Understanding Psychosis
Psychosis is a symptom involving the distortion or loss of contact with reality often accompanied by disorganized thoughts or behavior, hallucinations and delusions. There are many causes of psychosis including substance intoxication or withdrawal, adverse effects of prescribed medications, metabolic abnormalities, infection and sleep deprivation.
What are psychotic disorders?
Psychotic disorders are mental health conditions characterized by repeated episodes of psychosis or ongoing psychotic symptoms. A few psychotic disorders include:
- Schizophrenia
- Schizoaffective disorder
- Bipolar disorder with psychotic features
- Major depression with psychotic features
What is the impact of psychotic disorders?
Psychotic disorders can have a devastating impact on individuals and society. Psychosis can severely disrupt a person's life, making it difficult to form and maintain relationships, succeed in school or work and take care of themselves. Psychotic disorders are also a major public health concern, with around 3% of people experiencing a psychotic episode at some point in their lives and 1% being diagnosed with schizophrenia.
Symptoms
What does clinical high risk mean?
Clinical high risk (CHR) refers to people who experience very early psychotic symptoms but have not yet had their first psychotic episode. During a span of one to five years, various warning signs appear. While psychotic symptoms may be much milder at this time, the person is often highly impacted by them. A minority of people are at risk because a first-degree relative (mother, father, sibling) has a psychotic disorder. By itself, this genetic risk is minor. However, if this person experiences a significant decline in functioning, they would also be considered at clinical high risk.
Being at risk does not mean a person will go on to have a psychotic episode. It does mean they are at higher risk than the general population. After showing symptoms, about 33% of people go on to have an episode within the next two years. With treatment to prevent the onset of symptoms, that risk can be reduced to less than 10%. Research indicates that treatment during the CHR phase is the most effective way to reduce the progression of symptoms and possibly prevent a psychotic episode. The goal of treatment during this phase is to reduce stress, prevent psychosis, and support individual and family functioning.
How do you know if you are at clinical high risk?
If you or someone you know is experiencing any of the early warning signs of psychosis, please call First Hope at 925-608-6550. We can help you understand your risk and potential need for services and we can schedule an in-person assessment if needed.
What is the first episode of psychosis?
Psychotic symptoms can worsen to the point where they take over a person's mind, making it difficult to distinguish between reality and fantasy. Hallucinations, disturbing thoughts or ideas, feelings of dread or doom and mistrust of others' intentions may occur. Familiar people and places may seem unfamiliar or unreal, accompanied by confusion, anxiety and panic. This is known as a first episode of psychosis, which typically occurs in adolescence or early adulthood.
For some people, a psychotic episode is not unpleasant. They may experience a feeling of expansiveness or perceive spiritual connections. Often, loved ones are more concerned about the person experiencing the episode. The person experiencing the episode may not be interested in treatment since the episode was not unpleasant to them.
The goal of treatment is not to discredit those experiences but to integrate them into everyday life. Research has shown that treatment within 18 months following a first episode offers the best chance of regaining functioning. Even though symptoms may subside after the first episode, it may take many months before a person feels recovered. With time and treatment, symptoms may improve. However, once someone has had their first episode, they are no longer just at risk; additional episodes and difficulty regaining one's functioning may occur.
What is the course of psychotic disorders?
People with psychotic disorders often experience psychosis in episodes, with low-level symptoms between episodes. The overall course of psychotic disorders can be described as follows:
- At risk- The person does not experience any symptoms but has risk factors (genetic, traumatic, prenatal or perinatal complications, substance abuse) for developing psychosis.
- Clinical high risk (CHR/Prodromal)- The person has some changes in their emotions, motivation, thinking and perception or behavior (See Early Warning Signs). This period may last one to five years, with an average of about two years, and is the phase in which early intervention is most effective in preventing progression.
- Acute psychosis– The person is unwell with psychotic symptoms such as delusions, hallucinations, disorganized thinking and reduction in their ability to maintain social relationships, work or study. People often require hospitalization during this phase.
- Recovery– Follows an acute episode. While psychotic symptoms may decrease with treatment, it may take months to regain functioning and well-being. Many people experience some loss of function compared to their previous level. People who seek help immediately following the first episode of acute psychosis do best.
- Relapse– Recurrence of an acute episode after a period of stability. While some people have only one psychotic episode in their lifetime, the majority go on to have other acute episodes. Each episode takes longer to resolve, is more difficult to treat and often results in a decrease in functioning.
Support
What helps?
Family support and involvement. Psychosis is no one's fault. We do not believe families are to blame when their child develops psychotic symptoms. At the same time, family involvement and support are key factors in recovery. Our experience and research show that young people recover best when families are willing to face challenges, listen closely to their child and engage in all aspects of treatment, including our multifamily groups. At First Hope, we welcome anyone who has a close relationship and wants to be involved in supporting a young person with psychosis. Of note, siblings can be profoundly affected by their sibling's brother or sister’s suffering and their parents' distress. They also hold a unique perspective and power to help the healing process.
Maintaining hope. It is easy to lose hope when psychosis sets in but help is always available. Many people have moved past psychosis and are living and positive and meaningful lives. It can take time and be difficult, but things can get better.
What hurts?
Stigma. Many people continue to hold unjust prejudice against people with mental health problems. People may blame themselves or their families for the problems they are experiencing. They may be ashamed to admit they or their loved ones need help. This stigma can interfere with people getting the help they need, especially seeking help early. We are here to reassure you that there is nothing wrong with seeking help for any type of mental health problem.
Denial and delay. Often, we see people deny the earliest warning signs are happening. Denying symptoms or wishing they did not exist delays treatment, which is associated with a slower and less complete recovery. Please speak up if you are experiencing any symptoms.
Substance Use. Street drugs complicate and worsen outcomes. The use of marijuana, in particular, increases the risk of developing a psychotic disorder at a younger age. We are here to help you explore how substance use may be impacting your mental health and to support you in making any changes you want.
First Hope
First Hope is an outpatient treatment program for young people and their families experiencing early symptoms of psychosis or a recent psychotic episode. Anyone who wants to be involved in supporting young people with psychosis is welcome. We work alongside you and your loved ones to help you learn, cope and find support.
Contact us
391 Taylor Boulevard, Suite 100
Pleasant Hill, CA 94523
Phone: 925-608-6550