First Hope for Professionals
"Early Identification and Intervention in Psychosis" refers to current approaches to the treatment of
psychosis that emphasize the importance of both the timing and types of intervention
provided to persons experiencing the early warning signs of psychosis."'Early" is as early as
possible following the onset of symptoms; the "intervention" is
comprehensive, intensive, phase specific and individualized.
Psychosis is a brain disorder that is characterized by loss of contact with reality and may involve severe disturbances in perception, cognition, behavior, and feeling. Approximately 3% of people will experience a psychotic episode at some stage in their life. Usually a person’s first episode occurs in adolescence or early adult life, an important time for the development of identity, relationships and long-term vocational plans.People usually experience psychosis in episodes. An episode can involve the following phases, which vary in length from person to person.
Increasingly strong evidence tells us that, although psychotic illness may be triggered by psychosocial stresses, it is also caused in large part by a host of biological events or disorders. These include genetics, fetal viral infection, birth complications, paternal age, RH incompatibility, infant or early childhood head injury, and autoimmune disorders.
The initial warning signs of psychosis can be particularly confusing and traumatic for the person and their family. A lack of understanding of psychosis often leads to delays in seeking help. As a result, these treatable illnesses are left unrecognized and untreated. Even when appropriate help seeking does occur, further delays in diagnosis and treatment may result from skill and knowledge gaps among professionals.
- Premorbid (at risk phase) – the person does not experience any symptoms but has risk factors for developing psychosis.
- Prodromal/ Clinical High Risk (CHR) (becoming unwell phase) - the person has some changes in their emotions, motivation, thinking and perception or behavior. (See early warning signs)
- Acute (psychotic phase) – the person is unwell with psychotic symptoms such as delusions, hallucinations, disorganized thinking and reduction in ability to maintain social relationships, work or study.
- Recovery – this is an individual process there person goes through to attain a level of wellbeing.
- Relapse – the person may only have one episode in their life or may go on to have other episodes.
Recognizing Psychosis?The early warning signs for psychosis can be hard to identify because they can be mistaken for other mental health issues or adolescent development crises. It is not always easy in the early stages, but there are early warning signs in the CHR phase, they include:
- Social withdrawal. The person just is not interested in being with others, even people who were previously liked.
- A decline in school or athletic performance.
- Behavior that is unusual for the person. Maybe they have started to hoard things, or have developed an unusual habit or interest.
- Heightened sensory sensitivity. Has the person started to be more sensitive to lights, sounds, or the feel of their clothing?
- Difficulty concentrating. The person may have trouble following a conversation or class discussion, or even have trouble reading a sentence.
- Worry, fear, and suspicion. Is the person more worried than before, especially about other people causing them harm?
- Exaggerated beliefs. The person may believe they possess powers that they don’t really have.
- Hallucinations. The person may see or hear things that aren’t there.
When talking to an individual who you suspect may be experiencing the early warning signs, it is essential to remember that they are often likely to be quite distressed and frightened. Acknowledge that the individual may be nervous or wary and try to find some common ground for discussion, gradually building up towards more specific questions about their experiences. Be supportive and non-judgemental.
Once you have established rapport, do not be shy about asking direct questions. Ask the individual about their mood and thoughts or if they have been hearing or seeing things. Inquire about how things have been going with school, work, and relationships. Ask if they have experienced any stressful events or had any unusual experiences lately. Also, do n'o be hesitant to ask in a matter-of-fact manner, if they have had any thoughts about hurting themselves or anyone else.
It is best to describe your concerns in specific behavioral terms and not speculate about their diagnosis. Repeat visits over a couple of weeks can often make things much clearer. It often takes time for the person to build up trust and open up to you. If the individual refuses to talk with you, let them know that you will be available if they would like to talk with you in the future, but if you get enough information make the referral.
Make the Referral
The purpose of gathering information is to determine if a referral to First Hope is in order. It is important to convey a message of hope to the individual. Assure them that help is available and things can get better. If you can, prepare the individual for what they might expect when following through with the referral. You can make the referral with the individual present and/or you can offer to accompany the individual to the first appointment. If the person refuses to get help and follow-through on the referral (and it is not an emergency situation), remain friendly and open to the possibility that he/she may want help in the future. If you have determined that the person is in a potentially life threatening or emergency situation, you must ensure that the individual gets professional help immediately.
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