What is psychosis?
Psychosis affects around 7 out of 1,000 adults. Onset tends to occur between 15-35 years of age. Psychosis is characterised by acute episodes of distressing hallucinations and delusions, disturbed behaviour, and memory and concentration difficulties. The acute episodes are usually preceded by a ‘prodromal phase’, involving some deterioration in personal functioning and the emergence of psychotic symptoms that are shorter and less intense than those of an acute episode. The main challenge for General Practitioners (GP’s) is detecting symptoms of psychosis promptly and to be able to distinguish these from other mental health issues.
What are the symptoms of psychosis?
The specific experience of symptoms can be quite unique and individual to a person. However, symptoms usually affect the following domains:
Confused thinking and speech: Everyday thoughts can become confused, making sentences unclear or hard to understand. Sometimes, people may make up words, or use words out of context. They might have difficulty concentrating, following a conversation or remembering things. Thoughts can seem to speed up or slow down, or unrelated to the topic of conversation.
False beliefs (delusions): People may strongly believe something is real, even in the face of contradictory information. For example, they may believe that the way cars are parked outside the house shows that they are being watched by the police, even if police confirmed this was not the case.
Hallucinations: People may hear, feel, smell or taste something that is not actually there.
Changed feelings: How a person feels may change for no obvious reason. They might feel strange and cut off from the world, with everything moving in slow motion. Mood swings are common, and they might feel unusually excited or depressed. They may seem to feel less emotion or show less emotion to those around them.
Changed behaviour: A person may be extremely active or have difficulty getting the energy to do things, laugh when things don’t seem funny, or become angry or upset without any cause.
How is psychosis diagnosed?
To understand if a person is experiencing symptoms of psychosis they would usually be invited to attend an assessment with a mental health professional. This assessment may include a discussion of the experiences someone is having and completing some questionnaires. The mental health professional would be interested in gathering information about the above domains to confirm whether someone seems to be experiencing psychosis.
There can be many reasons someone experiences symptoms of psychosis. For example, some physical health issues such as infections, or brain injury can cause symptoms that can look similar to psychosis. It will be important to rule out any physical health concerns during the assessment process.
Psychosis isn’t usually used as a diagnostic term on its own. If someone is experiencing symptoms of psychosis, they may be given one, or more, of the following diagnoses.
* Bipolar disorder (Manic depression)
* Schizoaffective disorder
* Paranoid disorder, delusional disorder or paranoid personality disorder
* Puerperal psychosis (A severe form of postnatal depression)
* Severe depression
When and from whom should people seek help and support?
Evidence suggests that the sooner people seek support for their psychosis symptoms, the better the prognosis for their recovery. This evidence has informed National Institute for Health and Care Excellence (NICE, 2015) and Royal College of Psychiatrists’ (2016) quality standards for care which state that adults experiencing a first episode of psychosis should start NICE concordant treatment within an Early Intervention in Psychosis Services within 2 weeks of a referral being received.
Early Intervention in Psychosis Services are teams of mental health professionals with specific training in assessing and treating symptoms of psychosis. They do this by providing a full range of evidence-based treatment including pharmacological, psychological, social, occupational and educational interventions. People can access this support for up to three years once they have been accepted to an Early Intervention in Psychosis Service. Support can be extended if the person has not made a stable recovery. Evidence suggests that Early Intervention in Psychosis Services can improve clinical outcomes, such as admission rates, symptoms & relapse, for people with first episode psychosis.
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