I live with psychosis. This symptom of my bipolar disorder has had a devastating impact on my mental health and my life — including extensive professional and personal disruptions, family conflict, multiple involuntary hospitalizations and an arrest. That’s why I believe that anything and everything must be done to identify and treat the signs of early psychosis, with the hope of preventing or reducing symptoms.
The early identification and treatment of psychosis is possible. In many people, it can even prevent the development of a full-fledged episode of psychosis, which can lead to a better long-term prognosis. Research shows that early treatment for first-episode psychosis results in greater improvement in quality of life and symptoms compared to usual community care.
Studies estimate that between 15 and 100 people out of 100,000 develop psychosis each year, presenting many opportunities for early intervention.
Understanding The Symptoms of Psychosis
To identify psychosis, we must first understand what it looks like.
There are a few types of symptoms associate with psychosis:
- Positive symptoms: when a person experiences a change in their behavior or thought. The most common positive symptoms are delusions (false beliefs) and hallucinations (seeing or hearing things that others do not see or hear).
- Negative symptoms: when a person experiences withdrawal, isolation, lack of motivation and feeling that they can’t feel their emotions.
- Thought disorder: refers to an impaired capacity to sustain coherent discourse and occurs in the person’s written or spoken language. Disordered thinking might include paranoid delusions, ideas of reference or hallucinations. Disordered forms of thinking involve a disorganized flow of ideas that may become illogical, tangential or otherwise hard to comprehend.
People may also experience “attenuated” symptoms, which are milder symptoms that sometimes precede the development of a full-fledged illness. For example, instead of someone having a severe delusion like, “the FBI is following me and controlling my every mood through mind control” — they might have a milder one like, “I wonder if something might be happening that I don’t understand and is affecting me.”
According to recent studies, 73% of young people at clinical high risk (CHR) for psychosis do not develop psychosis within the first two years of follow-up. Nearly half of these individuals who do not “convert” to psychosis experience full remission from attenuated psychotic symptoms (APS), but may still experience other challenges, like difficulty with social interaction.
Early Identification of Psychosis
Most of the time, when a person begins to develop psychotic symptoms, it goes unrecognized. A self-screening test may help. A primary doctor may be able to detect early psychosis and refer the person to an early psychosis intervention clinic. There are 500 first-episode clinics and 100 psychosis risk clinics in the U.S.
The PRIME Clinic
The PRIME Clinic is a leading early psychosis intervention clinic in the U.S. that offers many free services. Two of the most important services are an evaluation and assessment interview and cognitive behavioral therapy for psychosis (CBTp).
For evaluation and assessment, the PRIME clinic uses the Structured Interview for Psychosis-risk Syndromes (SIPS). SIPS is a semi-structured interview, met to be administrated by a person who has some clinical training. Some questions are meant to be delivered verbatim and some questions clinicians can deviate from in an unstructured way. It takes about 30 minutes to two hours and has been used very extensively in U.S.
CBTp is an evidence-based practice, which was developed to reduce the distress associated with the symptoms of psychosis and improve functioning.
The mission of the STEP program is to:
- Reduce the impact of psychosis on educational, occupational and social functioning
- Determine the effectiveness of intensive early intervention on long-term functioning
- Determine whether intensive early intervention is practical and economically feasible
- Model what an early intervention service should look like
Facilitate research to better understand psychotic illnesses and develop new treatments
Developing a treatment plan is an ongoing process, as there is no single perfect treatment for everyone experiencing psychosis. Because early psychosis includes many symptoms – including depression, anxiety, and cognitive difficulties – many types of psychosocial treatments can be helpful. While medication can be a valuable part of the treatment plan, many individuals choose to explore non-medication treatment options before including medication.
Family should let their loved know that they are not alone, and many people have this condition. They should emphasize that improvement and remission is possible and that there is cause for optimism. It is important to encourage a loved one to get into treatment and be open to talking about it. It may also be helpful to discuss lifestyle factors (like marijuana use) and how they can affect symptoms and treatment.
Part of family support may also involve recognizing that family dynamics may need to be addressed through therapy. Research shows that family stress, conflict, criticism and communication issues contribute to the experience of mental illness. As a result, family therapy can help achieve better treatment outcomes for the loved one with mental illness.
The Accelerating Medicines Partnership program for schizophrenia – a public-private partnership between the NIMH, the FDA, and multiple organizations including NAMI – is one of the most important developments in the field. With a budget of more than $117 million, the program’s goal is to establish an international research network focused on young people at clinical high risk for schizophrenia. With a better understanding of how psychosis conditions develop, researchers will be able to design more effective clinical trials to find new and better treatment options.
Not enough people are aware of how psychosis begins; or that it is much milder when it first starts; or that there are people working on identifying psychosis early. Most importantly, people need to be aware that early psychosis intervention works.
Katherine Ponte is happily living in recovery from severe bipolar I disorder. She’s the Founder of ForLikeMinds’ mental illness peer support community, ForLikeGoals, collaborative goal management, BipolarThriving: Recovery Coaching and Psych Ward Greeting Cards.Katherine is also a New York Certified Peer Specialist-Provisional and a faculty member of the Yale University Program for Recovery and Community Health and has authored ForLikeMinds: Mental Illness Recovery Insights. She is on the NAMI-NYC Board.
I would like to thank Dr. Scott Woods, a leading early psychosis scholar with PRIME Psychosis Prodrome Research Clinic at Yale University for generously taking the time to share his insights and for his heartfelt commitment to the psychosis community.
Additional resources: PRIME Clinic, Yale University, Accelerating Medicines Partnership, Mini-SIPS Study, ProNET: Psychosis Risk Outcomes Network, SAMHSA Early Serious Mental Illness Treatment Locator, and SIPS Training and SIPS Directory.