What Is Psychosis?

This first chapter explains what psychosis is. Psychosis is a treatable mental illness. For many people with first-episode psychosis, symptoms begin to clear up partially or completely within weeks of starting treatment. Although the symptoms of psychosis may be frightening to the individual and his or her family, there are treatments for these symptoms. First-episode psychosis is the period of time when a person first begins to experience psychosis. It is during this time that young people and their families need detailed information about the initial evaluation and treatment. People who get into treatment earlier often do better. In many places, specialty treatment programs now exist that specifically focus on first-episode psychosis. Those programs often provide treatments designed to help young people get back on track in terms of school and work goals.

What Diagnoses Are Associated with Psychosis?

In this chapter we discuss the different diagnoses associated with psychosis. Schizophrenia is one of several primary psychotic disorders, a group of psychiatric disorders that primarily cause psychosis. Other disorders can cause psychotic symptoms—or symptoms similar to these—but are not considered psychotic disorders. A few examples of such disorders are major depressive disorder, bipolar disorder, and some substance-related disorders. It is often difficult to make a specific diagnosis when long-term information is not available at first. In instances in which a definitive diagnosis is uncertain, a working diagnosis allows the healthcare provider to begin effective treatments for psychosis even before a more certain diagnosis is made.

Embracing Recovery

Recovery is a broad concept, pertaining to one’s life goals, rather than to just getting symptoms under control. It means successfully living with a mental illness by not being confined by it; embracing hope, empowerment, and self-determination; and focusing on one’s personal life goals and roles in society. The goal of the recovery model of mental health treatment is to empower individuals to achieve their full potential in life. Individuals themselves decide on their personal goals for treatment and recovery instead of mental health professionals deciding for them. Recovery requires learning, support, courage, and patience. People who are successfully living with psychosis, including peer specialists (also called peer counselors or peer navigators), can help support others with similar experiences because they have had their own journey in recovery.

Going Back to School and Work

Finishing high school, going off to college, and getting a first job are visible signs of adult independence and set the foundation for future employment, income, and achievements. Though some may think that going back to school or work could be too stressful for a young person who has recently experienced a first episode of psychosis, psychosocial treatments called supported employment and supported education have been shown to be beneficial. These specialized supports help many young people get back into school, find and keep a job, or pursue both school and work goals. Doing well in school, or going to work, gives one a sense of purpose and achievement. These are important steps in recovery that can be achieved with the right supports from family, friends, and mental health professionals.

Knowing Your Early Warning Signs and Preventing a Relapse

This chapter explains early warning signs, which are mild symptoms that occur before another episode of illness, or a relapse. To help prevent a relapse, young people can stick with treatment, watch for early warning signs, and work with their mental health professional to intervene promptly. Young people can identify their unique warning signs by thinking back to the time just before the first episode to identify the two or three early warning signs that they should watch for. Family, friends, and mental health professionals can help identify the changes they observed as well. Open communication between the young person and his or her family, friends, and mental health professionals is important when early warning signs start to occur. By carefully monitoring early warning signs, young people, their families, and their mental health professionals can work together to help lessen the severity of any future episode of psychosis that a person may have—or prevent a relapse altogether.

The Initial Evaluation of Psychosis

For a young person with psychosis, the evaluation process can provide the start of a path toward effective treatment and recovery. Although the initial evaluation can be done in inpatient or outpatient settings, treatment of early psychosis often begins with a short stay in the hospital or related inpatient setting. In some instances, mental health professionals may be able to start treatment in the outpatient setting if there are no immediate safety concerns. The evaluation may include gathering additional information from sources other than the young person experiencing psychosis. Individuals experiencing psychosis often receive a physical exam, labs, and other tests to look for any medical problems that can cause symptoms. Understanding the evaluation process and providing mental health professionals with all available information can help in making a diagnosis and planning for the best treatment that will help the young person move toward recovery.

Psychosocial Treatments for Early Psychosis

This chapter discusses the importance of psychosocial treatments for psychosis. The recovery process focuses as much on resuming school, work, relationships, and recreation/leisure activities as it does on treating symptoms. The purpose of psychosocial treatments is to help young people with psychosis overcome common challenges in these areas and resume a full life. Group therapy can help young people to feel less alone and give them a chance to talk to others who are going through similar difficulties and discover what’s working for them. Family interventions help families to cope with stress, improve their social supports, and reduce the effects of stigma. Supported employment aims to move young people toward successful paid employment. Social skills training focuses on teaching people how to approach and navigate personal and professional social situations through a combination of learning new techniques and practicing these skills in various settings.

Understanding Mental Health First Aid for Psychosis

This last chapter includes advice on how to provide mental health first aid to someone who may be experiencing an episode of psychosis. These guidelines were developed by and reprinted here with permission from Mental Health First Aid Australia. These guidelines are designed to help members of the public to provide first aid to someone who may be experiencing psychosis. The role of the first aider is to assist the person until appropriate professional help is received or the crisis resolves. These guidelines are a general set of recommendations. Each individual is unique, and it is important to tailor your support to that person’s needs. So, these recommendations may not be appropriate for every person.

What Are the Symptoms of Psychosis?

Understanding the various symptoms of psychosis, and the treatments that are most effective for them, is key to engaging in treatment and recovery. Symptoms of psychosis can be very scary for those experiencing them and for their families. Help is available. Symptoms, whether in the past or present, are important to discuss with your mental health professional. An individual’s early symptoms are important to remember because they usually are the same ones that occur before another episode and are therefore early warning signs. Family and friends can provide information to mental health professionals about symptoms and behaviors, as well as report how symptoms are changing over time, including when they are improving or getting worse. Sharing information and making shared treatment decisions are key to successful treatment.

What Causes Primary Psychotic Disorders Like Schizophrenia?

It is believed that a combination of certain genes and a number of early life risk factors probably leads to subtle abnormalities in brain development, which set the stage for the later development of psychosis. It is unlikely that only one gene can cause psychosis. Instead, a number of genes each play a small role in a person’s risk for developing psychosis. The abnormal brain development that happens early in life among people who later develop psychosis is very subtle and usually remains undetected and quiet. School difficulties and social problems may develop during childhood and adolescence. In addition to the subtle abnormalities in early brain development, additional subtle abnormalities may also happen during the important period of adolescent brain maturation. Research suggests that adolescent drug use, especially marijuana use, increases one’s risk of developing psychosis.