Psychosis is a medical condition that affects the brain. It is characterized by a loss of contact with reality. A person experiencing psychosis finds it difficult to tell what is real from what is not real. They may also find they are overwhelmed by sights and sounds of things around them.
When this happens, it is called a psychotic episode. A psychotic episode is a period of time when symptoms are intense and interfere with a young person's life. It may last only a short period of time - or it may continue for weeks, months, or even years unless the person receives proper medical treatment.
"First episode psychosis" refers to the first time someone experiences psychotic symptoms. Often, the person will not understand what is happening. Symptoms are unfamiliar and education or knowledge about mental illness, their fear may be increased by negative myths and stereotypes.
We often talk about psychosis as if it were one illness, but it is actually a cluster of symptoms that can occur in a number of medical disorders, or sometimes as a consequence of drug or alcohol use.
Bipolar Disorder (Manic Depression)
Bipolar disorder is characterized by unusual shifts(extreme highs and lows) in a person's mood, energy, and ability to function. Severe episodes can include psychotic symptoms.
Brief Reactive Psychosis
Psychotic symptoms may arise suddenly in response to major stress in someone's life, such as a death in the family or other important change of circumstances. Symptoms can be severe, but the person makes a quick recovery in only a few days.
Strong beliefs that are not based in reality. Paranoia (belief that you are being persecuted) is the most common type of delusion.
Psychosis can emerge with the use or withdrawal from certain drugs. Recreational drugs and hallucinogens such as PCP, amphetamines, cocaine, marijuana, or alcohol may trigger a psychotic reaction. Symptoms usually disappear as the substance wears off, but sometimes the psychosis remains. Some people who abuse drugs and alcohol may also have an underlying chronic psychotic illness.
Psychotic symptoms sometimes occur in severe depression.
Psychotic symptoms may appear after a head injury or infection that disrupts brain functioning. There are usually other symptoms present, such as memory loss or confusion.
Psychosis associated with childbearing is rare, but when it happens it usually occurs after a baby is born rather than during pregnancy.
Psychosis is common in schizophrenia, a brain disorder characterized by hallucinations and delusions. Other less dramatic symptoms include social isolation, withdrawal, disorganized thoughts, unusual speech, bizarre behavior, lack of energy, and lack of interest in routine activities.
This diagnosis is usually given when psychotic symptoms have lasted for less than six months (but more than one month).
A person diagnosed with schizoaffective disorder shows symptoms of schizophrenia and a mood disorder (depression or bipolar disorder), occurring at the same time or alternating over time.
"He would sit and stare at his hands for hours. When I asked what was wrong with his hands, he would say they were different then they used to be."
Families often recognize problem signs in a loved one-mood swings, problems with school or friends-and are troubled by them. These changes can be the first signs of emerging psychosis. But it can be hard for the family to identify the emerging illness, or to know what to do about it.
Most psychotic episodes have three phases. These vary in length from person to person. Symptoms also vary from person to person, so individuals may have very different experiences.
Phase 1: Prodrome
In the beginning phase, clear signs of psychosis have not yet appeared. Early signs are often a combination of minor changes that are barely noticeable. But they are enough to make someone feel different, and often to seem different to those who know them well. Prodrome is often described as 'something is not quite right'. Signs are fairly general, so they may be seen as normal adolescent behavior or "just a phase". Or sometimes changes are attributed to drug use.
"In phone calls, my brother's voice no longer had the same tone of excitement and humour; instead it was very flat. At the same time he began to tell us about a situation at work that just didn't seem possible; he was complaining that a group of fellow workers were out to get him." -Sibling
Early signs can include:
Phase 2: Acute Phase (Psychotic Episode)
"A few months ago, I was happy and full of life. Now I don't want to be around my friends. It's really hard for me to focus on school and I get confused. I hear voices that say mean things. No one believes these voices are real. I don't understand what is happening to me."
Typical psychotic symptoms emerge in the acute phase. These are hard to miss as they interfere with the young person's day-to-day functioning. They are intense, active and continuous. In the acute phase of psychosis, people lose touch with reality. Thoughts, feelings and perceptions can all be seriously affected.
The main symptoms during the acute phase are grouped into three categories: positive, negative, and disorganized (or cognitive) symptoms.
Positive as used here does not mean good. It refers to having symptoms that ordinarily should not be there. Positive Symptoms include:
Hallucinations: Hearing, seeing, tasting, smelling, or feeling things that are not there. Although these perceptions are not real, they feel very real to the person experiencing them. People with psychosis often hear voices. Sometimes the voices are threatening or condemning; they may also give direct orders such as, "kill yourself". There is always a danger that such commands will be obeyed.
People who are ill may also have visual hallucinations-a door in a wall where no door exists; a bird, a tiger, or a long-dead relative may suddenly appear. Colours, shapes, and faces may change before the person's eyes.
There may also be hypersensitivity to sounds, tastes, and smells. A ringing telephone might seem as loud as a fire alarm bell, or a loved one's voice as threatening as a barking dog. Sense of touch may also be distorted. Someone may literally "feel" their skin is crawling. Ore, conversely, they may feel nothing, not even pain from a real injury.
Delusions: False beliefs that have no basis or evidence in reality. Again, the person is convinced these beliefs are true and cannot be swayed by arguments or logic. Attempts at reasoning or discussion usually only lead the anger or mistrust.
Examples of common false beliefs include:
A first episode of psychosis can be very stressful and frightening for a young person. It is also distressing for family and friends. The onset of a psychotic disorder usually occurs at a critical time in development. Typically, it happens just as the young person is establishing their self identity, forming key relationships, and pursuing education and career goals.
Treatment delays result in damage to the person's ability to function, strained family relationships, social isolation, and disruption in education and employment. Untreated psychosis also increases the risk of depression, suicide and violence. The earlier psychosis is recognized and treated, the better the outcome. This means fewer hospitalizations, less severe symptoms, earlier remission, fewer relapses, less disruption to the young person's development, and an improved quality of life.
Being able to treat psychosis early greatly increases the person's chances of enjoy a healthy and productive future.
Benefits of Early Intervention
"He would frequently be up all night pacing in his bedroom after barricading the bedroom door with furniture so that the unseen enemy couldn't get him. Then he would sleep until 2pm or 3pm - only to get up, eat, and then sit down to stare into space."
-Parent of a son with psychosis
"It is difficult to rationalize with an irrational mind."
-Mother of a young person with psychosis