Psychosis

Psychosis refers to an impaired relationship with reality which often involves hallucinations or delusions.

What is psychosis (NAMI, 2021)?

  • Psychosis refers to an impaired relationship with reality which often involves hallucinations or delusions

    • Hallucinations can be both auditory (hearing things) or visual (seeing things)

      • Example: Seeing or hearing someone who is not actually there

      • Auditory hallucinations tend to be more common than visual hallucinations

      • Hallucinations can also be sensory (smelling things, feeling of bugs crawling all over one’s skin, etc.)

    • Delusions refer to strongly held false beliefs and impressions that contradict reality. Below are the different types of delusions:

      • Paranoid – individual believes that they are being followed or secret messages are being sent to them

      • Grandiose – individual has an exaggerated sense of importance

      • Somatic – individual believes that their internal or external bodily functions are abnormal when in reality they are healthy

 

What causes psychosis (NAMI, 2021)?

  • Psychosis can be brought on by many things including:

    • Psychotic disorders such as Delusional Disorder, Psychotic Depression, and Schizophrenia

    • Drugs and alcohol

    • A head injury, infection, or illness that affects the brain (organic psychosis)

    • Genetics

    • Trauma

    • Severe stress

    • Medication

 

Are there early warning signs before psychosis?

  • Yes! Typically, an individual experiences gradual and non-specific changes to their thoughts and perceptions; meaning psychosis does not present “suddenly”. Early warning signs can be hard to distinguish from typical teen and young adult behavior. According to NAMI (2021) the warning signs are as follows:

    • Significant drop in grades or job performance

    • Trouble thinking clearly or concentrating

    • Suspiciousness or uneasiness with others

    • Decline in hygiene and self-care

    • Spending more time alone than usual

    • Strong and inappropriate emotions or being emotionless

 

What are the signs of early or first-episode psychosis (NAMI, 2021)?

  • Hearing, seeing, tasting, feeling, or believing things that are not real or not there

  • Persistent, unusual thoughts and beliefs that cannot be set aside regardless of what others think and believe

  • Lack of emotion or strong and inappropriate emotions

  • Withdrawing from friends and family

  • Sudden decline in hygiene and self-care

  • Difficulty thinking clearly or concentrating

 

What do I do if I or someone I know is experiencing psychosis (NAMI, 2021)?

  • If you feel that you or the individual is a risk to themselves or others:

    • Take yourself or the individual to the nearest emergency room for evaluation

    • Call “911” for the police or ambulance

  • If you feel that you or the individual is NOT a harm to themselves or others:

    • Contact their Primary Care Provider or Mental Health Provider to discuss next steps and to be evaluated

 

NAMI’s (2018) General guidelines in helping someone with psychosis:

  • Here are the DON’Ts when speaking to someone who may be experiencing psychosis:

    • Criticize or blame the individual for their actions or thoughts

    • Deny or argue with the individual about their reality

    • Take things personally

    • Confront the individual in a direct manner

    • Tell the individual that they are “psychotic”

    • Dismiss or laugh at the individual’s concerns

    • Confirm delusions

    • Correct the individual’s reality or delusions

    • Get angry

  • Here are the DO’s when speaking to someone who may be experiencing psychosis:

    • Be gentle and calm

    • Try to make the individual feel comfortable sharing what is going on in their life

    • Focus on what is troubling the individual

    • Be empathetic with the individual’s situation

    • Focus on the individual’s feelings, not the actual facts of what they are saying

    • Ask the individual if and how you can help

    • Ask about things you know the individual enjoys

    • Emphasize the individual’s strengths

    • Share love (in a manner they can tolerate) – even if it is just giving them your full attention

    • Never underestimate the power of human connection

    • Contact the individual’s treatment team

 

Crisis Resources:

  • NAMI HelpLine

  • NAMI Crisis Text Line

    • Text NAMI to 741-741

  • COPE (Hennepin County)

    • Adult: 612-596-1223

    • Child: 612-348-2233

  • Ramsey County

    • Adult: 651-266-7900

    • Child: 651-266-7878

  • Text Connect (Crisis counseling via text)

    • Text “HOME” to 741741

 

Patient Story on Personal Psychosis: From My First Episode to My First Child

My name is Chris Crutchley. I’m 37 years old and I was diagnosed with Bipolar Disorder as a 20-year-old college junior. I’ve never publicly told my story. In college I feared my peers would view me as a freak. As a professional I worry disclosure can cost me opportunities. This is why I’m speaking out. I want to be part of the solution that ends the stigma.

My first child was born this week. Honestly, I thought that would have happened in my late twenties. There was also a time I didn’t think fatherhood would happen at all. I hope my story can help those who suffer from mental illness and enlighten others to the challenges we face receiving adequate care.

In college I was a two-sport athlete on academic scholarship. I had my insecurities but was confident I would succeed in life. I had no history of mental illness and did not understand anxiety as I do today. I’ve replayed the events that lead to my 2001 hospitalization over and over in my mind throughout the years. I spent that summer training for the upcoming season. I wasn’t drinking or doing drugs. I didn’t feel any emotional distress. For whatever reason I stopped sleeping at night.

It was a gradual decline into psychosis over a matter of days. There were moments of clarity followed by delusion. I now can tell you my hallucinations were extensions of normal thoughts I had prior to suffering sleep deprivation. At times I tried to warn my family something was wrong. At other times I would convince them I was fine. They brought me to a hospital within a week of my First Episode Psychosis.

I read an article on FEP or First Episode Psychosis which is what I experienced in 2001. The article talks about the chances for the individual to have a successful future largely depends on how quickly the patient gets care after the first psychotic episode. It shocks me that the average time for a US citizen to get care after their first episode is 74 weeks (that could be due to a number of factors I guess). In Europe it’s 2 to 7 weeks. I am extremely fortunate to have family members who were responsive to my medical needs and sought care immediately when I couldn’t do it myself. Not everyone is that fortunate.

When I returned to school for my junior year I left both athletic teams I competed on to focus on my health. I was turning 21 and I had strict orders to stay away from alcohol and keep a 10pm bedtime. I was on very strong medication that made it difficult to follow conversation and “feel” typical emotions. I felt like a hollow shell of my former self.

I made the decision to own my story. I would confide in people I trusted. I was surprised how many people had experiences with depression, anxiety, or other mental illnesses or knew someone who did. I read books on mental illness and emotional intelligence so I could recognize my symptoms while they were happening.

I made it through college and graduate school but was unprepared emotionally to make the transition to functioning adult. In my mid-twenties and early thirties, I suffered a handful of setbacks that landed me in the hospital. After graduation my insurance lapsed and I stopped taking my medication or seeing a psychiatrist due to the expense. I know realize that medication compliance is critical to proper care. Not everyone has the ability to pay for the prescriptions written for them.

There was a time when I cut myself because I had been sent home from an emergency room after stating I am bipolar with suicidal thoughts. I returned to the same emergency room with a cut on my wrist and was admitted. That was my last hospitalization and I’m not proud of that moment in my life. I just want to illustrate how desperate a mental illness can leave you and how difficult it can be to get care.

I was 30 and given a month leave from work. I decided to make it count. I made a list of all my insecurities. I worked on everyone until I felt comfortable. On my list I questioned if I should be a father someday. Now I look at my 4-day old daughter and feel completely blessed. I want to help others who believe having a mental illness means they won’t have a productive career and shouldn’t start a family of their own.

 

Retrieved from: https://www.nami.org/Personal-Stories/From-My-First-Episode-to-My-First-Child

 

 

 

 

 

                                                                          References

 

NAMI. (2018). How to best support someone with psychosis.    https://namicambridgemiddlesex.org/best-support-someone-psychosis/

 

NAMI. (2021). Psychosis. https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Psychosis