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Frequently asked questions about psychosis and schizophrenia for both patients and family members.
1. What is psychosis?
"Psychosis" is a term that is often misunderstood. Psychosis is a real medical condition for which effective treatments are available. Hearing things that other people do not hear, or holding strong beliefs about being persecuted that other people don’t share, are examples of typical symptoms of psychosis. Other examples include: strange experiences (such as thinking that others can read your mind or that thoughts are being broadcast outside your head), confused or blocked thinking, or the experience that particular words, colors, or other things in the environment have taken on special meaning to you. These experiences are usually puzzling and distressing. Not everyone with psychosis will have all of these symptoms, they may just have one or two, but they will still require similar treatment.
2. What is schizophrenia?
Schizophrenia is the most common form of psychosis. Not everyone who has a first episode of psychosis will end up having schizophrenia, psychosis can be a manifestation of other conditions such as bipolar disorder, depression, substance misuse or in rare cases can even be as a result of a medical illness. Schizophrenia can only be diagnosed when the illness has been present for at least six months. It too is treatable, with many recovering from their initial episode and living fulfilling lives. It is not a "split personality" and contrary to popular belief, people with schizophrenia are not characteristically violent.
3. Why is earlier better?
Psychosis and schizophrenia are treatable medical conditions and research throughout the world has shown that the earlier the treatment the faster the recovery. Early treatment also helps prevent symptoms becoming severe and more difficult to treat. In addition it also results in less stress and anxiety for both the patient and the family.
4. I am not "psychotic", why should I come to a program that evaluates and treats psychotic people?
Sometimes it is important to be sure that psychosis is not present, so a visit with us reassures you and your family members. If psychosis is present, it is important to determine its cause. Psychosis is likely to be causing you and your family a good deal of stress and anxiety. Effective treatment can alleviate this stress and anxiety and help you to move on with your life.
At times, we will disagree with you about whether or not you have experienced psychosis. In these cases, we still can work together and “agree to disagree”. One thing that we often find we can agree on, however, are areas in which there might be problems, such as sleep problems, anxiety, depression, or stress-related problems at home, work, or school. We may focus with you on these problems rather than on psychosis.
1. Why is it happening to us?
It is a stressful time for everybody and it is important to be aware that developing a psychotic illness is not the fault of either the person or the family. Psychosis is a medical condition just like asthma or diabetes and can affect anyone at any time. Because it is a disease of the brain, it affects people's thinking, behavior and the way they perceive the world around them. This, and the fact that there is no laboratory test to confirm the diagnosis can make it confusing for patients and their families.
2. Maybe it will go away?
Sometimes it can be difficult to accept that this is happening and many people are tempted to wait and see if the problem will go away by itself. However, like other medical conditions, this does not tend to occur and neither a person nor their family can make their symptoms go away by willpower or discussion. However, with appropriate treatments, many can and do recover, and in fact the earlier that people get the right help, the faster and better the recovery.
3. Why did we not notice there was a problem sooner?
With the benefit of hindsight, families will often report that there were a number of non-specific warning signs leading up to the moment where it was obvious that there was a problem. These warning signs include problems such as emotional changes, disturbed sleep, decline in function at work or school, apparent loss of interest, lack of drive and/or social isolation. Health professionals refer to this period as the "prodrome", and due to its non-specific nature, it is difficult to detect in these early stages, even for them. Just like families are not responsible for the illness occurring they should not feel responsible for not recognizing it sooner.
4. What can we do now?
Families have a huge role to play in the recovery of individuals with psychosis. They can help their relative access the best care and they can endeavor to learn as much as they can about the illness (see list of suggested reading material). This helps families understand some of what their loved one is experiencing and also puts them in a better position to be able to help. The first thing to do is to get an appointment with a mental health professional. Accurate diagnosis is the first step towards recovery. Centers that specialize in first-episode psychosis are probably the best equipped to do this.
5. Does treatment always include medication?
The decision to recommend medication is only made after a full evaluation. Your doctor may believe that medication will be the quickest route to recovery, but generally it will be the person's choice whether or not he or she agrees to try the recommended medication. Some people will want to learn more about medication before agreeing to try it. Some people have found it helpful to at least take some medication temporarily to help stress, anxiety, and sleep problems that have interfered with the ability to function normally. In some cases it may be necessary for the courts to order a person to take medication for their own safety or the safety of others.
6. Are there psychological treatments that could help?
Yes. One successful treatment is called CBT, which stands for Cognitive Behavioral Therapy. The focus of this treatment is to reduce stress and teach people how to cope with symptoms like anxiety, paranoia, depression and hearing voices. Typically, patients come once a week to meet with a therapist. Typically, CBT is combined with medications.
7. Why don’t they know that they’re sick?
One of the more common issues that arise with families is that often people suffering from a psychotic illness do not even believe that they are ill. This can be very frustrating for friends and families and trying to convince someone that they are ill may result in arguments. In this situation, it is often useful to talk about the problems that the person themselves thinks they are having and trying to agree on how the treatment being offered may help with those, rather than focusing on getting the person to see that they are ill.
8. Why won’t they listen to me?
Another situation that can be difficult is when a family member wishes to talk about their symptoms or strange beliefs. It is important to remember that these beliefs are very real for the person and it might not be helpful to try to disprove them or directly question their reality. This can lead to arguments and to the person shutting down and no longer disclosing their experiences. A useful strategy may be to empathize with the feelings that the person has as a result of their symptoms without commenting on their reality. If a person insists on an opinion, it is best to be truthful while acknowledging that they are a very real concern for them.
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