Psychosis - Info for carers, siblings and workers
Psychosis is a condition which impairs a person's sense of reality. It affects approximately 1 in 50 people over their lifetime, and most commonly occurs later in adolescence and young adulthood. Males tend to experience symptoms a few years younger than females. A number of theories have been suggested as to what causes psychosis, but much more research is needed. There is some indication that psychosis is caused by a combination of biological factors in early development which contributes to an increased risk of developing psychosis in later life. Having a family member with a history of psychosis is another known risk factor. Symptoms may be triggered in response to stress, substance use, or social changes/disruptions in vulnerable individuals. Psychosis can happen to anyone, but like other illnesses it can be treated. Most young people can recover to live full and satisfying lives.
What are the signs of psychosis?
The term psychosis refers to a group of symptoms that reflects a change in a person's sense of reality and may lead to changes in their mood. The symptoms vary for each person and may change over time. When a person becomes ill in this way, it is referred to as a psychotic episode. Signs of a psychotic episode can include:
- Changes in thinking - Everyday thoughts can become confused, making a normal sentence unclear and difficult to understand. Someone who is living with psychosis may have difficulties following a conversation or remembering things, and their thoughts can seem to speed up or slow down.
- False beliefs (delusions) - A person may strongly believe that something is real when it isn't. The person is so convinced about their delusion that even the most logical argument won't change their mind. For example, they may think that cars parked outside their house mean that they are being watched by the police. This can at times lead to them becoming suspicious of the people around them.
- Hallucinations - Some people may see, hear, taste, smell or feel which isn't real. A common feature of psychosis can be auditory hallucinations, in which a person may hear voices that no one else can hear. These voices may comment on their activities or give them instructions.
- Changes in mood - A person may experience rapid mood changes for no apparent reason, such as feeling unusually excited or depressed. Some people may feel strange and cut off from the world. It may feel to the person that everything is moving in slow motion. As a result they may experience less emotion, or show a narrower range of emotions to the people around them.
- Changes in behaviour - Someone with psychosis may demonstrate odd or unusual behaviour, often when responding to their hallucinations or delusional thinking. They may also demonstrate an increase or a decrease in their energy, or changes in their sleeping patterns.
- Social changes – Someone experiencing psychotic symptoms may demonstrate a withdrawal or isolation from friends and family, such as staying in their room or refusing to attend social gatherings.
- Changes in functioning - Given the impact of psychotic symptoms, there is often a decline in someone's school or work performance. They may also demonstrate deterioration in their self-care including personal hygiene.
What are the types of psychosis?
Everyone's experience of psychotic symptoms is different, and when someone is experiencing their first episode it may be difficult to make a clear diagnosis. It may sometimes be only with the opportunity to look back over the progression of symptoms that a diagnosis can be made. Psychotic symptoms/episodes can occur in a number of mental illnesses, including:
- Bipolar disorder - Psychotic symptoms may feature as part of this disorder (which used to be referred to as manic depression). When present, they tend to fit in with the person's mood. For example, if depressed a person may hear voices telling them to commit suicide. When experiencing an elevated mood, however, they may believe they have special abilities which are out of keeping with their normal functioning.
- Brief reactive psychosis - Psychotic symptoms may appear a major stress in a person's life, such as a death in the family or a change in living circumstances. Symptoms can be severe, but a person can make a full recovery in as little as a few days.
- Drug-induced psychosis - Using or withdrawing from drugs, especially cannabis or amphetamines, can cause psychotic symptoms. These may resolve as the effects of the substance wear off. In other cases, the symptoms may last longer but begin with a drug-induced psychosis.
- Organic psychosis - Sometimes psychotic symptoms may appear as a result of a head injury or physical illness which disrupts brain functioning.
- Psychotic depression - Psychotic symptoms can develop in very extreme cases of depression. However, someone with psychotic depression does not experience an elevated mood as occurs in bipolar disorder.
Schizophrenia - An illness in which psychotic symptoms have lasted for at least six months. The types and length of symptoms vary from one person to another, and contrary to popular opinion people with schizophrenia can often lead fulfilling lives in learning to manage their illness, thereby preventing ongoing psychotic episodes.
Psychosis is often misunderstood by the general public. The early signs of psychosis may also be difficult to detect, and can be mistaken for the normal changes of adolescence. Symptoms may also be viewed differently by people from a culturally or linguistically diverse background. The impact of psychosis can be very traumatic for the young person and can disrupt their life at a critical developmental stage. The longer it takes to receive effective treatment, the longer it is likely to take for symptoms to go away. Delayed help also increases the risk of further episodes. It is therefore important to get help as soon as possible. Noticeable and persistent changes in the young person's behaviour and moods should not be ignored. Earlier treatment of psychosis increases the likelihood of the young person having a good recovery. Young people with their first episode of psychosis may be reluctant to seek treatment because they don't think anything is wrong or they hope their symptoms will go away. Due to their distorted thinking including delusional beliefs, they may also believe that people taking an interest in their symptoms may be trying to hurt or trick them. Help is needed for the young person to find out what is happening and what treatment is required. Families also need support to understand what is happening and how they can help. In very severe situations a person may need to be assisted involuntarily by use of the Mental Health Act.
In recent years, research has led to the development of improved medications and therapy. Selection of the right treatment options for each individual will be determined by an assessment undertaken by a trained professional, such as a psychiatrist or mental health professional. Having someone to talk to is an important part of treatment. Mental health workers can provide reassurance and information for the young person and their family. Ultimately, determining the best treatment will depend on factors such as personal preference, how severe the symptoms are, how long they have been present for and the apparent cause. A person with psychosis will need regular appointments to assist them. Sometimes admission to hospitalisation is required. Living in their normal environment rather than going to hospital minimises distress and disruption for the young person and their family. Hospitalisation is generally only considered when the psychotic symptoms place the person or others at a level of risk that cannot be managed by them remaining in the community.
Medication is usually recommended as a part of the treatment of psychosis to assist recovery and prevent further episodes. A psychiatrist can determine if medication is needed. There are several different types of medication that may be recommended and young people usually start on low doses. Details on how much to take and when to take it should be discussed with the treating doctor, who will monitor any side-effects associated with the prescribed dose. This is vital so that the type or dose or medication can be reviewed to minimise any side effects that may prevent the person from staying on medication to assist in their recovery. It is important to continue taking medication to prevent the occurrence of another psychotic episode, and ceasing medication should only be done with medical advice. In addition, it is important for the person to learn additional strategies to cope with stress and learn to recognise warning signs of any future episodes. Because of the potential impact of psychosis on a person's functioning, treatment may also include assistance with practical tasks such as getting back to work or school, securing accommodation or obtaining financial help. Throughout treatment, it is important for the person with psychosis to be actively involved in their recovery. Sometimes they may need to sort out secondary problems such as catching up on the school they have missed, or dealing with the depression arising from their experiences. They need to be informed of their rights, and have the opportunity to ask questions. A good outcome for someone with psychosis includes the following components:
- Early detection;
- Rapid start of treatment;
- Short duration of untreated psychosis;
- Participation in developing treatment plans that include recovery and maintaining functioning.
- Optimal treatment including medication, individual counselling, family support, psychosocial treatment and information;
- A supportive social network;
- A stable living environment;
- Structure and calm;
- Meaningful occupations: work, study and hobbies;
- Someone to share their experiences with;
- Good physical health;
- Rapid and lasting absence of symptoms; and
- Realistic expectations and hopes for the future.
Helping a young person with Psychosis
It is not uncommon for family and friends to go through a series of their own stages in response to a loved one experiencing psychosis, from the initial crisis to seeking help, needing reassurance, feeling relief and a possible return of anxiety as the person recovers well enough to return to their everyday world. Family and friends may also be involved in supporting a person's access to treatment, with confidentiality ideally not being used as a barrier to providing assistance to support people. If you are involved in someone's treatment, consider the following strategies to assist their recovery:
- Identify the key people in the treating team, and attend relevant appointments prepared with questions and relevant issues;
- If you don't understand what you are being told, say so and ask for clearer explanations;
- Ask where you can access additional information; and
- If cannabis or other substance misuse is a problem, ask the treating team what can be done about it and talk to the young person themselves about it. Let them know where you stand on their substance use, and encourage them to seek help to reduce or ideally cease their use.
It can be very distressing watching their experience of psychosis, and can generate a range of feelings including grief, anxiety, confusion and guilt. Listed below are a number of strategies that may help in supporting someone when they are at the acute phase in particular. Offer support and encouragement throughout, and convey that while you may not always like or agree with your behaviour, you still care for them as a person;
- Understand that the person might be talking and acting differently due their psychotic symptoms;
- Don't take it personally if they say hurtful things while unwell;
- When someone is in the midst of an acute episode they may seem more child-like, and so may need a comforting environment and support in making decisions;
- Don't get involved in long disagreements about their fixed ideas or beliefs. Instead, listen with interest to demonstrate empathy and develop understanding to discuss this with them further when they are well. It is important to generally maintain a calm environment, as conflict can contribute to the stress experienced by everyone; and
- Take care of yourself by acknowledging and expressing your feelings, obtaining information about the illness and how to cope with it and drawing upon your own sources of support.
This fact sheet was based on:-The Family Health Kit (NSW Health 2002) and The Early Psychosis Prevention and Intervention Centre 2006 fact sheets.
Information for siblings - How to get help
Your child's general practitioner, teacher, guidance officer, school counsellor or school health nurse. If more specialised assessment or intervention is required, general practitioners, schools or other health professionals can make a referral to a Child and Youth Mental Health Service (CYMHS) if they are under 18 years of age. If they are over 18 years, they will need to be referred to an Adult Mental Health Service. For your local clinic, look under Health in the White Pages telephone directory or call 13 HEALTH (13 43 25 84). Your general practitioner may refer you to other specialists who work with children and young people such as a private practitioner. In an emergency contact your local hospital Emergency Department. Occasionally a young person may need to be assessed and treated using the powers of the Mental Health Act. The Brisbane North Youth Service Provider Directory has details of many services, and can be accessed at: www.health.qld.gov.au/rch/professionals/BNYSPD.pdf or you could also consider one of the following:
- Alcohol and Drug Information Service - Free confidential counselling and information service 24 hours a day, 7 days a week. Phone: 1800 177 833.
- Association of Relatives and Friends of the Mentally Ill - Support and information for significant other/s of those affected by mental illness. Call their head office on (07) 3254 1881 or see www.arafmiqld.org for local support groups.
- Community Action for the Prevention of Suicide - Not-for-profit association that aims to provide a practical non-clinical support service to coordinate care, attention and support for people at risk of suicide, those who are concerned for someone at risk, and the children of someone at risk. Phone (07) 3870 8359 or see www.caps.org.au.
- Family Connections program - Correspondence-based program developed for family members where a relative has developed psychosis. Phone 1800 153 340 to register your interest.
- 13 HEALTH (13 43 25 84) - - For general health information and referral. Includes the Child Health Line.
- Indigenous Youth Health Service - Provides assistance on all health issues relating to Aboriginal and Torres Strait Islander youth. Phone (07) 3393 0055 (B/H).
- Kids Help Line - Free national telephone counselling for children & young people 24 hours, 7 days a week. Phone 1800 55 1800.
- Lifeline - Free counselling and support, 24 hours a day, 7 days a week. Phone 13 11 14.
- Mental Illness Fellowship of Queensland - Provides services and support for people living with schizophrenia and other serious mental illness, and their families. Call their Brisbane office on 07 3358 4424 or see www.mifa.org.au/mifq/ for local support groups.
- National Cannabis Information and Helpline - Phone 1800 30 40 50.
- Parentline - Counselling and support for parents, available 8am-10pm, 7 days a week. Phone 1300 30 1300.
- Queensland Transcultural Mental Health Service - Provides mental health assistance and information to people from culturally diverse backgrounds. Phone (07) 3167 8333 (B/H)
- SANE Australia - National charity aimed at enhancing mental health through campaigning, education and research. Phone: 1800 187 263.
- www.beyondblue.org.au- National, independent, not for profit organisation working to address issues associated with depression, anxiety and related substance disorders.
- www.copmi.net.au Information and resources for children, young people, families and service providers assisting families affected by parental mental illness.
- www.counsellingonline.org.au Counselling via text-interaction for information and support for those seeking help with their own drug use or use by a friend or family member.
- www.eppic.org.au Information about Melbourne's Early Psychosis Prevention and Intervention Centre, including written information about psychosis in eleven languages.
- www.headspace.org.au Website for the National Youth Mental Health Foundation, which aims to support Australian young people with mental health and related problems.
- www.health.qld.gov.au/mentalhealth Queensland Mental Health Branch website developed for the community, service providers, non-government organisations, consumers, carers and families, providing information on mental health and related issues and initiatives.
- www.health.qld.gov.au/mhcarer Queensland Health website for information and support for those caring for someone with a mental illness.
- www.kidshelp.com.au- Kids Help Line online counseling available for young people.
- www.livingisforeveryone- Australian government suicide prevention strategy website.
- www.ncpic.org.au- National Cannabis Prevention and Information Centre; provides information on all issues relating to cannabis.
- www.opendoors.net.au Up-to-date information and resources for lesbian, gay, bisexual and transgender young people, including direct email links to workers.
- www.reachout.com.au Interactive forum for young people to access support and assistance.
- www.somazone.com.au- Information for young people about health and well-being issues.
- www.suicidepreventionstudies.org Provides information and resources to help young people with suicidal and self-harm behaviours, and the people who care for them.
This fact sheet was updated in April 2009 by the Child and Youth Mental Health Service of the Royal Children's Hospital, Children's Health Service District, Brisbane, to raise awareness and provide information to families, young people and community members. This and others fact sheets in the series can be downloaded from:
Last updated: 21 March, 2011