undergoing the episode may feel “different”, but without the necessary awareness of prodromal symptoms, he may not understand the significance. Indeed, there may not be any significance to these feelings however if they continue, a medical assessment is required to rule out psychosis.
Even if an individual, or their loved ones, recognize that “something is wrong”, the prejudice and discrimination associated with mental illness can discourage people from seeking help. The misguided hope of a “wait and see” attitude leads people to delay treatment and in the process, only serves to prolong the disease process.
Low doses of anti-psychotic medications are a key component of treatment, along with education and support for the individual and their family. Treatment strategies are aimed at allowing the individual to maintain their daily routines as much as possible. There have been tremendous advances in the treatment of psychosis during recent years, reducing the need for hospital stays and promoting faster, fuller recovery. Typically, psychosis does not disappear on its own. Instead, if left untreated, the condition can worsen and severely disrupt the lives of individuals and families.
If you or someone close to you, is experiencing symptoms of psychosis:
- Don’t wait. Look for help – Many persons with psychosis wait a long time before seeking treatment. But recovery is more difficult when effective treatment is delayed.
- Talk to your family doctor – They can refer you to a specialist for a full assessment. At present, early psychosis intervention is the focus of much interest in the mental health community. Many medical and mental health professionals are themselves learning about the best approaches to treatment. Some cities in Canada already have centres designed specifically for the treatment of early psychosis.
- Ask questions. Be persistent – It is important to consult with a medical professional who is familiar with early psychosis.
- Educate yourself. Get the facts – There is a great deal of information available about early psychosis and recent developments in treatment. An excellent starting point is the web site developed by the Early Psychosis Prevention and Intervention Centre (EPPIC) in Melbourne, Australia.
Learn all that you can about psychosis, including the signs and symptoms of both the prodromal and acute stages. It is particularly helpful if you increase your knowledge about the subtle changes that occur in the early stages of a psychotic episode; learn to recognize them and act without delay. In the initial stages, it may only be the person with psychosis who actually notices small changes in the way they feel, and it is not until the psychosis develops that family and friends see the more obvious signs.
If you are part of the support network for a person with psychosis, be sure to encourage them to seek help if you see signs developing in their behaviour. Help them to see their family doctor or mental health professional for an assessment. Ensure that the professionals they see are experienced in early psychosis, identification and treatment.
Do all you can to shatter the stigma around mental illness. Our society tends to discriminate against those with any disease of the mind at the same time as we try to help those with physical ailments. Why? Fear and ignorance play a big role; dispel them by learning the facts and sharing that knowledge.