PSYCHOSIS Royal Brisbane and Women’s Hospital What is Psychosis?

Royal Brisbane and Women’s Hospital
Metro North Hospital and Health Service
Inner North Brisbane Mental Health Service
Mental Health Services
PSYCHOSIS
What is Psychosis?
Psychosis is a condition which is characterised by a specific group of symptoms. It affects the way
a person thinks, feels and behaves. A person who has psychosis becomes ‘out of touch’ with
reality for a period of time, often behaving very differently from the way they usually do.
A psychotic episode occurs in three phases. The length of each phase varies from person to person.
Phase 1: Prodrome
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. There may
be difficulties in performing wok or study and there may be withdrawal from social situations.
Phase 2: Acute
Clear psychotic symptoms are experienced, such as hallucinations, delusions or confused thinking.
Phase 3: Recovery
Psychosis is treatable and most people recover. The pattern of recovery varies from person to person
Why learn about Psychosis?
To have greater personal control over the illness and reduce its negative impact on quality of life and life
roles. We need to know and have a clear understanding of:
 Psychosis and related illnesses
 Treatments
 How to better manage psychosis
This process of getting information and increasing understanding of mental illness and related issues is
referred to as psychoeducation.
How common is Psychosis?
Psychosis is a fairly common condition with around 3 out of every 100 people experience a psychotic
episode in their lifetime. Psychosis is most likely diagnosed in early adulthood and affects men and women
in equal numbers.
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What Causes Psychosis?
While the exact cause of psychosis is not yet fully understood, it is known to be influenced by a
combination of factors.
Genetic Factors
Research indicates that some people may have a genetic predisposition to develop a psychotic illness.
People with a close relative who has had psychosis have a greater chance of developing the disorder
compared to the general population.
Biochemical Factors
Psychosis is believed to be associated with a chemical imbalance of the brain’s neurotransmitters
dopamine and noradrenaline, affecting the pathway of electrical impulses. Certain medications attempt to
improve this chemical imbalance and promote more adequate functioning of the brain.
Environmental Factors
Stress has been shown to increase a person’s vulnerability to psychosis. High levels of social and
physiological stress can exacerbate or even trigger a psychotic episode. Environmental factors shown to
trigger or exacerbate psychosis include limited personal support, traumatic life events and physical illness.
Substance Use
Excessive alcohol use, alcohol withdrawal and cannabis use has been shown to trigger and/ or exacerbate
symptoms of psychosis. A causal link has been found between the use of illicit amphetamines (eg–speed)
and hallucinogens (eg–ecstasy), and the development of a psychotic illness.
What are the Symptoms of Psychosis?
In order to try and understand the experience of psychosis it is useful to group together some of the more
characteristic symptoms:
Confused thinking
Everyday thoughts become confused or don’t join up properly. Sentences are unclear or don’t make sense.
A person may have difficulty concentrating, following a conversation or remembering things. Thoughts
seem to speed up or slow down
False beliefs
It is common for a person experiencing a psychotic episode to hold false beliefs, known as delusions. The
person is so convinced of their delusion that the most logical argument cannot make them change their
mind. For example, someone may be convinced from the way cars are parked outside their house that they
are being watched by the police.
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.
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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 behaviours
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 behaviour 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.
What are the Different Types of Psychosis?
A diagnosis is a form of medical shorthand, which identifies the type of psychosis based on symptoms and
course of the illness. When someone is experiencing a psychotic episode for the first time it is particularly
difficult to diagnose the exact type of psychosis. A firm diagnosis requires longitudinal consistency in the
psychotic symptoms.
First episode psychosis
This 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.
With the right help, a large percentage of individuals many never experience another psychotic episode. A
proportion may develop a more long term illness and require ongoing treatment.
Drug Induced Psychosis
Symptoms of psychosis that result from the use of or withdrawal from alcohol or other substances (eg-illicit
drugs). For most people, the symptoms of psychosis will abate as the effects of the substance/s wear off.
However, a significant proportion may develop a more long term psychotic illness.
Organic Psychosis
The presence of psychotic symptoms due to a physical illness or problem (eg – head injury, brain tumour,
encephalitis, AIDS).
Brief Reactive Psychosis
Symptoms of psychosis are triggered by a traumatic event or extremely stressful life events (eg – death of
loved one, traumatic accident). While symptoms are severe, the person usually recovers in a short span of
time.
Schizophrenia
When the symptoms of psychosis have been present for a period of more than six months. Other
symptoms experienced include diminished motivation, social withdrawal, reduced interaction and
communication, impaired concentration, and diminished insight into being unwell.
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Schizophreniform Disorder
Where a diagnosis of schizophrenia is likely, but the symptoms have been present for less than six months.
Bipolar Affective Disorder
A condition where the person experiences feelings of mania (highs) and feelings of depression (lows). The
psychosis tends to relate to the person’s mood state at that time, for example, hearing derogatory voices
when depressed or believing they have magical powers when manic.
Schizoaffective Disorder
A condition where the person experiences both a mood disorder (manic & depressive symptoms) and a
psychotic illness concurrently.
Psychotic Depression
A severe depressive illness with psychotic symptoms.
What Treatments are Available for Psychosis?
Sometimes people with psychotic symptoms are reluctant to seek treatment. Perhaps they believe there is
nothing wrong, or hope the symptoms will go away without treatment. They may be concerned about the
actual treatment or worried about what people may think. It is important to remember that psychosis is like
any other illness, in that it is treatable. Most people make a good recovery.
What else is involved in treatment?
Recovery
Recovery is described as a “journey toward a new and valued sense of identity, role and purpose outside
the parameters of mental illness; and living well despite any limitations resulting from the illness, its
treatment, and personal and environmental conditions”. It is very important for you to be an active
participant in your recovery journey working closely with the treating team (doctor, case manger and others)
to develop your strengths assessment and goal plan which are tools that can guide your recovery. A
Framework of recovery ensures that hope, respect and pathways to community participation are
incorporated into the day to day activities of rehabilitation programmes.
Rehabilitation
Rehabilitation is the provision of practical support and guidance and may include: community follow up,
counselling, education on early warning signs, family psychoeducation, stress management and relaxation
training, cognitive behaviour therapy, employment programs, living skills training, encouraging maintenance
of physical health, social support and engagement, connecting with community activities, social skills
training, financial interventions, or drug and alcohol programs.
Medication
Along with other forms of treatment, medication plays a fundamental role in recovery from a psychotic
episode and in prevention of further episodes. There are a number of different types of medication which
are very effective in reducing the symptoms of psychosis and the anxiety and distress these symptoms can
cause. Treatment usually commences with prescription of anti-psychotic medication. Details about how
much to take and when to take it will be worked out with the doctor. Medication should be monitored and if
side-effects develop the type of medication or the amount taken may need to be changed.
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Medication is a significant factor in the recovery and health maintenance of individuals with psychosis. It
reduces the frequency and severity of symptoms by helping to restore the chemical balance of the brain.
Research indicates that relapse of symptoms is much less likely for people who comply with medication.
The main type of medications prescribed for psychotic conditions are the antipsychotics. The newer style
oral antipsychotics (‘atypicals’) are used widely as they cause far fewer side effects than older style
medications and help improve lethargy, concentration & motivation. The atypicals available are:
Zyprexa (Olanzapine)
Seroquel (Quetiapine)
Risperdal (Risperidone)
Solian (Amisulpride)
Clozaril (Clozapine)
Abilify (Aripiprazole)
Other medications that may also be prescribed include:
 Antidepressant medication
 Mood stabilisers
 Antianxiety medication
 Medications to reduce side effects
What maximises my recovery?
 Having a better understanding the illness and early warning signs.
 Adhering to medication as discussed with your treating doctor.
 Abstaining from excessive alcohol use and abstaining from illicit drug use.
 Actively participating in programs and interventions aimed to improve coping strategies and reduce
stress levels.
 Maintenance of regular routines and activities (including sleep patterns).
 Supportive friends, family and contact with health care workers.
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Further Information
SANE www.sane.org
(07) 3254 1881
Information on Psychosis and other mental disorders
Mental Illness Fellowship Queensland http://www.mifq.org.au/fact_sheets.htm
(07) 3358 4424
Information and support for persons with mental illness
Brisbane Office: 95 Arthur Street, Fortitude Valley
EPPIC- Early Psychosis and Prevention and Intervention Centre
www.eppic.org.au
Information on a psychiatric service aimed at addressing the needs of older
adolescents and young adults with emerging psychotic disorders.
Multicultural Mental Health Australia www.mmha.org.au
Providing mental health information and support to consumers, families and carers
for Australians from culturally and linguistically diverse backgrounds. Increasing
awareness of mental health issues and reducing stigma associated with mental
illness in multicultural communities in Australia.
Mental Health Association of Queensland www.mentalhealth.org.au
(07) 3271 5544
Information about forums, projects and latest research related to mental illness
ARAFMI Queensland Inc. – Support for Families www.arafmiqld.org
(07) 3254 1881
Provides support and advocacy for families and friends with mental illness or
disorder
GROW www.grow.net.au
1800 558 268
Support for people with mental illness.
(07) 3394 4344
Lifeline
13 11 14
Relationships Australia
1300 364 277
Psych Central www.psychcentral.com
Online mental health network providing information and self-help support
communities
Mental Health Matters www.mental-health-matters.com
Information about mental disorders, including psychosis
Mental Help Net www.mentalhelp.net
Mental health education and provides scientifically accurate and up-to-date
coverage of mental health and illness topics
Drug Aware www.drugaware.com.au
Information about various drugs and resources to help deal with them.
Continuing Medical Education www.cmellc.com
Website delivers high-quality continuing medical educational activities developed by
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influential clinicians and leading healthcare researchers.
World Federation for Mental Health www.wfmh.org
Mental health help www.mentalhelp.net
Mindbodylife www.mindbodylife.com.au
This website is presented as a source of information on ways to enhance physical
wellbeing - especially for people living with a mental illness and for the people who
care about them
References
EPPIC 2006.
McClellan, J et al (2002) Symptom Factors in Early Onset Psychotic Disorders. Journal of American
Academy of Child & Adolescent Psychiatry, 41(7), 791-98.
Melamed, E et al (1999) Psychosis: Impact on the patient & family. Journal of American Academy of
Neurology, 52(3), 14-16.
Queensland Health (2005) Sharing Responsibility for Recovery: creating and sustaining recovery oriented
systems of care for mental health, Queensland.
SANE Australia (2001) The Blueprint Guide to Psychosocial Rehabilitation. SANE Australia, Melbourne
Treatment Protocol Project (2004) Management of Mental Disorders, World Health Organisation
Collaborating Centre for Mental Health & Substance Abuse, Sydney.
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