Psychosis

A psychotic episode is when you cannot tell the difference between what is real and what is not real. For example, you are hearing voices and there is no one there or you are smelling smoke and there is no fire.The symptoms of psychosis are different for each person and can change over time.

What are the symptoms of psychosis?

Signs or changes you may experience with psychosis include:

  • Experiencing things that do not exist that involve our senses
  • Hearing things, seeing things, tasting things, smelling things or feeling things, that are not real like smelling smoke all the time. These are called hallucinations. The most common hallucinations are auditory ones hearing voices or sounds that others don't hear.
  • Having problems thinking and communicating. Problems concentrating, confusion, racing thoughts, remembering or even completing a thought.
  • Having beliefs that others around you eg; friends and family don't share. These ideas are called delusions and they may start to take up a lot of your time and concern. A common delusion is a belief that people are watching you or are out to harm you. Another one is a belief that you have special powers such as being able to change the weather or control world events. Or that you can control others' minds or that they are controlling yours.
  • Experiencing problems with feelings. Out of control emotions or feeling numb. Feeling the wrong thing at the wrong time eg; your dog dies and you can't stop smiling despite feeling real grief. Depression, agitation or feeling really high and elated without the use of street drugs.
  • Having trouble with behaviour. Problems with ordinary things like getting dressed, keeping clean or taking care of yourself. Often just getting up in the morning is a problem or getting a shower.
  • Other changes. Sleep and eating problems. Lack of motivation. Lack of interest in friends. As well as withdrawing from life, school and normal activities. You can feel totally apathetic just can't get the energy up for doing anything.
What causes psychosis?

In general, we don't know. What we do know is:

  • 3 out of every 100 people will have a psychotic episode.
  • If your have a family member who has experienced some kinds of psychotic events, you are more likely to be vulnerable.
  • If your are between the ages of 16 and 25, you are at higher risk.
  • Brain chemistry affects psychosis as does genetics and biology.
  • Drug use, especially marijuana, can trigger a psychotic episode as can the use of other drugs like cocaine, LSD, crystal meth and alcohol.
  • Psychotic symptoms may be part of a number of illnesses including schizophrenia, severe depression, bipolar disorder and post-traumatic stress disorder.
  • Stress can play a role in psychosis. Some people are more sensitive to their environment and to stress and are therefore more likely to develop psychosis when exposed to these things.
  • Psychosis may start slow or erupt suddenly, usually in late teens or early 20's. When in doubt, a thorough medical assessment should be the first step in treatment, to help rule out physical illness as the cause e.g. a head injury.
Why should I get treatment for psychosis?

Why suffer when recovery is possible? "Psychosis is a medical condition that responds well to treatment. With prompt and appropriate treatment, most people will recover fully" Canadian Mental Health Association (see resources). Getting quick treatment for a first episode can be critical. Psychosis does not usually get better on its own. Getting professional help as soon as possible can make a big difference in your recovery time and the intensity of treatment required to manage the event.

Getting treatment can change the picture, even before a diagnosis. The beginning of psychosis may be delayed by medication according to the Yale School of Medicine. The use of anti-psychotic drugs can "lower or delay" the rate of psychotic events in youth who seem to be developing early signs of schizophrenia.

How can I cope with changes?

Treatment today involves low-dose, anti-psychotic medications, education, coaching/counselling and support. The more you know, the better you will cope. Ask questions and get your family or friends involved. Bring them to appointments and invite them to get help through family support programs (see resources). Build a personal support network. Apathy and depression, two commons symptoms of psychosis, can be so challenging, building a personal, informed support network is important.

Medication is an important part of treating psychosis as it reduces symptoms and prevents relapse. The medications used for treating psychosis are called antipsychotics and are usually divided into two categories.

  • Typical antipsychotics are older medications which include haloperidol, loxapine and many others
  • Atypical antipsychotics are newer medications which include risperidone, olanzapine, quetiapine and clozapine
  • There are also other medications that are sometimes used along with antipsychotics, depending on the symptoms. For example, antidepressants or mood stabilizers may be used for problems with mood

Antipsychotics differ in terms of side effects. Many side effects are reduced over time and some people do not have any side effects at all. If you are prescribed a medication and have any questions or concerns about it or any side effects, it is important to speak with your treatment team or your doctor. Often, a medication can be adjusted or changed to reduce side effects.

How can I get control of my life?

Part of the treatment process can be getting support through a local agency. Working with your peers in a group to learn to manage issues like lack of motivation, maintaining a normal schedule, managing stress, staying connected to friends and prior activities can be an important part of recovering from earlier symptoms. One-to-one counselling can help you regain your composure and confidence or get a job. The counsellor can help you and your family to better manage all parts of your life.

In short, counselling whether peer, group or one-to-one can help you regain active control of your life.

For how family can help support a loved one, click here.

Will I be able to recover?

Most people who get into treatment early will have good recovery. The earlier psychosis is treated the greater the chance for a successful recovery. If psychosis is left untreated there is often a greater disruption in relationship and life plans like school and work. Sometimes people in treatment will still have some symptoms but they can learn how to cope with them.

Recovery is Different for Each Person. Treated symptoms can quickly disappear or diminish enough that you can get on with your life. Some people may need weeks or months to recover. There will be other individuals who will need medication and support for the rest of their lives. Some individuals will be treated in hospital and some will be treated on an out patient basis or a combination of both at different times.

Sometimes when people start feeling better they decide to go off their medication. This can cause a relapse of symptoms. With each relapse it can take longer to recover and the person might not make a full recovery. If you are thinking about going off your medication, talk to your doctor/treatment team so that you can come up with a plan together, eg; maybe slowly reduce the medication and have more frequent appointments to ensure symptoms are not returning.

Over time, an individual with recurring symptoms will return to treatment to have their medications assessed or changed. This may be necessary throughout their lives as they mature for a variety of reasons. One cause of diminishing effects of specific medications has to do with the developmental phases of the body. For example, a 16-year-old will not encounter the same effects from a medication when they are 40. Or the fact that personal chemistry or hormone levels may change eg; after childbirth and around menopause. These are just some of the factors determining long term recovery.

Frequently asked questions about psychosis

What about my future? With treatment and support you can continue to follow your dreams. There are many people with psychosis who are attending high school, college or university. Many others are working and in positive relationships. You may need to take things a bit slower while you are recovering but you can still strive and meet your goals.

Will I be put into an institution or life in a psych ward? Many people with psychosis can be treated in the community by visiting a local mental health clinic regularly. In some cases hospitalization might be required but usually for just a short time.

Does this mean I'm 'crazy'? No, you are not crazy. You have an illness. Psychosis is a medical condition like any other, however it affects the brain. A person with psychosis needs to follow medical recommendations and take steps to stay well, through treatment, follow-up and support just like an individual with diabetes needs to monitor their blood sugars and have treatment to stay well. Psychosis is just a part of you. You are still the same person with skills and talents and interests. You just have some additional challenges to be aware of now.

How do medications work and how long will they take to work? The medications help to bring the chemicals in the brain back into balance and stop the symptoms. This is different from person to person. It is really important to speak with your doctor about what is best for you. Some people are on medications for a lifetime (just like with diabetes). Others can reduce their medications and sometimes stop them eventually but only with the supervision of their doctor.

What if I take myself off medication when I'm feeling better? Many people do stop taking the medications when they start feeling well, just like many people stop taking antibiotics before the prescription runs out. Unfortunately most people with psychosis who stop taking their medication abruptly will experience a relapse of symptoms. This can happen within days or months and may then interrupt your plans to attend school or work or other things. If you feel like stopping your medications talk with your doctor about it.

What if I can't afford the drugs? Talk with your doctor about this. There are often programs that will help with the costs of medications.

Can I still drink/ use marijuana/ take other party drugs? Using marijuana can increase the risk of relapse and slow down the recovery. It can also increases the risk of developing other problems such as depression and anxiety. Alcohol use can react dangerously with some medications. It is important to discuss this with your doctor and ask what amounts would be safe. Recovery can be slower and the risk of relapse is higher if you take party drugs. Even if you have no plans to change your use of drugs or alcohol, it is important to be truthful about your use so that the treatment team can have a better understanding of "the whole picture" and be the most helpful. Don't worry they have seen lots and heard lots so they won't be judgmental.

I've gained weight. Weight gain can be a problem for some people. Sometimes the medication can affect the part of your brain that tells you, you are full so you want to keep on eating. Other times if you have been withdrawing from life because of your symptoms you might not be as active as you were before. Try to find activities you enjoy. You may feel unmotivated, but challenge yourself. Even walking a bit each day can help. Maybe a friend or family member will join you for company. Also, keep an eye on the amount you are eating and try to include healthy food like fruits and vegetables. Ask for help with this if it is a problem.

I just can't get motivated. This is common in psychosis. Try taking one step at a time. Maybe you will start with making sure you take a shower every day for a week and then add something else on. Ask for support from people close to you.

If my life will ever get better. How? Things will get better. Just take one step at a time. Set some realistic short and longer term goals and don't put too much pressure on yourself in the beginning. Don't be afraid to ask for help and get educated about the illness so that you feel you have some control. If you like writing maybe keep a journal about how you are doing day to day. Then you can look back and see how far you have come in your recovery.

How do I deal with my family bugging me? Sometimes families do not have a good understanding of psychosis. They may not realize that lack of motivation is common in the beginning. See if someone from the treatment team will meet with you all together to talk about realistic goals. There are also some great websites available where they can learn more (see the resource section).

I'm tired all the time and can't get up.

With school:  It is important to set realistic goals with school in the beginning. Some people will take a bit of time off from school or reduce the school load for a semester or two. Speak with a school counsellor about your options. Sometimes they are able to make accommodations to meet your needs, eg; having longer to write exams etc.

With friends:  Friends are important and you don't want to lose touch but you might want to scale back your socializing in the beginning. Some people who are experiencing symptoms find it hard to be around big groups of people. Perhaps you might spend shorter times with one or two friends at a time for a while and stay away from big parties.

With a job:  It is important to set realistic goals with work as well. Talk with your treatment team about strategies for being successful at work. Many people take some time off for a while and then return part time for a while until they are fully recovered. Find out about your options and the best way to approach your employer.

More information...

It takes courage to ask for help. Remember this can happen to anyone. It is not a sign of weakness. It can be hard to tell family and friends but if they are aware of what is happening they can be better supports. Often friends and family have noticed changes and are concerned but are not sure what is going on. Start by telling someone you trust, perhaps they will come with you to some appointments and learn more about the illness and how they can help.

Canadian Mental Health Association

Centre for Addiction and Mental Health

Get Help Early

e-mentalhealth.ca

The National Institute of Mental Health

The Prevention and Early Intervention Program for Psychoses (PEPP)

Psych Central

Psychosis Sucks

Centre for Suicide Prevention

Schizophrenia Society of Ontario