The word "psychosis" is used to describe conditions that affect the mind, in which there has been some loss of contact with reality. The terms "early psychosis" or "first episode psychosis" mean that an individual is experiencing psychosis for the first time. Hallucinations, delusions (false beliefs), paranoia and disorganized thoughts and speech are symptoms of psychosis. These symptoms can seem so real that often the person does not realize that they are experiencing psychosis. Psychosis also affects feelings and behaviour.

Psychotic episodes are periods of time when symptoms of psychosis are strong and interfere with regular life. Although the lengths of these episodes vary from person to person and may only last a few hours or days, psychosis is most likely to continue for weeks, months or even years unless the person is given proper treatment.

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

Who gets psychosis?

Approximately 3% of people will experience a psychotic episode at some stage in their life, although a first episode usually occurs in adolescence or early adult life. Psychosis occurs across all cultures and levels of socioeconomic status and affects males and females equally.

Being able to treat psychosis early is very important, since it usually starts during a very critical stage of a young person's life. Adolescents and young adults are just starting to develop their own identity, form lasting relationships, and make serious plans for their careers and future. A successful recovery leads to a healthy, productive future.

Phases of a psychotic episode

There are three phases to psychosis; however, not all people having a psychotic episode will experience clear symptoms of all three phases. Each person's experience will differ.

The first phase is called the Prodromal Phase.

This is the period before the psychosis becomes more obvious. There are often changes in feelings, thoughts, perceptions and behaviours. Prodromal symptoms vary from person to person and some people may not experience a prodrome. The duration of this phase is quite variable, although it usually spans several months.

The second phase is the Acute Phase.

This is the stage when the typical psychotic symptoms emerge. It is also the stage that is easiest to recognize and diagnose. Therefore the acute phase is when most people begin receiving treatment.

The third phase is Recovery.

Some of the symptoms that are apparent in the Acute Phase may linger in Recovery. With appropriate treatments, the great majority of people successfully recover from their first episode of psychosis.

Signs and Symptoms

Early Signs (Prodromal Phase)

Prior to the onset of acute psychosis people may have symptoms that are characterized as Prodromal symptoms. Some of the more common Prodromal symptoms include:

• social withdrawal
  
• reduced concentration, attention
  
• depressed mood
  
• sleep disturbance
  
• anxiety
  
• suspiciousness
  
• skipping school or work
  
• irritability

These symptoms are very general and could be signs of many different things, including normal adolescent behaviour. It is always important to be on the alert for such changes in thoughts, feelings, perceptions and behaviour especially when they are continuous over a period of time. The earlier the treatment starts, the greater the chance of a successful recovery.

Definite Psychotic Symptoms

It is in the Acute Phase that typical psychotic symptoms emerge. These are the symptoms that are hard to miss. They are intense, active and continuous. They interfere with normal life functioning. These symptoms are frequently separated into "positive" and "negative" categories.

Positive symptoms are referred to as "positive" because they are viewed as an excess or distortion of the person's normal functioning.

Some of the positive symptoms include:

Delusions (Fixed false beliefs)

Such as:

• being followed or monitored
  
• being plotted against
  
• having special abilities or "powers"
  
• certain songs or comments are specifically directed toward oneself or communicating a hidden message
  
• being controlled by forces or other individuals
  
• having one's thoughts broadcast so others can hear them

Hallucinations
Hallucinations involve seeing, hearing, feeling, smelling or tasting something that is not actually there. The most common type of hallucination involves hearing things - such as voices or particular sounds. These hallucinations can be so real that the individual may not realize that what they are hearing is false. It is often the odd behaviour that happens as a result of the hallucinations that gets recognized as a problem.

Disorganized Speech or Behaviour
The speech of individuals with psychosis may be disorganized in such a way that the person moves quickly from one topic to the next, or to the point where the person's speech may not be understandable.

The behaviour of individuals with psychosis also may be disorganized. The person may have difficulties performing activities of daily living (e.g., cooking, self-care) or display inappropriate behaviours or responses (e.g., laughing while describing a personal tragedy).

Negative symptoms reflect a decrease in, or loss of, normal functions. These symptoms are often less evident than positive symptoms and require careful assessment.

Some examples of negative symptoms include:

• little display of emotions
  
• not speaking very much
  
• difficulties in thinking or coming up with ideas
  
• decreased ability to initiate tasks
  
• lowered levels of motivation or drive

It is also common for other symptoms or problems to occur along with the psychotic symptoms.

Some examples of other problems include:

• depression
  
• anxiety
  
• suicidal thoughts or behaviours
  
• substance abuse
  
• difficulties functioning
  
• sleep disturbance
  

Recovery Stage

In the recovery stage, the acute symptoms mentioned above will lessen and start to fade; however, some symptoms may linger. Even after the psychosis has responded to treatment, problems such as depression, anxiety, decreased self esteem, social problems and difficulties with work or school may occur.

What causes psychosis?

Unfortunately, at this time there are many theories about what causes psychosis, but no definite answers. Psychosis occurs in a variety of mental and physical disorders; therefore, it likely has multiple causes. Biology, stress and drug use are three of the most common theories.

Biology

Neurotransmitters. There is strong evidence that some psychoses involve a dysfunction in neurotransmitters in the brain. Neurotransmitters are the "chemical messengers" of the brain. They transmit impulses throughout the brain and the central nervous system. Of particular importance is the neurotransmitter dopamine. Most antipsychotic drugs that control the positive symptoms of psychosis also block the transmission of dopamine.

Genetics. Individuals whose close relatives experience psychosis are themselves at increased risk. For example, the risk of developing psychosis associated with schizophrenia in the general population is approximately 1%, yet the children and siblings of those with schizophrenia have respective lifetime risks of 13% and 9%.

Brain Changes. Changes have been found in the brains of some individuals with schizophrenia, which appear to have been present since birth or early childhood. Possible causes of the changes include: genetic transmission, abnormal neurodevelopment and pregnancy or birth complications (e.g. exposure of mother to a virus during the second trimester of pregnancy).

Stress

Some psychoses appear to occur primarily in response to stress. In most cases, it is believed that a vulnerability to psychosis combined with stress will lead to psychosis.

Drugs

Psychosis can be induced by drugs or can be drug assisted. For example, it appears that amphetamines can cause a psychotic episode, while other drugs, including marijuana, can increase a person's natural vulnerability to psychosis resulting in a psychotic episode.

Vulnerability and Stress

Vulnerability to psychosis is acquired through a genetic predisposition, or as a result of an environmental insult to the brain (brain damage). Vulnerability can be measured by a family history of psychotic disorders, birth complications (e.g. oxygen deprivation of the baby) or brain injuries.

Stresses can be such things as significant life events (e.g. death of a loved one, moving to a new city, etc.), abuse of alcohol and drugs or stressful living conditions (e.g. high levels of family conflict or financial problems).

The degree of vulnerability varies from person to person. Likewise, the amount of stress that may trigger psychosis likely differs for each individual. For example, a person with a low vulnerability might withstand a large amount of stress without experiencing psychosis, whereas, a person with a high vulnerability might only withstand a minimal amount of stress without experiencing psychosis.

Is a psychotic person dangerous?

Although some individuals with psychosis may experience mood swings and increased feelings of agitation, they are more likely to present emotional dampening and social withdrawal. While strong delusions and hallucinations may cause a person to react unpredictably or even aggressively, individuals with psychosis are rarely violent and, in fact, they are at much greater risk of causing harm to themselves than to others.