Displaying items by tag: psychosis

I am not bipolar. I have bipolar disorder. My diagnosis and my identity are linked only in so far as experiencing mental illness has contributed to my personal growth.

My perspectives have broadened, my empathy has grown and I have consolidated certain personal attributes such as resilience and confidence. I have also gradually created a toolbox — one that is instrumental to maintaining my mental health.

I wish the process had have been easier and quicker. But, at the end of the day all that matters is I now have it as I move forward with life.

My mental illness at times caused much distress. Since my first episode of illness, a gradual process of receiving professional help, reaching out for support around me, improving my own understanding and self-awareness, and developing a tool kit of self care and coping strategies has allowed me to evolve from struggle to recovery and ongoing management

I am able to live, enjoy and adventure in spite of having a complex mental illness.

My handle on my condition is strong. I experience warning signs of mania, including restlessness, erratic or racing thoughts, difficulty sleeping and urges to complete unnecessary tasks. Recently I reflected that, although I can identify them (an important step which itself took time to achieve), I was struggling to deal with them in the moment.

I decided to contact a psychologist for guidance around developing coping strategies and ways to approach calming these symptoms better. My GP set up the referral, commending my proactive choice to seek support even though my illness has little current impact on my day-to-day life.

I have learnt the hard way that reaching out for support early is crucial in staying on top of mental illness. A culture of help-seeking is vital for staying well.

When I was 17, my condition surfaced for the first time. I experienced depression for several months. Among my negative thoughts was guilt — a feeling that I had no reason to be depressed and it was silly to feel this way. Consequently, I was too ashamed to tell anyone.

I had a friend who noticed I was withdrawn and quiet, which was unlike my positive, bubbly self. She asked me if everything was ok and said they were there if I needed to talk. That showed me that people did want to help. Though I chose not to open up, being approached was comforting.

However, I struggled in silence instead of reaching out for help, and things went from bad to worse. I fell into a period of prolonged mania and this meant my behaviour changed in a way which was, at first, not overtly noticeable to those around me.

Suddenly things rapidly became more acute as I transitioned into a psychotic episode. I had severe emotional distress, exacerbated from experiencing visual hallucinations and my ability to function at school and home derailed. I was taken to the doctor, and subsequently hospital emergency on my GPs directive. From the psychiatric evaluations, I was admitted to hospital to begin my recovery.

My illness had become so bad others needed to intervene. I often wonder what disruption and distress to me, my family and others around me could have been avoided if I had have sought help when I was struggling with depression, or if I had understood the changes in my behaviour as concerning and spoken up.

The exposure to professional help began my road to recovery. Initially I lacked awareness of my mental health and the necessary tools of to manage my illness.

My mood was returned to a range which enabled me to function at home and socially, and to finish year 12 with a positive prognosis. I was transferred to a community team consisting of a psychiatrist and a counsellor for ongoing care. I started university and enjoyed beginning a new phase of my life.

I was taking medication that was being progressively lowered, but I was struggling to cope with warning signs as my mental illness again reared its head.

I experienced a relapse, but this was a constructive turning point in how I would handle my condition. It represented certainty and I learned of the permanency of my diagnosis. I became motivated to learn about bipolar, my own signs and symptoms and the coping strategies and self-care techniques I could use.

This nuanced understanding of myself, my illness and what tools worked for me have helped me manage my condition and live my life with bipolar having minimal impact.

I still see my psychiatrist routinely, though this is now infrequent, and I seek the support of those around me when I need it.

I have learnt to say no, to prioritise time to rest my body and mind, to implement a strong sense of routine and scheduling, and to ensure I sleep adequately. I have activities I know help me to relax, energise or burn off steam, and I know when I need to use these to change my current behaviour.

It took time to establish what methods worked for me. Combining these methods with new thought-based strategies that I am developing with my psychologist has, for now, completed my tool kit for managing my mental illness.

It may be in future that other things arise, and new instruments for coping may be added, or others taken away. I have established professional medical support, a help-seeking culture, medication regime, self-care and behavioural coping strategies which together ensure I stay at my optimal mental health as much as possible.

It was by no means an easy path, but it was an important one, for me and those around me. Now I have created my toolbox, I can take it anywhere, to use as needed to keep my condition in check in order to continue getting on with my life.

'Be kind to your mind' is an initiative of SANE supported by Future Generation Global, in partnership with batyr.

When I was diagnosed with Schizophrenia at 18, I thought that I’d be sitting in a room for the rest of my life. I thought that I wasn’t going to be able to do anything I wanted to do. I felt so hopeless and like everyone around me was giving up on me too, like nobody expected me to get better.

People think that if someone’s really unwell at one point, they can never recover from that. But, they can. I’m living proof of that. Still, I often feel like I’m taking one step forward, ten steps back, but when I take a step back at look at the big picture, I can see how far I’ve come. A bit over a year ago, I couldn’t even really go outside by myself, and now I’m doing things I never thought I could ever be capable of. I almost can’t believe it. It’s hard to look at myself positively, but if someone else were me, I’d think they were amazing.

My battle with my mental health started in high school. I struggled with depression and anxiety, but towards the end of school, I started experiencing something different. I didn’t really know what it was, and I thought that I could just ignore it. I moved out of home and started uni. I thought that I could leave everything that happened during high school behind me – that if I could just ignore everything going on in my head and try to push through, it would be ok. But it didn’t turn out that way.

I’d never lived out of home before. I felt isolated and alone, and I just couldn’t handle the stress alongside everything else going on in my head. That’s when things really took a turn for the worst, and I experienced my first episode of psychosis.

I felt like I was being watched all the time. I thought that someone was watching me through a camera in the air conditioning. I was completely paranoid. I couldn’t focus on anything or do my uni work. I heard voices saying that everyone hated me, they didn’t want me around and they wanted me to die. I became totally isolated.

I knew that I needed help – and on one level I did want help – but I also felt like I didn’t deserve it.

I remember the day when they told me I had schizophrenia. I didn’t know much about it at the time. I just knew all the stereotypes surrounding it. I was thinking ‘Does that mean I’m dangerous? Does it mean that they’re going to lock me away’. They just said it like it was nothing. But for me it was this huge, life altering thing.

There’s just not enough understanding, and so much stigmatisation surrounding this illness. People get all their ideas from horror movies. They can be really flippant, calling people ‘psycho’ or ‘schizo’. It’s a pretty scary illness , but it doesn’t make the people who have it scary people. We’re human, just like everyone else. We all want the same things.

I still experience psychosis, but I can manage it a lot better than I used to be able to. I understand what it is now and why it’s happening. I’ve learnt ways to help manage it, and I know how important it is to talk to people about what I’m dealing with, rather than keeping it all to myself.

I’m so passionate about sharing my story now, because if people understand what Schizophrenia is, it will make it easier for people to get help early. I want my story to show others that it’s not the end of your life if you’re diagnosed with schizophrenia.

I’m living proof that you can keep going and live a full life.

Conducted in 2010, the People Living with Psychotic Illness study is the largest ever carried out in Australia on the impact of conditions such as schizophrenia.

Commissioned by the Australian Government, Department of Health and conducted by a team of experts spanning the country, the study provides a comprehensive insight into the impact of psychotic illness on the lives of Australians.

SANE - a proud partner in the project - produced People Living with Psychotic Illness: A SANE Response summarising the key findings, and outlining action needed in response.

SANE's findings included:

1. How many are affected? Sixty-four thousand people with psychotic illness are in contact with public mental health services every year. Two in three experience their first episode before the age of 25.
2. Who is affected? People with psychotic illness are more likely to be male, living alone and have disrupted education.
3. What are the effects? Psychotic illness often has a severe impact on ability to function in daily life.
4. Physical health. People with psychotic illness are experience very poor physical health, and are more likely to attempt suicide than the general population.
5. Mental health services. People with psychotic illness are the predominant users of mental health services, and make heavy, regular use of other health services.
6. NGO services. Mental health non-government organisations (NGOs) provide a range of services, and are highly valued by people living with psychotic illness.
7. GP services. People with psychotic illness see their GP nine times a year on average: almost twice as often as the general population.
8. A home and a job. People with psychotic illness have a very high rate of unemployment and are at greater risk of homelessness.
9. Social isolation. Nearly a quarter of people with psychotic illness reported feeling socially isolated and lonely. One in eight had no friends at all.
10. The challenge. The People Living with Psychotic Illness study provides compelling evidence of the need to improve our mental health services, and recommendations on this are spelled out under Action on every page of A SANE Response.

ABC television's current affairs program 7.30 reported on the launch, featuring SANE Speakers, David Braniff and Sandy Jeffs, as well as former SANE Executive Director, Barbara Hocking.

For further insight into the perspective of people with lived experience you can view David's Parliament House speech, or read Sandy's column for the news website Crikey.

Download People Living with Psychosis: A SANE Response (1.5 MB), or for a copy of the full report visit the Australian Government, Department of Health.

James has a mission. At the age of 36, he found something that gave real purpose to his life – to educate young people about the dangers of drugs which can trigger mental illness.

Tentatively he sat down and began to write:

When I opened my eyes it was morning, but not your average start to the day. The distinctive voices of four friends I had not seen for months were talking to me inside my head.

He had taken himself back to the day he was admitted to Rozelle Hospital in Sydney when he was just 18.

Putting into words the experience of his drug-taking, mental illness and the long journey to reconstruct his life took James two years.

‘I found it very cathartic,’ he says. ‘I wouldn’t be able to remember it all now because I dealt with it by writing the book.’

He describes the process as healing not only for himself, but also for his mother, Victoria, with whom he lives in Sydney. She read everything he wrote each day. ‘It was horrendous,’ she recalls with a shudder. ‘It brought everything back.’

James relates his story with raw honesty and great courage. He started taking drugs when he was 15 because everyone he knew was doing the same.

‘I never thought about the damage,’ he says. ‘I didn’t know what Schizophrenia was before someone told me I had it. I went to one rave party called Psychosis 4 and I didn’t even know what Psychosis meant. Then all of a sudden I just messed my whole brain up.’

He wrote the book –  Escaping to Reality – ‘to stop people from ending up like me. I can’t even hold a part-time job at the moment.’

Since that day when he was first admitted to Rozelle, James has been hospitalised four times. Victoria has been there for him every day.

His mother had no idea James was taking drugs.

‘It has been a huge learning curve for me,’ she admits. ‘At the beginning when James became ill, I didn’t know what to do with him. We took him to Rozelle and the doctors were great, but watching him go into the locked ward was like a scene from One Flew Over the Cuckoo’s Nest.'

When James came home from hospital he would lie for hours on the settee in what Victoria describes as ‘his great big old coat’. She felt helpless and isolated.

'He had done so well at school.' she says, 'I was tempted to say to people that that is what James is really like – that this James is not him. Apparently mothers do this.'

Although she says she is over it now, Victoria’s anguish is still palpable.

At the start of James' illness, during the months before he was settled on the most helpful medication, he was, says Victoria, in a terrible state. At one point Victoria took him back to hospital, where doctors tried him on a new medication.

‘I hung around for hours,’ says Victoria. ‘Eventually they said I could go and see him. He was asleep so I shook his shoulder gently. He looked up at me and said, "Hello Mum." It was marvellous! He was back – just like that.’

Once his medication was working well, James started a traineeship in Star City Casino. He was sharing a house with friends and enjoying his work but unfortunately slipped back into the party scene.

He stopped taking his medication, started using ecstasy and wildly overspent on his credit card. He was soon unwell and back in hospital.

‘Once I got out of that place,’ he says, ‘there was no way I would ever touch drugs ever, ever again. I just didn’t want to destroy my whole life completely.’

James now lives quietly, taking each day as it come. He sees his psychiatrist once a month, takes his medication, and gets on with his life.

He enjoys a game of pool, rides his mountain bike in the bush, and practices on his beloved electric guitar. He would like to play in a cover band one day.

‘That’s not taking me back into a drug environment,’ he hastens to add. ‘I would be a damn fool to give up everything I’ve worked for.’

James still gets 'the horrors' every now and then – the voice in his head, severe paranoia and attacks of extreme anxiety. When that happens he takes sanctuary in his mother’s lounge.

‘I come and sit in here,’ he says, ‘It’s safe. I don’t want to talk to anyone – I can’t. It can last 20 minutes or all night. No-one can understand it. If there is a hell, that is what it is.’

James is careful to avoid what he calls bad stress. ‘Caffeine will do it,’ he says. ‘Alcohol, or even being in a crowd.’

Writing and publishing his book has given direction to his life. He had an edition printed privately and is keen to bring it to the attention of Year 10 students in schools.

He is particularly thrilled by a message he received from a friend of his father’s, whose son had read a copy of Escaping to Reality.

He sent James an email saying his son had stopped taking marijuana, stopped smoking cigarettes and turned his life around at school.

‘Your words have made a difference,’ he told James. ‘You helped my boy and I thank you.’

‘If I had had this book at 16 or 17, things would have been very different for me too,’ he says quietly. 

Quick facts 

• Antipsychotic medication can help manage symptoms of psychosis. 
• Antipsychotic medication can be helpful for some, but may not suit everyone. 
• It can take time to find the best medication and dose for you.  
• It is important to talk to a doctor about different options, side effects, and how to use medication. 

• About antipsychotic medication 

  Antipsychotic medication refers to a few types of medication that can reduce symptoms of psychosis, like hallucinations and delusions. They also help prevent those symptoms from returning. 

  These medications work on brain chemistry – neurotransmitters that influence thoughts, mood and emotions. 

  Antipsychotic medication is often used for the treatment of schizophrenia spectrum disorders, but can also be used as part of treatment for other mental health issues. They can be used alongside other forms of help such as psychological therapies or community support. 

• When are antipsychotic medications used? 

  Antipsychotic medication can be life-changing for some people, although it may not suit everyone. It is ok if you need, or want to try, medication for your mental health. 

  Antipsychotic medications are considered a front-line treatment for psychosis. They can be prescribed for an episode of psychosis, or as part of longer-term treatment. They help reduce symptoms such as delusions and hallucinations, and can also help with mood, memory, planning, and other thinking problems. Antipsychotic medication can also be helpful in the treatment of other mental health issues, such as bipolar disorder and depression. 

  They are not addictive, do not make you euphoric, or change your personality. All antipsychotic drugs are designed to do the same thing — reduce psychotic symptoms and keep them away. However, they’re known to affect people in different ways, so your experience of taking them will be unique to you. 

  Antipsychotic medication can be prescribed alone, or with other medications. Many people use antipsychotic medication to feel more stable and find it helps them engage with other support services. People often use them alongside other forms of help like psychological therapies, support with housing and employment, physical and occupational therapy, and more. 

• Is antipsychotic medication effective? 

  Antipsychotic medication is generally effective. Most people with psychosis have fewer symptoms after starting medication. 

• What treatment with antipsychotic medication involves 

  Initial consultation and prescription 

  Antipsychotic medication is prescribed by a medical doctor (a GP or a psychiatrist). A doctor can discuss options for you, and prescribe you a dosage that they feel matches your symptoms and circumstances.  

  Different medications work for different people; you and your doctor can talk over to help decide which is most likely to be right for you. While there is usually a period of trial and adjustment, there are some things that can be worth discussing to help decide on a treatment plan: 

  • The impact and severity of symptoms. 
  • What different types of medication are available  
  • What your doctor recommends, and why 
  • How long it might take to start working 
  • How long you will need to take it for 
  • Any side-effects and how to manage these 
  • What to do if you wish to stop taking the medication 
  • Any allergies or physical health problems you may have 
  • If you are pregnant or planning to become pregnant 
  • Any other medications that you are taking, or have taken previously 
  • How and when to take the medication  
  • How to store medication safely 
  • Other factors such as foods which may need to be avoided. 

• Taking the medication 

  There are two ways to take antipsychotic medication: by mouth or as a depot (sometimes called a ‘long-acting injectable’).  

  • Medication by mouth usually means a tablet. It is important to take medication as directed.  
  • Medication by depot is a regular injection, meaning you don’t have to remember to take it. It is a slow-release medication, so it lasts a lot longer than a tablet. 

  Depots are used if there are challenges swallowing medication. They are also used if there’s a risk of forgetting or stopping taking medication, which can lead to a rapid worsening of symptoms. You can choose to take medication by depot. There are also circumstances where a doctor can legally require someone to take medication by injection, even without consent. That’s only done rarely, and always with health and safety in mind. 

  It can take several weeks, or even a few months, after the first dose of medication before it has an effect. Checking in with your doctor over time can help keep an eye on how you’re going, and monitor any side effects.  

  If you have any challenges – such as struggling to remember to take medication – it important to raise these with your doctor. 
   
  Choosing the best medication is not always straightforward because the way people respond to medication is different. This means that finding the right one for you may involve trying one or more types, or making adjustments. 
   

  Coming off the medication 

  Antipsychotic medication is often long term. Many people with psychosis need to take medication as prescribed on an ongoing basis to ensure their symptoms don’t return. 

  When medication starts working and symptoms reduce, people can be tempted to stop taking it. Some people may also want to stop taking medication due to side effects. Others might find that memory problems, or the symptoms of psychosis interfere with their decision-making.  

  Before stopping or reducing any medication it is important that you discuss with a doctor. They can help with decisions about the best path forward. Stopping antipsychotic medication suddenly can cause problems, and lead to a return of psychosis. So any changes need to be done step-by-step under your doctor’s supervision.  

• Types of antipsychotic medication 

  There are two key types of antipsychotic medication available:  

  • A newer group known as ‘second generation’ or ‘atypical’ antipsychotics 
  • An older group, known as ‘first-generation’ or ‘typical’ antipsychotic medications. These are generally only prescribed if the second-generation medications aren’t working for you. 

• Risks and side effects of antipsychotic medication 

  If you’re taking antipsychotic medication, it’s very likely you will experience some side effects. Work is being done to improve medications, but at the moment it’s often necessary to weigh up the benefits of medication against how side effects might impact you 

  They vary from person to person, but can include: 

  • drowsiness 
  • weight gain 
  • unusually dry or watery mouth 
  • restlessness 
  • trembling, especially in the limbs 
  • muscle stiffness 
  • dizziness 
  • eyesight problems 
  • moving more slowly 
  • changed interest in sex, or problems having sex 
  • nausea 
  • constipation 
  • increased sweating 
  • pain or irregularity in menstruation. 

  It’s important to tell a doctor about side-effects as soon as possible, and discuss any concerns.  

  For some people, it can take months to find the right medication — that’s normal. 

  If the side-effects of the medication you’re taking are too severe, or if your psychotic symptoms don’t subside, it might be possible to try other options. 

• Finding out more 

  To learn more, a GP or psychiatrist can provide a personalised discussion about whether antipsychotic medication is the right option for you.  

• Resources 

  • 1300 MEDICINE (1300 633 424) – Medicines Line 
  • Schizophrenia and Psychosis (SANE Fact Sheets) 
  • The patient-psychiatrist relationship: it's a matter of trust (SANE Blog) 
  • Stopping and switching antipsychotic drugs - NPS Medicine Wise 

• References

  1. 4329.0.00.003 - Patterns Of Use Of Mental Health Services And Prescription Medications, 2011’ Abs.gov.au. Australian Bureau of Statistics, 2017. Accessed 17 March 2017.
  2. Galletly et al (2016) ‘Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders.’ Aust NZ J Psychiatry, Vol. 50(5) 1-117

Quick Facts

Cannabis (marijuana, hashish, weed, dope) is the most commonly used illicit recreational drug in Australia. It’s a depressant psychoactive substance that can cause temporary psychotic symptoms and, in some cases, full psychotic disorders like schizophrenia.

• Cannabis facts

  • It’s addictive: cannabis contains THC, a highly addictive chemical.
  • It’s common: more than 1 in 10 Australians aged 14+ have used cannabis in the past year
  • It’s very common in people with psychotic disorders: cannabis use is much higher in people living with psychotic disorders than in the general population or even people with other mental illnesses. Up to a quarter of people diagnosed with schizophrenia may also have a cannabis use disorder.

• Cannabis myths

  • Myth: ‘A little bit is harmless’
  • Reality: Cannabis can cause psychotic symptoms even at low doses.

  • Myth: ‘My mate is fine, so I’ll be fine’
  • Reality: Cannabis affects different people differently. Other people’s use can’t predict your reaction.

  • Myth: ‘Cannabis is the biggest cause of psychosis’
  • Reality: Cannabis use makes you more likely to experience psychosis, but your genetics, early development and life experiences have a much stronger effect on your chances of becoming ill.

• Can cannabis cause psychosis?

  Here’s what research says about cannabis use and psychosis:

  Cannabis use can cause you to experience psychotic symptoms

  Along with the traditional high, cannabis use can cause paranoia, delusions and hallucinations in people who don’t already have a mental illness, even in small doses.

  Cannabis use can also trigger or worsen psychotic symptoms in people living with an illness like schizophrenia, even when their illness is otherwise stable and responding well to treatment.

  Cannabis can trigger a psychotic illness in susceptible people

  Some things can make it more likely that you will experience a psychotic disorder at some point in your life. These include your genetic make-up, your mother’s health during pregnancy, complications with your birth, child abuse, some kinds of head injury and infection, drug abuse, living in urban areas and experiencing high stress and social disadvantage.

  If you already have a predisposition like this, cannabis use can trigger an illness. It can also cause symptoms to occur far sooner than they would otherwise have done.

  Although anyone can experience psychotic symptoms from cannabis use, it hasn’t been demonstrated yet whether cannabis can cause a psychotic illness in someone who isn’t otherwise susceptible.

• What about medical marijuana?

  Medical marijuana was made legal in Australia in late 2016. It has a growing range of uses, but it isn’t a proven treatment for psychotic illness.

  If you’re worried about the risk of psychosis in using medical marijuana to treat another condition, talk to your doctor.

• References

  http://www.aihw.gov.au/alcohol-and-other-drugs/illicit-use-of-drugs/cannabis/

  Schoeler T, Monk A, Sami MB, et al. ‘Continued versus discontinued cannabis use in patients with psychosis: a systematic review and meta-analysis.’ Lancet Psychiatry. 2016;3(3):215-225.

  Johanna Koskinen, Johanna Löhönen, Hannu Koponen, Matti Isohanni, Jouko Miettunen; Rate of Cannabis Use Disorders in Clinical Samples of Patients With Schizophrenia: A Meta-analysis. Schizophr Bull 2010; 36 (6): 1115-1130. doi: 10.1093/schbul/sbp031

  Nunez, L. and M. Gurpegui, ‘Cannabis-induced psychosis: A cross-sectional comparison with acute schizophrenia.’ Acta Psychiatrica Scandinavica, 2002. 105: p. 173–178.

  Favrat, B., et al., ‘Two cases of “cannabis acute psychosis” following the administration of oral cannabis.’ BMC Psychiatry, 2005. 5(17)

  D’Souza, D.C., et al., ‘Delta-9-tetrahydrocannabinol effects in schizophrenia: Implications for cognition, psychosis, and addiction’. Biological Psychiatry, 2005. 57: p. 594–608.

  Dean K and Murray RM (2005) ‘Environmental risk factors for psychosis’. Dialogues Clin Neurosci. 7(1): 69-80.

  Veen, N.D., et al., ‘Cannabis use and age at onset of schizophrenia.’ American Journal of Psychiatry, 2004. 161: p. 501–506.

  McLaren J, Lemon J, Robins L and Mattick RP, Cannabis and mental health: put into context. Commonwealth of Australia, 2008, p.33.

Quick facts

• People can experience psychosis as part of a range of mental and physical health issues.
• Psychosis includes delusions and hallucinations, across one or more episodes.
• Treatments for psychosis include medications, psychological therapies, and social supports.
• A person who has experienced psychosis can live a long and fulfilling life.

• About psychosis

  Psychosis impacts a person's sense of what is real and what isn't. This could be because of hallucinations (seeing, hearing, or sensing something that doesn’t exist) or delusions (false beliefs that the person believes are true or real).

  An estimated 0.5% of Australian adults experience a disorder involving psychosis (a ‘psychotic disorder’)¹.

  Psychosis occurs on a spectrum. A person can have just a single episode of psychosis or may have multiple episodes over a lifetime. Psychosis can occur as a symptom of mental health issues like schizophrenia, neurocognitive conditions like dementia, or as a result of substance use. It can also occur in many other conditions that affect the brain (for example, Parkinson’s disease, epilepsy, or migraines).

  Other people experience psychosis in the context of other mental health issues, such as bipolar disorder (during a period of mania), depression, or personality disorders. Women may experience postpartum psychosis after childbirth.

• Symptoms of psychosis

  Psychotic symptoms vary from person to person, and even between one episode and another. Symptoms can include²:

  • Delusions: false ideas or beliefs that can’t be changed by evidence and aren’t shared by other people from the same cultural background.
  • Hallucinations: seeing, hearing, feeling, tasting or smelling something that isn’t there.
  • Disordered thinking: making up words or use them in strange ways, using mixed-up sentences or changing topic frequently.
  • Disordered behaviour: seeming agitated, muttering, swearing, or otherwise acting inappropriately for the situation they’re in. They may find it challenging to keep up their personal hygiene and housework. In severe cases, a person may become unresponsive to the world around them – this is sometimes referred to as ‘catatonia’.
  • ‘Negative’ symptoms: these symptoms include reduced emotional expression (like a lack of eye contact, speech, or facial expression), irritable or depressed mood, low motivation, less talking, or struggling to experience enjoyment and pleasure. 

  In most cases, psychosis is experienced as an ‘episode’– a period of short-term symptoms of delusions or hallucinations. The length of an episode varies from person to person and depends on factors such as the type and cause of the episode.

  Episodes can be as brief as a few hours (in the case of some drug-induced episodes). But for some psychotic disorders, a person can experience symptoms for months.  

  Around 25% of people who experience psychosis have low ‘insight’ – meaning they believe their delusions or hallucinations are real¹. Others will be aware that what they are experiencing is  part of psychosis. Awareness can also change over time, and many people experience a high level of insight in between episodes.

  It’s important to note that people with psychosis are much more likely to have experienced violence than they are to be violent themselves³.

• Early signs of psychosis

  Early signs of psychosis can be subtle or hard to pinpoint. Some common signs to look out for are:

  • Changes in emotion: depression, anxiety, irritability, suspiciousness, and flattened or reduced emotional responses. 
  • Changes in thinking: trouble with concentration or attention, changed sense of self or the world, and odd ideas or perceptual experiences. 
  • Changes in behaviour: changes in sleep or appetite, withdrawing socially, or having troubles at work, school, or socially. 

  If untreated, these symptoms can develop into a full episode of psychosis.

• Causes of psychosis

  The causes of psychotic disorders are complex. Genetics, early-childhood development, traumatic life experiences, physical illness, injury or infection, and other factors can increase the chance of experiencing psychosis⁴.

  Episodes of psychosis can be triggered by stress or trauma, medication changes, or sleep deprivation. Cannabis use can also bring on  psychosis, especially for those who are already vulnerable to developing it⁵. Methamphetamine and alcohol-use can also induce psychosis ^6,7. Some types of psychosis are only experienced in certain time periods, like the perinatal period.

• Managing life with psychosis

  Some people who experience psychosis find the following strategies can help prevent episodes, help them feel better in between episodes, or help them feel more in control. It can take some time to figure out what is helpful – and it’s a very individual process:

  • learning more about psychosis
  • looking after physical health
  • improving sleep
  • accessing peer support
  • developing a relapse prevention plan – including identifying early warning signs, what to do when an episode occurs, and who to contact (and making sure family and a trusted health professional have a copy)
  • Advance care planning can also be an option for times when a person may not be able to make decisions for themselves. The nature of these documents vary by state.

• Treatment and support for psychosis

  The best place to start in getting a diagnosis is a GP. They can make an assessment and provide a referral to a psychiatrist for full diagnosis and treatment if appropriate.Your diagnosis might change  over time.

  Early intervention can be helpful. During assessment, some people may be classified as at ‘high risk’ of developing psychosis. Although this can sound scary, identifying this risk early helps a person get supports in place. This may include case management, support for families and carers, group programs, and minimising disruptions to school or work⁸.

  Although antipsychotic medications are usually the first line of defence, psychological therapies, including cognitive behavioural therapy, psychodynamic therapy, and open dialogue, can also be helpful for psychosis⁹.

  Community support programs can also help with social connection, physical health, accommodation, and work or school.

  Treatment for mental health issues involving psychosis can span over many years and often involves a multidisciplinary team. During that time, treatments may change to improve the results and reduce any side-effects.

• Help for family & friends

  Those caring for someone living with psychosis need support too. It’s okay for family and friends to prioritise their own mental and physical health while supporting someone else. Learning about psychosis and talking to a mental health professional about any concerns you have can be a good start.

  Many other people out there share the experience of supporting someone with mental health issues, and services designed to help carers. Check out our Guide for family, friends and carers. 

  Experiencing psychosis can be challenging, but with support it is possible to live a full and meaningful life.

  To connect with others who get it, visit our online Forums. They’re safe, anonymous and available 24/7.

  VISIT FORUMS

• Resources

  • Early Psychosis treatment guide (Orygen)
  • Relapse prevention plan example
  • Resources for family and friends: Mental health first aid for psychosis, SANE ; Mental Health Carers Australia(formerly ARAFEMI)
  • Self-help when hearing voices – SANE blog

• References

  1. Morgan VA, Waterreus A, Jablensky A, Mackinnon A, McGrath JJ, Carr V, et al. People living with psychotic illness in 2010: The second Australian national survey of psychosis. Aust New Zeal J Psychiatry [Internet]. 2012 Jun;46(8):735–52. Available from: http://dx.doi.org/10.1177/0004867412449877

  2. American Psychiatric Organization. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub; 2013.

  3. Whiting D, Lichtenstein P, Fazel S. Violence and mental disorders: a structured review of associations by individual diagnoses, risk factors, and risk assessment. The Lancet Psychiatry. 2021;8(2):150–61.

  4. Radua J, Ramella‐Cravaro V, Ioannidis JPA, Reichenberg A, Phiphopthatsanee N, Amir T, et al. What causes psychosis? An umbrella review of risk and protective factors. World psychiatry. 2018;17(1):49–66.

  5. Hasan A, von Keller R, Friemel CM, Hall W, Schneider M, Koethe D, et al. Cannabis use and psychosis: a review of reviews. Eur Arch Psychiatry Clin Neurosci [Internet]. 2020;270(4):403–12. Available from: https://doi.org/10.1007/s00406-019-01068-z

  6. Castillo-Carniglia A, Keyes KM, Hasin DS, Cerdá M. Psychiatric comorbidities in alcohol use disorder. The Lancet Psychiatry [Internet]. 2019;6(12):1068–80. Available from: https://www.sciencedirect.com/science/article/pii/S2215036619302226

  7. Greening DW, Notaras M, Chen M, Xu R, Smith JD, Cheng L, et al. Chronic methamphetamine interacts with BDNF Val66Met to remodel psychosis pathways in the mesocorticolimbic proteome. Mol Psychiatry [Internet]. 2021;26(8):4431–47. Available from: https://doi.org/10.1038/s41380-019-0617-8

  8. Henry LP, Amminger GP, Harris MG, Yuen HP, Harrigan SM, Prosser AL, et al. The EPPIC follow-up study of first-episode psychosis: longer-term clinical and functional outcome 7 years after index admission. J Clin Psychiatry. 2010;71(6):6560.

  9. Cooper RE, Laxhman N, Crellin N, Moncrieff J, Priebe S. Psychosocial interventions for people with schizophrenia or psychosis on minimal or no antipsychotic medication: A systematic review. Schizophr Res. 2020;225:15–30.