Psychosis affects an individual's thoughts, feelings and behaviours. Some of the more characteristic symptoms include confused thinking, delusions, hallucinations, changed feelings and changed behaviour.

A psychotic episode commonly isolates the person from others and impairs family and social relationships. Difficulties in school and work performance arise and secondary problems such as unemployment, substance abuse, depression, self harm or suicide and illegal behaviour can occur or intensify.

The experience of psychosis varies greatly from person to person and individuals experiencing psychosis may have very different symptoms.

Diagnosis

Diagnosing a psychotic episode in its early stage can be difficult. Often, because psychosis affects young people, the early symptoms are mistaken for normal teenage behaviour. Even when acute psychotic symptoms are evident it is sometimes not properly diagnosed due to lack of knowledge, dissatisfaction with mental health services or a belief that making such a diagnosis would label or offend the patient and/or family.

Diagnosis may take some time and can be frustrating for patients and families who want to know what is happening.

How does the doctor decide on a diagnosis?

In order to properly diagnose what specific type of psychotic disorder an individual has, patterns of symptoms must be assessed, often over many months. A comprehensive assessment is more likely to lead to a proper diagnosis. Medical professionals use information from medical and family history along with a physical examination. Sometimes, certain specialized types of assessments (such as a brain scan or assessment of cognitive functioning) may aid in clarifying the specific diagnosis.

Why does the diagnosis change sometimes?

There are a range of disorders that can produce psychotic symptoms. In first-episode psychosis, distinguishing between these disorders can be difficult. Therefore, around 30-40% of diagnoses are changed within three months.

Kinds of mental illness that may include psychosis

Psychosis is associated with several different mental and physical disorders. Some examples are schizophrenia, schizophreniform disorder, brief reactive psychosis, bipolar disorder, organic psychoses, delusional disorder, drug-induced psychosis, psychotic depression and schizoaffective disorder.

Prognosis (do people recover?)

With appropriate treatments, the great majority of people recover well from their initial episode of psychosis.

The pattern of recovery from psychosis varies from person to person. Some people recover quickly with very little intervention. Others may benefit from support over a longer period.

Following recovery from a first episode, a significant number of people will never experience a second episode (called a relapse) of psychosis. However, the risk of relapse is greatly increased if medication and other treatments are discontinued too soon.

The likelihood of a complete and lasting recovery is much better with proper treatment.

Dealing with stigma

To many, mental illness is frightening. Unfortunately, this fear can discourage people from seeking help early. Neither denial of the problem nor delay will help a young person with psychosis. Much of the fear surrounding mental illness is based on myths and misunderstandings. Mental illness need not be feared. Like other medical conditions, mental illness can be treated.

Some common myths about psychosis are that people with psychosis have multiple personalities, that they are dangerous, and that they never recover. In fact Multiple Personality Disorder is a rare condition unrelated to psychosis; people with psychosis often withdraw and are more of a danger to themselves than other people, and with current treatments, most people make successful recoveries.

Education about psychosis is the best way to deal with the stigma. Finding out what treatment is available, and how recovery is possible can not only reduce some of the fear associated with psychosis, but can also promote recovery by helping people anticipate and prepare for what to expect from treatment and from themselves.