Seeking More Information

As we have discussed in previous chapters, it is very important for people with psychosis and their family members to learn about psychosis and effective treatments. This sort of learning is an important step towards recovery and preventing a relapse. However, seeking information to better understand psychosis can be frustrating at times. The amount of information received from mental health professionals and other sources can be overwhelming. However, aside from this book, very few books focus on first-episode psychosis. When searching the Internet, it is difficult at times to tell the difference between Web sites with correct and helpful information from those that contain opinions and confusing information. This chapter describes the benefits of educating yourself about psychosis and then describes different resources that are available. As discussed in Chapter 7 on Psychosocial Treatments for Early Psychosis, psychoeducation is a type of education that focuses on the topic of mental illnesses. The goal of psychoeducation is to help individuals with a mental illness, and their family members, better understand the illness. If a person understands his or her illness, then he or she will be able to deal with it more successfully. Psychoeducation, for both patients and their families, is an effective form of treatment in itself and an important step in preventing relapse and hospitalization. Research has shown that those who receive psychoeducation are less likely to have a relapse and enter the hospital compared to those who do not receive psychoeducation. The patient’s mental health professional is one of the best sources of information. Do not be afraid to ask him or her to explain more if some piece of information is unclear. Another good idea is to bring a list of questions with you when you meet with the mental health professional to make sure that you leave the appointment with all of your questions answered. Asking questions and getting answers helps you become confident that you understand the next steps. Worksheets provided in Chapters 2 and 9 will help you keep track of information that may be important to share with the mental health professional.

Reducing Stress, Coping, and Communicating Effectively: Tips for Family Members and Patients

As discussed in previous chapters, psychosis often first begins in late adolescence or young adulthood. Thus, many people who experience a first episode of psychosis live with and rely on their families for support. In addition to providing a place to live and other basic support, families are key in the recovery process because they love and care for the person with the illness and they want to help. Family members may need to provide emotional support, arrange for treatment, and find new ways to cope with the signs and symptoms of psychosis or other problems that result from the illness. Families are a very important part of the team that is necessary to properly manage psychosis. In fact, now that more effective antipsychotic medicines and psychosocial treatments are available, many people with psychosis often can receive treatment in the community and with their families rather than having extended stays in the hospital. Families play a major role in helping their loved ones manage their illness. As a result, it is vital to create a supportive family environment by reducing stress, coping, and communicating effectively. This chapter focuses on three essential domains of a supportive family environment: reducing stress, enhancing coping, and ensuring effective communication. First, we begin by defining …Families play a major role in helping their loved ones manage their illness. As a result, it is vital to create a supportive family environment by reducing stress, coping, and communicating effectively.… stress and the ways that the early stages of psychosis can lead to stress. We discuss three ways to reduce stress in the family as well as three related ways the family can help the patient to reduce stress. Second, we define coping and talk about the importance of coping with a stressful event, like an episode of psychosis in a family member. We offer three ways of coping effectively for family members as well as three ways that patients can practice effective coping. Third, we address the value of good communication and how the symptoms of psychosis can sometimes interfere with productive communication patterns. We then provide eight points of advice for effective communication within the family.

What Causes Primary Psychotic Disorders Like Schizophrenia?

Doctors and researchers have been able to identify the causes of a variety of medical conditions, such as the common cold, a heart attack, and gout, to name a few. For example, there are different types of viruses that cause the symptoms of a common cold. By knowing what causes a medical problem, doctors are able to treat the condition in the most focused way possible. In the previous chapter, three general categories of causes of psychosis were presented: medical causes, substances, including certain drugs of abuse and several medicines, and a number of psychiatric illnesses. This chapter presents what is currently known about the causes of the third of these, psychiatric illnesses, especially primary psychotic disorders like schizophrenia. Some health conditions have a single, straight-forward cause. As mentioned earlier, a common cold is caused by a virus. However, many illnesses do not have a single identifiable cause. Rather, they are caused by a combination of risk factors. A risk factor is any event, exposure, or entity that occurs before the illness and that research has shown plays a role in causing the illness. For example, cigarette smoking is a well-known risk factor for lung cancer. Smoking occurs before the lung cancer develops, and researchers have proven that smoking cigarettes plays a part in causing many cases of lung cancer. Because schizophrenia and related psychotic disorders are such complex illnesses, it is sometimes unclear if some of the risk factors truly occur before the illness. Some risk factors may make some people more psychosis-prone. In other words, some risk factors are best thought of as increasing one’s tendency towards psychosis rather than actually causing psychosis. Over the past several decades, researchers have identified some of the likely causes of complex medical conditions like diabetes, high blood pressure, and psychosis. For each of these, as is true of most medical conditions, there is no single cause. Rather, a number of risk factors, both internal (like certain genes) and external (like exposures that stress the body, such as stressful life events or drugs) combine in complex ways to bring about the illness.

Understanding Mental Health First Aid for Psychosis

Throughout this guide, we have tried to explain all parts of a first episode of psychosis in a detailed way. But what happens if you know someone who may be experiencing an episode of psychosis and you have to act fast or help them get into treatment? This last chapter includes advice on how to provide mental health “first aid” to those who may be experiencing an episode of psychosis. These guidelines were developed by and reprinted here with permission from Professor Anthony Jorm and Ms. Betty Kitchener from the University of Melbourne and ORYGEN Research Centre in Melbourne, Victoria, Australia. As a result of an extensive process, they are based on the agreement of a panel of patients, family members, and mental health professionals from Australia, Canada, New Zealand, the United Kingdom, and the United States. For more information on their Mental Health First Aid program, please visit www.mhfa.com.au. The remainder of this chapter is organized around nine questions that are addressed to help people who may need to provide “first aid” to someone experiencing psychosis. The purpose of these guidelines is 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 he or she receives appropriate professional help or the crisis resolves. These guidelines are a general set of recommendations about how you can help someone who may be experiencing psychosis. Each individual is unique, and it is important to tailor your support to that person’s needs. So, these recommendations will not be appropriate for every person who may have psychosis. It is important to learn about the early warning signs of psychosis and the symptoms of psychosis so that you can recognize when someone may be developing psychosis. Although some of these signs may not be very dramatic on their own, when you consider them together, they may suggest that something is not quite right. It is important not to ignore or dismiss such warning signs or symptoms, even if they appear gradually and are unclear.

Fighting Stigma

Mental health professionals now understand more about mental illnesses than ever before. Effective treatments are available that support many people with mental illnesses living full and productive lives. Despite this and the general public’s broader understanding of mental illnesses, negative and incorrect beliefs about these disorders continue. These incorrect beliefs include that mental illnesses are moral failures and that people with mental illnesses are dangerous, incompetent, and unable to function in the community. This can cause persons with mental illnesses and their families to delay seeking treatment in an attempt to avoid being labeled with a mental illness diagnosis. Once diagnosed, they may worry about people finding out and treating them differently. They may experience discrimination in various parts of their lives. This is due to the stigma of mental illness. The traditional definition of stigma is a mark of shame that usually lasts forever. Stigma can have negative effects on both the affected person and his or her family. The stigma related to mental illnesses often begins when doctors diagnose the patient with a mental illness. This diagnosis, or label, sometimes links the patient to stereotypes, or negative ideas, about people with a mental illness. However, stigma can also begin even before a diagnosis, when the affected person begins to display signs and symptoms of an illness. These signs and symptoms (such as talking to oneself or having unusual beliefs) may link the person to negative ideas about those with a mental illness. The stereotypes that society holds about people with mental illnesses are usually wrong. Examples of such ideas are that a person with a mental illness is dangerous, not very intelligent, and unable to work. Other false ideas are that the person has no self-control and will never recover. Stereotypes can cause others to view people with mental illnesses as different and less human. Not understanding these disorders, others may look down upon or think less of those with a mental illness. As a result, patients and their families may feel that they are less important, or they may feel discriminated against. They also may feel that the stereotypes about those with a mental illness are in some way true.

Psychosocial Treatments for Early Psychosis

People experiencing psychosis often have to deal with a number of problems. These problems may stem from certain symptoms. As explained in Chapter 2, these symptoms may include positive symptoms (such as hearing voices or having unusual beliefs), negative symptoms (such as being isolated, withdrawn, or slow), cognitive dysfunction (such as difficulties with attention, learning, or memory), and other types of symptoms. However, psychosocial difficulties (like problems with school, work, relationships, and recreation/leisure activities) may disrupt life as well, even though they are not necessarily thought of as symptoms. Unfortunately, these types of problems are very common for people dealing with a psychotic disorder. Treating the se difficulties in addition to the specific symptoms is necessary to begin to feel better and to live a full life. In fact, the recovery process focuses as much on resuming school, work, relationships, and leisure activities as it does on remission (see Chapter 11 on Promoting Recovery). Although medicines are extremely important in treating symptoms, especially positive symptoms (see Chapter 6 on Medicines Used to Treat Psychosis), another type of treatments, called psychosocial treatments, focus more on helping patients with these broader problems. Normal psychosocial development begins in childhood but continues throughout adolescence and early adulthood. Adolescence and early adulthood are extremely important times when most people develop social skills and build relationships. Late adolescence and early adulthood is typically a time of finishing high school, starting college, getting a first job, having a first romantic relationship, beginning to live more independently from parents, buying a car, and establishing career goals. Success in all of these domains of life requires both psychological skills and social skills. The term psychosocial brings together these two words. So, psychosocial development refers to the important developmental stage when psychological and social skills mature. Unfortunately, for people who develop a psychotic disorder, late adolescence and early adulthood is the period of time when a first episode of psychosis usually begins. Thus, psychosis that first happens in this time period often interrupts psychosocial development, leading to psychosocial problems. Psychosocial problems refer to difficulties at school, at work, in relationships, or in recreation and leisure activities.

What is Psychosis?

We began the Preface with a list of questions that people experiencing psychosis and their family members often have. As we mentioned, an episode of psychosis can be frightening, confusing, and painful for the individual going through it and for his or her family members. We also noted that this book is meant to help readers through a very difficult time by providing much needed information. Part 1 of this book, Answering Your Basic Questions, focuses on explaining some of the most important facts about psychosis. This chapter addresses the first basic question, what is psychosis? In this chapter, we define what psychosis is and then dispel some myths by describing what psychosis is not. We then briefly describe what percentage of people develop psychosis and when it usually first begins. Next, we present the idea of a “psychosis continuum,” which means that experiences of psychosis can differ in level of seriousness. We then set the stage for later chapters by briefly introducing schizophrenia (one of the illnesses that is related to psychosis) and several other topics to come later in the book, including causes of psychosis, treatments, and recovery. Psychosis is a form of mental illness. A mental illness affects a person’s thoughts, feelings, and behaviors. Like physical illnesses, mental illnesses are treatable. Psychosis is a treatable mental illness syndrome. You may be familiar with some other mental illness syndromes, such as depression, posttraumatic stress disorder, and panic attacks. So what exactly does psychosis mean? Psychosis is a word used to describe a person’s mental state when he or she is out of touch with reality. For example, a person might hear voices that are not really there (auditory hallucinations) or believe things that are not really true (delusions). Psychosis is a medical condition that occurs due to a dysfunction in the brain. People with psychosis have difficulty separating false personal experiences from reality. They may behave in a bizarre or risky manner without realizing that they are doing anything unusual. Similar to any other health condition, psychosis consists of a combination of both symptoms that patients experience and signs that doctors observe.

Staying Healthy

To move towards recovery after a first episode of psychosis, patients must focus on both their mental and physical health. People with a serious mental illness are usually less healthy than those without such an illness. This may be because of the illness itself, fewer opportunities for health care, or unwanted effects of the medicines taken to treat mental illnesses. People with a long-lasting mental illness sometimes also deal with other issues, such as cigarette smoking, drug abuse, unhealthy eating habits, little exercise, and having few relationships with others. Even though it can be difficult at times, living a healthy lifestyle is necessary for patients to feel better and move towards recovery. In this chapter, we discuss problems sometimes faced by people with psychosis and ways to deal with and overcome these issues. Specifically, this chapter focuses on the importance of not smoking cigarettes, staying away from alcohol and drugs, having a healthy diet, getting plenty of exercise, and having good social support from family and friends. One problem sometimes faced by people with psychosis is cigarette smoking. About one in five people in the general population in the United States (about 21%) smoke cigarettes. Fortunately, this percentage is now decreasing because of the growing awareness of the health risks posed by cigarette smoking. However, a large percentage of people with psychosis smoke. For example, most people with schizophrenia (between 50% and 90%) smoke cigarettes. What’s more, this percentage has not decreased in recent years. People with psychotic disorders also have smoking behaviors that can cause even greater harm. Some of these behaviors include smoking heavily—up to two or three packs a day—and smoking cigarettes down to the filter where the greatest concentration of nicotine is. Why are people with psychosis so likely to smoke, and to smoke so heavily? Most researchers believe that it is because of the relationship between cigarette smoking, nicotine, and the symptoms of psychosis (see Chapter 2 on What Are the Symptoms of Psychosis?). Nicotine is a drug that affects anyone who uses it. In most people, nicotine may slightly improve attention and memory.

Early Warning Signs and Preventing a Relapse

In this chapter, we discuss early warning signs, which are signs and symptoms that often occur before an episode of psychosis. These signs and symptoms, though mild, may occur before the first episode of psychosis and also before later episodes. That is, some mild signs and symptoms may occur during the prodromal phase of the illness, before psychotic symptoms first develop. These same signs and symptoms often serve as warning signs before another episode of illness, or a relapse of psychosis, occurs. So, it is important to be familiar with early warning signs and what to do if they begin to develop. Many people who have had a first episode of psychosis will go on to have one or more relapses of their illness. A relapse happens when symptoms appear again. Some relapses may happen with little or no warning over a short period of time, such as a few days. However, most relapses develop slowly over longer periods, like a few weeks. A relapse may or may not require hospitalization, but it definitely calls for immediate attention, evaluation, and treatment. After a stay in the hospital or after outpatient stabilization, some people feel better quickly. Others take weeks, or even months, to function as well as they had before the relapse. One way of avoiding a relapse is to stay in treatment and attend all follow-up appointments (see Chapter 8 on Follow-up and Sticking with Treatment). Also, it is very important to become aware of one’s specific early warning signs, which are changes in thoughts, feelings, and behaviors that happen a few days or weeks before an episode (reappearance of symptoms). By carefully watching for these signs, patients, their families, and their mental health professionals can work together to help lessen the severity of any episode that may occur. Relapse prevention is the goal of preventing a relapse altogether, by sticking to treatment and watching for early warning signs. The first step in determining one’s specific early warning signs is to think back to the changes that occurred in the prodromal period of the illness, or the time just before the first episode of psychosis. While there are common early warning signs, they will show up slightly differently in each person. Early warning signs in one person may be clear and easy to detect, while in another person they may be trickier to figure out. Early warning signs are signals that symptoms are beginning again and that another episode of psychosis may happen.

Medicines Used to Treat Psychosis

Mental health professionals treat nearly all psychiatric illnesses using two types of treatments: medicines and psychosocial treatments. This is true for psychosis as well. We describe medicines used to treat psychosis in this chapter and psychosocial treatments for psychosis in Chapter 7. Medicines are a crucial part of the treatment plan for people who experience a first episode of psychosis. In fact, many mental health professionals view medicines to be the most important aspect of the treatment of psychosis. This is because psychosocial treatments are usually more effective when medicines help to adequately control symptoms. We discuss a number of medicines in this chapter. When a specific medicine is mentioned, two names are given. The first is the generic name and the second (in parentheses) is the trade name in the United States. For example, Tylenol is the trade name of the generic pain medicine called acetaminophen. Anyone taking medicine should be familiar with both the generic and trade names of the medicine, even though the generic names are sometimes more difficult to spell or pronounce. This chapter begins with an overview of the class of medicines used to treat psychosis, called antipsychotic medicines, or just “antipsychotics.” Before explaining antipsychotics in further detail, we set the stage by defining how antipsychotics work and some side effects and other serious problems called adverse events that may occur when taking antipsychotics. We then describe in more detail the two main types of medicines used to treat psychosis, the so-called “conventional” antipsychotics, and the “atypical” antipsychotics. Some mental health professionals refer to these as “first-generation” and “second-generation” antipsychotics, respectively. Then, we discuss the sometimes difficult task of finding the right medicine. We end by addressing two commonly asked questions about antipsychotic medicines: “Why is it important to take the medicine?” and “How long should the medicine be taken?” As mentioned earlier, the main types of medicines used to treat psychosis are the antipsychotics. These medicines are “antipsychotics” because they fight against (“anti-”) psychotic symptoms. As discussed in Chapter 1 (What Is Psychosis?) and Chapter 2 (What Are the Symptoms of Psychosis?), psychosis is a state of not being well-grounded in reality, due to symptoms like hallucinations or delusions.