Published Mon, 2012-02-13 16:20; updated 39 weeks ago.
"We know that if people are left untreated for long periods, their outcomes are poor," says Swaran Singh, professor of social and community psychiatry at Warwick Medical School.
"Stigma is the main barrier to getting treatment but if people are treated early on, they have every chance of going on to lead a normal life."
What is psychosis?
Psychosis is a condition where individuals lose contact with reality. It characterised by hallucinations and delusions.
Hallucinations can include hearing voices that exist only in their own minds. Delusions are abnormal notions that exist despite evidence to the contrary – like being spied on.
Someone suffering from psychosis in the early stages might be withdrawn because of handling the voices and behave in unusual ways in response to their delusions.
In the later stages, someone might lose motivation and be unable to feel emotions. Not knowing that something is wrong can also be a part of the condition.
"It’s about a loss of sense of self, the boundaries of the self breakdown," says Prof Singh. "Someone experiencing psychosis can’t tell what’s inside the self and what isn’t."
A number of mental illnesses are classed as psychotic disorders. Common ones are:
- Schizophrenia Bipolar disorders (manic depression)
- Shizoaffective disorder
- Psychotic depression
- Delusional disorder
- It can be caused by physical conditions like Parkinson’s disease or by drug or alcohol abuse.
What stops people getting the treatment they need?
Psychosis is a young person’s condition. In about 75% of cases, the illness begins between the ages of 16 and 30.
Signs of psychosis would be that the young person has become a bit withdrawn, is self pre-occupied, has become very interested in a cult or religious ideas.
In the early stages, when treatment is most effective, it can be difficult to distinguish psychosis from ordinary adolescence. A young person might become a bit withdrawn, be self pre-occupied, become very interested in cult or religious ideas.
"If the illness begins very suddenly, family members will realise there has been a dramatic change and will seek help. But sometimes the changes occur very slowly over a period of years, when it can be hard for families to see that help is needed," says Prof Singh.
In the past there has been a tendency to avoid making a diagnosis of psychosis.
In the 1960s and 70s, there was an anti-psychiatry movement, which strongly opposed viewing mental disorders as sickness. The popular thinking was that people were not ill, they were just different.
Later concerns about stigma meant even mental health clinicians were reluctant to diagnose psychosis in young people.
"I trained in India and when I came to this country I was astounded at the number of people who clearly had psychosis but who were not getting diagnosed," says Prof Singh.
"There would be collusion between the doctor, the family and the young person. The doctor did not want to the diagnosis because of concerns about 'labelling' the young person.
"The family wanted to believe that this was a short-term reaction to stress or drug use. The young person, often attending against their will, would disengage from treatment as soon as they could."
What are the benefits of intervening early?
The West Midlands has been at the forefront of the development of early intervention in psychosis services. These services have dedicated teams of highly skilled professionals who work with young people in the early stages of psychosis in their own homes, rather than in hospital.
Such an approach has been proven to work because the team is better able to engage the young person and see the treatment through.
With early intervention, young people have better recovery, are less likely to need hospital admission and are much more likely to return to work or education. Such teams have now been established all over England, several European countries, Canada and Australia.
"A major component of care has been the education of patients and their carers on the nature, causes, treatment and outcome of psychosis," says Prof Singh.
Due for review August 2013