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What is First Episode Psychosis?

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  • Written By: Tricia Ellis-Christensen
  • Edited By: O. Wallace
  • Last Modified Date: 31 October 2016
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Prodromal, or first episode psychosis, is the first appearance of psychotic symptoms in an individual. The term "episode," confuses people because this implies a sudden-onset and time-limited experience. In truth, first episode psychosis may emerge quickly or gradually, and the amount of time it lasts depends on its cause and treatment. Research suggests that early intervention frequently improves outcome, but many people are afraid of getting help because they fear being labeled “crazy.” Patients may deny they’re experiencing deviations from normal thinking patterns, but these denials are ineffective when psychotic symptoms are noticeable and significant.

Symptoms of first episode psychosis depend on causal factors and aren’t all present together. Doctors might suspect prodromal psychosis if a person reports inability to remember things, concentrate, or keep thoughts ordered. Other potential evidence of psychosis are different hallucinations that involve hearing, seeing, feeling, smelling, or touching things that are not there. In some individuals, psychosis is expressed by beliefs of having secret powers (delusions of grandeur) or feelings that others are somehow trying to harm the individual (delusions of persecution).

Additional symptoms could include strong negative moods like depression, or shifts between depression and mania. Loved ones or caretakers may notice these moods also. Another pattern caretakers often see is the person’s declining interest in any previous activities and strong social withdrawal.

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Any of the signs of first episode psychosis suggest seeking psychiatric help. Diagnosis is important to determine how best to assist the individual. A few conditions that might lead to psychosis are relatively varied and include: schizophrenia, bipolar disorder, bipolar affective disorder, rare forms of depression, and delusional disorders. Sometimes psychosis is brief and has been induced by head injury, use of alcohol or drugs, or simply occurs under extreme stress and then never happens again. Permanent brain injury or gradual deterioration of the brain via illnesses like Alzheimer’s disease can also result in ongoing expression of psychosis.

The underlying cause of first episode psychosis must be determined so doctors can decide what medicines, therapy or other interventions would best address symptoms. A correct diagnosis is vital to this process because different illnesses demand different therapies, and this is especially the case for drug therapy of any kind. Some people with first episode psychosis require hospitalization to get symptoms under control, and other times, particularly if the illness is found early, patients with supportive caregivers might remain at home and see psychiatrists and therapists on an outpatient basis.

Treatment outcome can be partially predicated on early intervention. A number of studies suggest that the sooner symptoms are recognized and diagnosed as first episode psychosis, the better the chances of successful treatment with fewer major interventions like hospitalization. Outcome also depends on cause. Some illnesses respond well to medicines and psychotherapy, but degenerative illnesses may not be curable. In contrast, brief psychosis may be fully recovered from and never occur again, so it may have the most favorable outlook.

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