Diagnosis and Associated Issues Diagnosis of Psychosis
Psychosis affects an individual's thoughts, feelings and behaviours.
Some of the more characteristic symptoms include confused thinking, delusions, hallucinations, changes in feelings (e.g. decreased intensity) and changes in behaviour (e.g. odd or disorganized). When a person is experiencing psychosis it is referred to as a "psychotic episode".
The experience of psychosis varies greatly from person to person and individuals experiencing psychosis may have very different symptoms.
In addition to the symptoms that occur during a psychotic episode, a person often becomes isolated from others or family and social relationships become impaired in some other ways. Difficulties in school and work performance often happen. Secondary problems such as unemployment, substance use problems, depression, self harm or suicide and illegal behaviour can also occur.
Psychosis is a condition and is not a particular disorder. Rather, psychosis is seen in a number of disorders - just as a high temperature is a condition that can be associated with many different illnesses.
Unlike taking someone's temperature, recognizing whether psychosis is present can be difficult – especially when it is in its early stages.
These early stages can be associated with a wide variety of nonspecific changes such as mood swings, taking up of new philosophies or "odd" behaviours or beliefs. Often, because psychosis affects young people, the early symptoms are mistaken for normal teenage behaviour.
A diagnosis of a particular disorder may not be made because:
- For some disorders the psychosis must be present for a certain length of time. The criteria to diagnose disorders often demand that the professional wait and monitor a person for months before a reliable diagnosis can be made. The wait for a proper diagnosis can be frustrating and stressful for clients and families who want to know what is happening.
- The professional might think that the symptoms are the result of drug use and does not assess to determine if an underlying disorder is also present. Just because a person has been using drugs does not necessarily mean that the drug use has caused the psychosis
- The professional believes that making a diagnosis of a psychotic disorder would label or offend the patient and/or family. This is old thinking and reflects the belief that most psychotic disorders have very poor outcomes. It could also reflect the societal stigma attached to psychotic disorders. In either case, the person would end up getting "late intervention" rather than early intervention. The main point of early intervention is to have better outcomes so this waiting is actually not doing the person a favour but could likely be making their future worse.
How is a diagnosis decided?
In order to properly diagnose what specific type of psychotic disorder an individual has, patterns of symptoms must be assessed, often over many months.
A comprehensive assessment is more likely to lead to a proper diagnosis.
Mental health professionals use information from medical and family history along with a physical examination. Sometimes, certain specialized types of assessments (such as a brain scan or assessment of cognitive functioning) may aid in clarifying the specific diagnosis.
Why does the diagnosis change sometimes?
There are a range of disorders that can produce psychotic symptoms. In first-episode psychosis, distinguishing between these disorders can be difficult. Therefore, around 30-40% of diagnoses are changed within three months.
Psychosis is associated with several different mental and physical disorders.
Some examples of specific diagnoses associated with psychosis are:
- schizophreniform disorder
- brief psychotic disorder
- bipolar disorder
- delusional disorder
- drug-induced psychosis
- major depression with psychotic features
- schizoaffective disorder
Prognosis (What Happens To People over Time?)
All the different disorders and diagnoses associated with psychosis are treatable and the great majority of people recover well from their initial episode of psychosis.
The pattern of recovery from psychosis varies from person to person. Some people recover quickly with little intervention. Others may benefit from support over a longer period.
Following recovery from a first episode, a significant number of people (close to 20%) will never experience a second episode (called a relapse) of psychosis.
However, the risk of relapse is greatly increased if medication and other treatments are discontinued too soon. Also, although everyone would hope to be in the group that does not experience a second psychotic episode, the fact is there is no reliable way to predict which individuals belong to that group.
People can make a good recovery even if they still continue to experience some symptoms. There are good techniques for managing symptoms that persist in spite of taking medications.
The likelihood of a good recovery is much better with proper treatment. Support from family and friends can greatly improve recovery.
Many people who experience psychosis also experience other difficulties including (but not limited to):
- Mood changes
- Stress and anxiety
- Substance use problems
- Cognitive changes such as decreased attention, memory and how quickly information can be processed
EPI Services will address all associated issues in the treatment plan.