Early Intervention in Psychosis Service (Totara House)

Welcome to Totara House

Totara House is a specialist multidisciplinary service for young people (18-30 years) who are experiencing their first episode of a mental illness.

The team aims to reduce the disruption to people’s lives by intervening early through a range of services, including community treatment and support, group programmes, and education about psychosis.

Please note: In an after-hours emergency, please call the Psychiatric Emergency Service (PES) Phone: 03 364 0482.

The word psychosis is used to describe a condition that affects the mind, where there has been some loss of contact with reality. This means a person is not thinking clearly and may believe things are true that are not. When someone becomes unwell in this way it is called a psychotic episode. Psychosis is most likely to occur in young adults and is quite common. Around three out of 100 people will experience a psychotic episode, making psychosis more common than diabetes. With treatment most people make a full recovery from their experience. It is important to remember psychosis can happen to anyone and, like any other illness, it can be treated.

The extract below from ‘Alice in Wonderland’ by Lewis Carroll describes quite well the loss of identity one can experience when mentally unwell. It is one of several extracts and poems discussed in the art therapy groups.

‘Who are you?’ said the caterpillar.
This was not an encouraging opening for a conversation.
Alice replied rather shyly, ‘I …I hardly know sir, just at present – at least I know who I was when I got up this morning but I think I must have changed several times since then.’
‘What do you mean by that?’ said the caterpillar sternly.
‘Explain yourself!’
‘I can’t explain myself, I am afraid, sir,’ said Alice, ‘because I’m not myself, you see.’

What are the symptoms?

Psychosis directly affects thinking but can also affect mood and behaviour. Everyone’s experience is different but listed below are common symptoms:

  • Confused thinking. Everyday thoughts become confused or disorganised. A person may have difficulty concentrating, following a conversation or remembering things. Often thoughts seem to speed up or slow down. Sometimes the things they say don’t make sense. Confused thinking in this way is referred to as thought disorder.
  • False Beliefs. It is common for people experiencing a psychotic episode to believe certain things are true which are not true beliefs within their religion and culture. They are so convinced of these beliefs that logical argument cannot make them change their mind. These beliefs are known as delusions.
  • Hallucinations. Someone experiencing a psychotic episode may hear, see, smell or taste something that is not actually there. These are hallucinations. The most common hallucinations are hearing voices.
  • Changed Feelings. How someone feels may change for no apparent reason. They may feel strange or cut off from the world. Mood swings are common, so they may feel unusually excited or depressed. People’s emotions may appear flat. That is they feel less than they used to or show less emotion than those around them do.
  • Changed Behaviour. People with psychosis behave differently from the way they used to. They may be extremely active or not do much at all. They may laugh at unusual times or become angry or upset with no apparent cause. Often changes in behaviour can be explained by the symptoms they have. For example, a person believing they are in danger may call the police. People may stop eating because they are concerned that the food is poisoned or have trouble sleeping because they are scared of something. It is important to remember that symptoms vary from person to person and may also change over time.

Art 1 and Art 2

These pictures represent what is was like to be mentally ill and were drawn by Totara House consumers while participating in an art therapy group in May 2009. During this group, the consumers wrote a poem describing what it was like to be unwell:

The day begins at eight
Who now decides my fate.
Wandering bored around the house,
Being watched when you are not,
I feel like a blob, no motivation.
Lying dull on my bed,
Not wanting to get up.
Won’t someone please fix my head.

Art therapy group consumers, May 2009.

What causes psychosis?

No-one is absolutely sure of the answer to this. It does seem that there is a vulnerability to psychosis that some people are born with and some aren’t. This makes it more likely for that person to get psychosis as a teenager or young adult. Often symptoms occur in response to stress, drug use or social changes. Some of these things will have more effect on one person than another. What we do know is that when people have symptoms like thought disorder, delusions and hallucinations, then there is an imbalance of brain chemicals that can be corrected.
Image 3
During the Art Therapy Group consumers drew a representation of the journey they are on, looking at the obstacles that they might face and what supports they have to help them reach their goals.

The effect of alcohol and drugs

Alcohol and other street drugs also effect brain chemicals. A number of drugs can cause psychotic symptoms and can also trigger psychosis in someone who is at risk. Use of drugs can also mask the signs of psychosis, which can mean delays in getting help. Further information on the effects of drugs is provided on our drugs and alcohol page.

Types of psychosis

When somebody presents with psychosis it is difficult to make a diagnosis or know for sure what is likely to happen in the future. Therefore it is often best to treat the symptoms without making a diagnosis. However it is useful to know in what illnesses psychosis may happen.

  • Drug Induced Psychosis. Using or withdrawing from drugs and alcohol can cause psychotic symptoms. Sometimes these symptoms settle quickly but sometimes the illness is set off by drugs and symptoms can take a long time to settle.
  • Brief reactive Psychosis. There are sudden psychotic symptoms after something very stressful in a person’s life. Symptoms may be severe but the person usually recovers quickly.
  • Schizophrenia. This diagnosis is made when there have been mainly psychotic symptoms but not significant mood symptoms for a period of at least six months. This means the diagnosis can include a range of people, not just those severely ill. Many people with schizophrenia lead happy and fulfilling lives, many making a full recovery.
  • Schizophreniform Disorder. This is just like schizophrenia, except the symptoms have lasted less than six months.
  • Delusional d​isorder. The main feature is a strong belief in things that are not true.
  • Bipolar Affective Disorder (Manic Depressive Disorder). In this disorder a person experiences swings in mood where they have had at least one period of being abnormally elevated (overly energised and/or overly happy) in mood and may also have episodes of depression. Psychotic symptoms, when present, often fit in with the person’s mood. For example, people who are depressed may hear voices telling them they should commit suicide, whereas someone who is manic may think that they are Jesus Christ or have special powers.
  • Schizoaffective Disorder. This diagnosis is made when someone has an illness, which on some occasions presents like a mood disorder with psychotic symptoms and, on other occasions, only psychotic symptoms are present. It has features of a mood disorder and schizophrenia but is not typical of either.
  • Psychotic Depression. This is a severe depressive illness in which the person also experiences psychotic symptoms. Further information is provided in our glossary of terms.

Further information is provided in our glossary of terms.

Recovery

This is different for each person. Some people recover quickly without much help. Others need more support over a longer period. Recovery from the first episode usually takes a number of months. If symptoms remain or return it may take a lot longer. Sometimes people have ongoing symptoms but this is not usually the case. The important thing to remember is that psychosis is treatable and most people recover and are able to lead normal lives.

Getting help early involves recognising psychosis at the earliest possible time and finding appropriate specialist treatment.

Don’t delay

The initial episode of psychosis can be a particularly confusing and traumatic experience. The change in the person’s behaviour causes concern and distress because no-one really understands what is happening. This lack of awareness often leads to delays seeking help. As a result, these treatable illnesses are left unrecognised and untreated. Even when help is sought, further delays may occur before the right diagnosis is made because recognition of these disorders can be difficult.
 

Why is it important to get help early?

When there is a long delay before treatment begins for the first episode of psychosis. The longer the illness is left untreated the greater the disruption to a person’s family, friends, study and work. The way they feel about themselves can be affected, particularly if treatment is prolonged. Other problems may occur or intensify, such as unemployment, depression, substance abuse, breaking the law and causing injury to themselves.  In addition, delays in treatment may lead to slower and less complete recovery. Disruption need not occur.  If psychosis is detected early, many problems can be prevented.

What are the early signs?

Normally there are some changes in a person before the obvious symptoms of psychosis develop. These changes are called early signs and this phase just before the psychosis is called the prodrome. The early signs are vague and hardly noticeable. The important thing to look for is if these changes get worse or simply do not go away. Early signs vary from person to person. In the prodromal phase, there may be changes in the way some people describe their feelings, thoughts and perceptions. However, they have not started experiencing clear psychotic symptoms such as hallucinations, delusions or confused thinking.

A person may become:

  • suspicious
  • depressed
  • anxious 
  • tense
  • irritable 
  • angry

A person may experience :

  • mood swings 
  • sleep disturbances 
  • appetite changes
  • loss of energy or motivation

A person may feel :

  • their thoughts are speeded up or slowed down 
  • things are somehow different
  • things around them seem changed
  • Often family and friends are the first to notice the changes.

Family and friends may notice when :

  • a person’s behaviour changes
  • a person’s studies or work deteriorate 
  • a person becomes more withdrawn or isolated 
  • a person is no longer interested in socialising 
  • a person becomes less active

Families often sense that something is not quite right even though they don’t know exactly what the problem is. These behaviours might be a brief reaction to stressful events like hassles at school or work or trouble with relationships. On the other hand, they may be early warning signs of a developing psychosis. It is important that these behaviours are checked out.
Copyright (1995) EPPIC & Department of Human Services (Victoria)

Who is at risk?

Well over 1% of the population will develop a psychotic illness sometime in their lifetime. Young people (men age 16-25 and women 16-35) are at particularly high risk. The risk is further increased with positive family history of a similar condition, and illicit drug abuse (including cannabis). An individual at risk can have the first episode of psychosis triggered by even mild use of illicit drugs, excessive alcohol use, or stress. Individuals with all levels of intelligence and from all social backgrounds can be affected by psychosis.

Can psychosis be treated successfully?

Yes there is effective treatment available. Research has shown that Early Intervention for Psychosis services have a significant positive effect for clients whilst in treatment. Early intensive treatment results in earlier psychotic and negative symptom remission, less psychosocial deterioration and increased treatment adherence. 

References

Turner MA. Evaluation of Early Intervention for Psychosis Services in New Zealand: What Works? Wellington, NZ: Health Research Council of New Zealand; 2002. Read this document now

Larsen TK, Friis S, Haahr U, Joa I, Johannessen JO, Melle I, et al. Early detection and intervention in first-episode schizophrenia: a critical review. Acta Psychiatrica Scandinavica 2001;103:323-34.

Malla AK, Norman R, Voruganti LP. Improving outcome in schizophrenia: the case for early intervention. Canadian Medical Association Journal 1999;160:843-6.  tervention. Canadian Medical Association Journal 1999;160:843-6. 

The first step

When these prodromal or psychotic symptoms appear it is important that the young person gets help. A good place to start is with a local doctor, community health centre, or community mental health service. School counsellors might also be available. Remember these changes in behaviour may not be early signs, but it is a good idea to get them checked out.

If a psychotic disorder is developing the sooner the young person gets help the better. The earlier psychosis is recognised and treatment commences, the better the outlook.  If you live in Christchurch and feel that you or someone you know may have what appear to be symptoms of psychosis, you are welcome to contact Totara House or email us for further help.

Potential consequences of delayed treatment

The longer duration of untreated psychosis (the period from the onset of psychosis to the implementation of ‘adequate treatment’) has been shown to predict poor outcome. In addition, the illness process of psychosis is most actively severe in the early phase. The majority of deterioration occurs within the first five years.

Reference

Birchwood, M. (1998) Early intervention in psychosis. The critical period hypothesis. British Journal of Psychiatry Suppl;172(33):53-9.

Potential consequences of delaying assessment and treatment include: 

  • slower and less complete recovery 

  • poorer prognosis 

  • increased risk of secondary morbidity 

  • interference with psychological and social development 

  • strain on relationships; loss of family and social supports 

  • disruption of person’s parenting skills (for those with children) 

  • distress and increased psychological problems in the family 

  • disruption of study and/or employment 

  • substance abuse 

  • criminal activities 

  • unnecessary hospitalisation 

  • loss of self-esteem and confidence 

  • increased cost of management

  • self-harm

What is cannabis?

Cannabis is the general name for marijuana ‘grass’ ‘pot’, ‘weed’, ‘dope’, ‘hooch’ and ‘hashish’. Cannabis comes from a plant and is smoked or eaten. It is a ‘depressant’ drug (that is, one that slows down thinking and the nervous system) and can also cause mild hallucinogenic (mind altering) effects.

How many people use cannabis?

Cannabis is the most widely used illicit drug. A study conducted in Christchurch (Christchurch Health and Development Study) shows that by age 21 years, 69% of the people interviewed had used cannabis.

Why do people use cannabis?

Some people use cannabis, like alcohol, to help them to relax. Some use cannabis because they feel it helps them with conversation and in social situations, while others use cannabis in an attempt to cope with life’s problems. Some people use cannabis in an attempt to treat the symptoms of psychosis.

Are there dangers in using cannabis?

Most people who use cannabis don’t experience any obvious harmful effects, but regular use may produce a number of short term effects including paranoia, confusion, increased anxiety, and even hallucinations, which can last up to several hours.

The Christchurch Health and Development Study found that cannabis use, and particularly regular or heavy use, was associated with increased rates of a range of adjustment problems in adolescence/ young adulthood including other illicit drug use, crime, depression and suicidal behaviours. These adverse effects were most evident for school-aged regular users.

In addition, longer term risks may include asthma and bronchitis, cancers of the mouth, throat, and lungs, poor concentration and memory, learning difficulties, and occasionally, psychosis.

A psychosis is a condition where a person experiences some loss of contact with reality. This is discussed more fully on the page:  What is psychosis.

Does cannabis cause psychosis?

It is believed that cannabis use may cause a condition known as a drug-induced psychosis, which can last up to a few days and is often characterised by hallucinations, delusions, memory loss and confusion.  However, in some cases, cannabis use may contribute to the development of a serious mental illness, such as schizophrenia.

A link between cannabis use early in life and the development of adult schizophrenia has been reported by researchers at the University of Otago’s Health & Development Research Unit.

The study, published in the Bristish Medical Journal, shows that early use of cannabis can significantly increase the risk of schizophrenic symptoms in adulthood. The research used data collected from 759 young New Zealanders who were studied from their birth in 1972 until age 26 in 1998. The results showed that adolescents who began using cannabis by age 15, were three-to-four times more likely to be diagnosed with schizophreniform disorder in adulthood, than their counterparts. Among individuals who used cannabis before age 15, 10 per cent developed a schizophreniform disorder by the age of 26, compared to 3 per cent of the remaining people.

How does cannabis affect someone who is already experiencing a psychosis?

Cannabis use can prolong the duration of symptoms of mental illness and can lower a person’s chances of recovering fully from a psychotic episode.

Who is most at risk from cannabis use?

People most at risk are those with a family history of psychotic illness or those who have already experienced a psychotic episode. So, people with a family or personal history of psychotic illness should avoid drugs like cannabis completely.

What about other drugs?

Although this page focuses on cannabis, other legal and illicit drugs should not be ignored. For example, some evidence suggests that substances such as alcohol, speed, hallucinogens (eg. acid, magic mushrooms, datura etc.) have a greater effect than cannabis in the development of a psychosis. Research is not yet available on the influence that party drugs such as ecstacy, have on psychosis, but these drugs have certainly been reported as being a significant factor in the emergence of psychosis.  For information on the consequences of using various drugs, visit the New Zealand Drug Foundation Consequences of Drugs website.

Where can I turn to for help?

Help can be obtained from a variety of sources. These range from family and friends to your local general practitioner and mental health services. In addition an Alcohol Drug Helpline is available from 10am – 10pm every day. Phone 0800 787 797. Further information is also available on www.druginfo.org.nz.

​The brain plays a central role in the onset of psychosis. Medical research tells us that, in patients suffering from psychosis, there are changes in the structure, function and balance of chemicals in the brain

  • We don’t know the exact cause of psychosis, but know that genes play an important role
     
  • The immediate environment is also important in the onset of psychosis, and in the persistence of symptoms

  • High levels of stress, eg losing a job, or situations charged with emotion, eg arguments at home, may spark off a psychotic episode

  • The use of drugs such as cannabis (dope), speed (‘P’, pure, crystal), or hallucinogenics ( LSD, mushrooms, acid, datura) can affect the chemical balance of the brain.

What Happens Normally?

Information is moved around the brain, from nerve cell to nerve cell, by means of chemical substances, called neurotransmitters

  • A message travels along the nerve and when it approaches the nerve ending a neurotransmitter is released.

  • The neurotransmitter is received by the next cell

  • some of the neurotransmitter gets reabsorbed

  • When enough neurotransmitter is received by the next nerve cell the message moves forward.

  • Dopamine and Serotonin are two neurotransmitters that are important in psychosis

  • ( In reality, it is much more complicated than this, as there are more than 100 different neurotransmitters)

  • In people with psychosis, the balance between these chemicals is disturbed

  • One theory, is that in psychosis there may be too much Dopamine

  • Excess dopamine causes an overstimulation of the nerves. This means that too many messages are being sent at the same time.

  • Symptoms of psychosis, like Hallucinations and odd beliefs ( Delusions ) are thought to be related to this overstimulation

  • When the brain is overstimulated for a prolonged period, it causes the nerve cells to shut down

  • Symptoms of poor concentration and reduced motivation, may be related to this shut down

  • The treatment of psychosis involves medications that work to restore the chemical balance in the brain

  • They work by “mopping up” the excess Dopamine

  • Treatment also involves managing stress and restoring the balance in the person’s environment

More information is available on the ‘Secret Life of the Brain’– This site includes much of the content of the PBS television special the Secret Life of the Brain. The graphics for the action of dopamine and the anatomy of the brain are excellent. Also talks about the impact of drugs on the brain.

Why have this group?

It can be very distressing when someone close to you experiences a psychotic episode. We recognise that psychosis has a major impact on the family, and it can be a lonely time for family members.

Families often don’t know any other people in similar situations, and want an opportunity to meet others who might be having similar experiences. The way in which family members respond to psychosis is influenced by the kind of knowledge they have about psychosis, and sometimes they have difficulty getting the information they want, or sufficient opportunities to talk with Mental Health workers.

The Totara House team is keen to support families who have a young person experiencing, or recovering from, a psychotic episode.

In addition to individual family support from a Case Manager and/or Family Support Worker, group education and support programmes significantly reduce levels of distress and enhance families’ coping resources.

What happens at this group?

The Family/Whānau Support Group is structured over 4 sessions. It includes information and discussion on:

  • Psychosis – possible causes, symptoms, and treatment

  • A video of a young man telling his story of psychosis

  • The role of alcohol and illicit drugs

  • The impact of psychosis on normal developmental processes

  • Recovery – especially the impact on the family

  • Setting limits and managing stress

What to expect

receive positive feedback about both the information and mutual support aspects of the group. Family members tell us that although they have felt anxious about coming to a group like this for the first time, by the end of the first session they are relieved to have met others with similar experiences and concerns, and to have an opportunity to ask questions in a supportive environment. Participants are welcome to choose how much of their own personal situation they feel comfortable discussing in the group. Any personal information disclosed in the group remains strictly confidential unless there are significant safety issues which need to be brought to the attention of the treatment team.

“For improved care in the commun​​​ity patients and their relatives need to be seen as partners in care rather than as passive recipients.”
Leavey et al; 1987

It can be very distressing to realise that someone close to you is experiencing psychosis. You may feel shocked, confused, bewildered and guilty. There is no right or wrong way to feel.

Recognising the problem may have been difficult, as it is easy to mistake early psychosis for the normal ups and downs of young people. You have lots of questions and may not know what to do next. You want to help, but are not sure how.

Where can I get help?

It can be very confusing to know where to get help. Families, partners or friends find it hard to make the decision to obtain help for lots of reasons. The person experiencing a psychotic episode may not wish to get help or even acknowledge that they are unwell. It can be extremely hard to cope alone with a person who is in a psychotic state.

Help is needed for the unwell person to find out exactly what is happening and what type of treatment is required. Help is also needed for families, partners and friends so they can understand what is happening and find out how to be involved in the assessment, treatment and recovery process.

A good place to start is with your local General Practitioner (GP), community health centre or mental health service. They will tell you what to do next and where treatment can be obtained. Initially, your biggest concern will be understanding what is happening and getting the right sort of help.
 

How can I help during treatment?

Once you have found a professional or service experienced in dealing with psychosis you may find it useful to:

  • Try to think of yourself and the professional as having the same goal to help the person with psychosis and work towards recovery. It is like a partnership between yourself and the treating person or team.

  • Find out who else is in the treating team – ask for their names and contact numbers. Ask the staff specifically what their role is now and what it will be in the future.

  • Ask who is the best person to contact and make a note of all this information.

  • Ask for a meeting with the key people in the team and prepare a list of questions to take with you. Feel free to write the answers down at the meeting. Ask for regular meetings and obtain an appointment time for your next meeting.

  • Ask for specific information. If you don’t understand what you are being told, say so and ask for a clearer explanation.

  • Ask where you can obtain additional information. For instance, are there specific education sessions you can attend or is there material available to read?

How should I relate to the person who is unwell?

If you are with a person when they are psychotic and behaving strangely, you may feel frightened or frustrated. It is important to remember that they are still your son, daughter, brother, sister, wife, husband, partner or friend. It is very difficult for a person who is ill to be how they usually are.

Often families and friends ask how they should behave and talk to a person who is psychotic. There are no set rules, however, some general guidelines can be helpful.

  • Be yourself.

  • Gain information and understand that the person may be behaving and talking differently due to the psychotic symptoms.

  • Understand that psychotic symptoms are stressful for everyone and that you may have a range of feelings–shock, fear, sadness, anger, frustration, despair.

  • Talking with other people will help you to deal with these feelings. Believe a person will recover–even if it takes time. Be patient.

  • When a person is in an acute stage they may seem child-like. Sometimes they need to be in a safe, comforting environment and sometimes they need others to help with decisions.

  • Try not to take it personally if a person says hurtful words to you when they are unwell.

  • When a person has acute psychotic symptoms they may be fixed in their beliefs and ideas. Don’t get involved in a long disagreement, but listen with interest to gain an understanding of their current reality – to show sympathy and for future reference, to discuss when they are better.

  • Take care of yourself.  It is a balance between care and concern and not getting too run down yourself.

How can I help recovery?

Family, partners and friends are very important in the process of recovery. When a person is recovering from their psychotic episode you can provide love, stability, understanding and reassurance, as well as help with practical issues.

However, you may need your own period of recovery and adjustment to all that has happened. It can be useful to understand some of the stages you may have gone through.

Common stages

It is quite common for families and friends to go through the following stages:

  • Initially you may be in crisis as you become aware that something serious is happening and your family member or friend is unwell. You may feel very anxious, worried and frightened at this time.

  • As it becomes clear that something is not quite right you start to seek help. This is also a time where you may be adjusting to the fact that your family member or friend is unwell and the situation cannot be left to clear up by itself.

  • As you find help you will probably have lots of questions and worries–What is happening? What is psychosis? What causes it? Will this happen again? How is it treated? What can we do to help? What will we tell other people? Will our family member or friend understand why help was needed? Should we have got help earlier? You will have mixed emotions and reactions during this time. Any feeling you have is appropriate.

  • As the person begins to recover and starts to show signs of being well, you may experience great relief and pleasure. You may also have started to understand the illness more by this time and start to feel more hopeful about the future.

  • As recovery progresses you may find your anxiety, questions or worries start to increase again as your family member, partner or friend starts to reintegrate back into the family and community. Often family members find themselves watching the person for signs of relapse or strange behaviour. You may feel protective and anxious, wanting the person to be well as quickly as possible and not do anything that may cause a relapse. It can be difficult balancing the needs for independence and care.

  • As recovery continues, there is a gradual adjustment by everyone concerned. You feel reassured that recovery is occurring and some normality returns to your life.  You speak with the patient about psychosis, what it was like for everyone and how to help each other in the future.

Art4

Art from the May 2009 Art Therapy Group focusing on the Journey of Recovery and looking at how consumers want their lives to look like once recovered.

Art5

Remember that families, partners and friends also need a period of recovery and time to understand and accept what has happened. Don’t keep things a secret – talking with others, whether it be with family members, friends or professionals, can be very helpful.

If you want further information about how to help, check out our links and resources page.​

What is Psychosis?

The word psychosis is used to describe conditions which affect the mind, where there has been some loss of contact with reality.

Symptoms of psychosis include changes in mood, thinking, perception (hallucinations) and behaviour as well as abnormal ideas (delusions).

Mood

  • mood swings are common
  • mood can be depressed or excited
  • emotions can seem dampened

Thinking

  • thoughts can become confused, disorganised, sped up or slowed down
  • Sentences may be unclear or don’t make sense
  • concentration can be affected

Behaviour

  • lethargy or over-activity common
  • unexplained laughter or anger
  • behaviour can be driven by abnormal beliefs eg a person who believes they are in danger may stay at home / call the police

Abnormal Beliefs

  • false beliefs, called Delusions are common
  • belief fixed and not open to logical argument
  • eg. the person may believe they are Jesus Christ, they may believe that they are being followed or that people are out to harm them

Perception

  • Changes in the way we perceive our environment are common in psychosis.
  • People can have the experience of hearing, seeing, feeling, smelling or tasting something that is not actually there. We call these experiences hallucinations. eg. a common example of an hallucination is hearing voices

Types of Psychosis

When someone has psychosis, a diagnosis of a particular psychotic illness is usually given.

  • Diagnosis means identification of an illness by a person’s symptoms

When someone is experiencing a psychotic episode for the first time, it is particularly difficult to diagnose the exact type of psychosis, because many of the factors which determine the label remain unclear – often only time and close monitoring will tell.

There are a number of disorders that can present with psychotic symptoms:

  • Schizophrenia

  • Depression

  • Bipolar Disorder ( also known as Manic Depression)

  • Schizoaffective Disorder

  • Delusional Disorder

  • Drug Induced Psychosis

  • Brief Psychotic Disorder

Schizophrenia – sufferers experience at least 2 (or more) of the following: delusions, hallucinations, disorganised speech, grossly disorganised behaviour – these are known as positive symptoms – plus loss of interest, poor motivation and social withdrawal – these are known as negative symptoms.

These signs and symptoms are associated with a marked reduction in social and occupational functioning.

Depression – sometimes people who suffer from a persistent low mood also experience psychotic symptoms (also called Psychotic Depression)

Bipolar Disorder – sufferers experience mood swings or “highs and lows”. Sometimes they can experience psychosis with these mood fluctuations.

Schizoaffective Disorder – sufferers experience a mood disturbance (either ‘high’ or ‘low’) with psychotic symptoms, but also experience significant symptoms of psychosis when their mood is normal.

Delusional Disorder – characterised by non – bizarre delusions (ie: plausible beliefs) without other positive symptoms of psychosis.

Substance Induced Psychosis – the psychotic symptoms are judges to be a direct consequence of drug abuse, or exposure to a medication or toxin.

Brief Psychotic Disorder – the psychotic disturbance is brief and lasts more than a day but less than a month.

 

Medications used to treat Psychosis

Antipsychotic – medications that target the chemical imbalance in the brain that causes psychosis. eg. Olanzapine (Zyprexa), Risperidone (Risperdal), Quetiapine (Seroquel), Clozapine (Clozaril)

Antidepressants – medications that treat depression eg. Fluoxetine (Prozac), Citalopram, (Cipramil), Paroxetine (Aropax)

Mood Stabilisers – medications that treat the mood fluctuations associated with Bipolar Disorder eg. Lithium, Sodium Valproate (Epilim), Carbamazepine (Tegretol)

Sometimes these medications are used in combination to treat psychosis.

Further information on medications can be obtained from Medsafe.

 

Who are the members of my health care team?

Case Manager –The health care provider whom you see the most for your mental health care in the public mental health system. They coordinate all your care with other members of the team. They can be medical doctors, or allied health specialist such as psychologists, social workers, occupational therapists or trained mental health nurses.

GP – General Practitioner/Local Doctor/Family Doctor ––Registered medical practitioners who have a general training in all areas of medicine, including psychiatry, but manage your general health care.

Psychiatric Nurse –A person especially trained to provide promotion, maintenance, and restoration of mental health, including crisis and case management. Nurses can administer medications but cannot prescribe them, whereas other allied health professionals can neither prescribe nor administer medications.

Occupational Therapist (OT) –A person trained to provide therapy through creative or functional activities that promote recovery and rehabilitation.

Pharmacist –A person licensed to sell or dispense prescription drugs.

Psychiatric Registrar –A registered medical doctor doing specialist training to be a psychiatrist.

Psychiatrist –A medical doctor who specialised in psychiatry. Psychiatry is a branch of medicine that deals with the study, treatment and prevention of mental illness and the promotion of mental health.

Psychologist – A person usually trained at a post-graduate level who works to apply psychological principles to the assessment, diagnosis, prevention, reduction, and rehabilitation of mental distress, disability, dysfunctional behaviour, and to improve mental and physical well-being.

Social Worker –A person with specialised training in individual and community work, group therapies, family and case work, advocacy and the social consequences of disadvantage and disability, including mental disorders. They can provide psychosocial treatments for mental disorders and assist with welfare needs such as finance, or accommodation.

 

Other Terms used

Anti-psychosis medication – A group of medications used to treat psychotic illnesses.

Delusion – A symptom of many mental illnesses. A delusion is an illogical belief that is held strongly, even in the face of evidence that it is false.

Depression – A mood disorder ranging from passing sad moods to a serious disabling illness requiring medical and psychological treatment. Major depression is a “whole body” disorder impacting on the patient’s emotions (feelings of guilt and hopelessness or loss of pleasure in once enjoyed activities), thinking (persistent thoughts of death or suicide, difficulty concentrating or making decisions), behaviour (changes in sleep patterns, appetite, or weight), and even physical well being (persistent symptoms such as headaches or digestive disorders that do not respond to treatment).

Duration of untreated psychosis – the period from the onset of psychosis to the implementation of ‘adequate treatment’

Hallucination – A false or distorted perception of objects or events, including sensations of sight, sound, taste, touch and smell, typically with a powerful sense of their reality.

Mental Illness – A general term for a wide range of disorders involving the brain where both psychological and behavioural symptoms may be exhibited.

Mental Disorder – A diagnosable mental illness under agreed international criteria such as ‘schizophrenia’.

Negative Symptoms – Symptoms where a normal behaviour or emotion, such as motivation, socialisation, or interest is lacking. They are called negative symptoms because the behaviour or emotion has been removed from the normal range of behaviours.

Neuroleptics – Another name for anti-psychotic medication

Paranoia – An insidiously developing pattern of unfounded thoughts and fears, often based on misinterpretation of actual events. People with paranoia may consider themselves endowed with unique and superior abilities or may have the delusion that others are conspiring to do them harm.

Positive Symptoms – Symptoms such as delusions, hallucinations, disorganised thinking and agitation (called positive because the behaviour adds to what is considered normal).

Prodrome – A period of change in behaviour and low-grade symptoms experienced before an episode of psychosis.

Psychosis – This is a group of mental disorders that includes loss of contact with reality eg hallucinations or delusions and breakdown of normal social functioning and extreme personality changes. A psychotic episode may be short lived or chronic.

Psychotherapy/Psychological Intervention – A form of treatment for mental disorders based primarily on verbal communication between the patient and a mental health professional, often combined with prescribed medications. Psychotherapy can be conducted in individual sessions or in a group.

Symptom – A feeling or specific sign of discomfort or indication of illness.

Parts of this list of terms was developed by the Australian and New Zealand College of Psychiatrists and published in the Australian and New Zealand Schizophrenia treatment guide for consumers and carers.

Page last updated: 30 October 2018

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