The term psychosis is used to describe conditions characterized by a loss of contact with reality.

Early identification of psychosis: a primer. Early Psychosis Initiative of British Columbia. 2000.

Periods of psychosis are often accompanied by disturbances in perception and reasoning, where an individual may have trouble distinguishing between what is real and what is not.

 

Approximately 3% of individuals will have a psychotic episode at some point in their life, with 80% of those people experiencing their first episode between the ages of 16–30.

 

Causes and symptoms of psychosis

Schizophrenia is the most common cause of psychosis. However, substance abuse, extreme stress, mood disorders, as well as inherited or acquired medical conditions can also lead to psychosis.

A family history of psychosis has also been linked to an increased risk of susceptibility to psychosis. For instance, children of individuals diagnosed with schizophrenia are at increased risk of developing psychosis associated with schizophrenia compared with the general population (13% vs 1%, respectively).

Psychosis symptoms can be classified as positive or negative. Positive symptoms can include delusions and hallucinations, while negative symptoms can include loss of motivation and poverty of speech. Patients may also experience secondary features such as sleep disturbances, social withdrawal, and agitation, as well as behavioral changes.

 

Consequences of delayed treatment

Prolonged duration of untreated psychosis is thought to be predictive of worse outcomes. Research has shown that for patients diagnosed with schizophrenia, only 13.5% are able to achieve recovery. Such outcomes haven’t improved significantly in recent years.

This is due in part to a lack of modifiable predictors of outcomes. However, reducing the duration of untreated psychosis has been extensively studied as a predictor of outcomes in patients with schizophrenia. Studies have shown a link between long duration of untreated psychosis and poor outcomes in the first years of illness.

To fill this gap, a study published by the British Journal of Psychiatry found a small (yet consistent) relationship between long duration of untreated psychosis and long-term poor outcomes, highlighting the need for early intervention strategies to diagnose and treat psychosis.

Penttilä M, Jääskeläinen E, Hirvonen N, et al. Duration of untreated psychosis as predictor of long-term outcome in schizophrenia: systematic review and meta-analysis. British J Psych. 2014;205(2):88–94.

 

A delay in treatment can lead to:

• Poor prognosis—and worse outcomes

• Substance abuse

• Unnecessary hospitalizations

• Strained relationships with family and friends

• Disruptions to studies or employment

• Disruptions to family life for young mothers/fathers with psychosis

 

Tips for clinicians

Clinicians may have difficulty recognizing that a patient is experiencing their first episode of psychosis. In general, patients may not share that they are having psychotic symptoms.

Even in cases when individuals go to clinicians for help, they may present with vague symptoms such as general feelings of stress or feelings that something is amiss. In other cases, patients present with sleep disturbances that can be common to other psychiatric diseases.

Clinicians should always consider underlying psychological disturbances for patients that present with persistent yet ill-defined complaints without any evidence of physical illness.

As a first step, healthcare professionals should aim to build a trust-based relationship with patients they suspect are experiencing psychotic symptoms in an effort to facilitate open communication. The second step is to obtain information to determine if a referral to a qualified professional is warranted.