The earlier that people with psychosis symptoms receive treatment, the better their recovery is likely to be.
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The Wisdom of Psychopaths
In this engrossing journey into the lives of psychopaths and their infamously crafty behaviors, the renowned psychologist Kevin Dutton reveals that there is a...
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Mike (not his real name) had always been an unusual child. Even as a toddler, he had difficulties relating to others and making friends, and he seemed strikingly suspicious of other people. After he entered high school, Mike became increasingly angry, paranoid and detached. He worried that people were searching his room and his locker when he was not around. His grades plummeted as he turned inward during class, sketching outlandish scenes in his notebooks and muttering to himself rather than listening to the instructor.
Paranoia and difficulties connecting with others are signs of psychosis, a mental illness in which people lose touch with reality. Psychotic individuals usually have problems forming rational, coherent thoughts. They also may hear voices or hallucinate while believing that what they perceive is real. Often such delusions result in bizarre behavior and, in severe cases, an inability to manage everyday life. But a psychiatrist deemed Mike’s symptoms too mild to qualify him as psychotic. Mike obviously needed some kind of professional intervention, so he bounced among psychiatrists who could not figure out how to help him.
Cases such as Mike’s have prompted some practitioners to propose the inclusion of a new psychosis risk diagnosis to the forthcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the “bible” of mental health diagnoses. To receive this diagnosis, a patient would first need to report, for example, having delusions or hallucinations about once a week (as opposed to most of the time for at least one month for clinical psychosis). In addition, either the patient or a loved one must be significantly distressed by those symptoms. The idea of including such a diagnosis in the DSM is highly controversial, but supporters argue that patients such as Mike not only need immediate help, they are at increased risk for developing full-blown psychosis, an outcome doctors might be able to prevent with early intervention.
An Ounce of Prevention
Currently patients diagnosed with full-blown psychosis find relief from so-called atypical antipsychotic medications such as risperidone and olanzapine, which help to reduce hallucinations and delusions. Patients may also benefit from some forms of psychotherapy. And data suggest that the earlier such patients receive help by either method, the better they fare. In a study published in 2005 psychiatrist David L. Penn of the University of North Carolina at Chapel Hill and his colleagues analyzed 30 studies evaluating treatments for first-episode psychosis. The researchers found that early, aggressive treatment with medication and psychotherapy, as compared with no treatment, showed promise in reducing both psychotic symptoms and their impact on patients’ lives. Thus, intervening with patients earlier, at the “risk” stage, could conceivably be even more beneficial, some argue.
In addition, several recent studies have found that two forms of psychotherapy alone—without medication—can help control psychotic symptoms even before a person can be officially diagnosed as psychotic. Using cognitive-behavior therapy, practitioners encourage patients to look for evidence supporting their hallucinations and delusions. And so-called acceptance and commitment therapy alleviates psychotic symptoms by teaching patients mindfulness—the ability to focus on the moment in a nonjudgmental way. What is more, in a study published in 2010 psychiatrist G. Paul Amminger of the Medical University of Vienna in Austria and his colleagues found that over-the-counter omega-3 fatty acid supplements reduced the onset of full-blown psychosis by 23 percent in young people with subclinical psychosis.
As a result of such data, psychiatrists such as William T. Carpenter, Jr., of the University of Maryland, who chairs the Psychotic Disorders Work Group for DSM-5, believe that intervening at a prepsychotic stage could ameliorate and even thwart this serious mental illness in a large number of people. Preliminary studies, he says, show that individuals who fit the putative criteria for the psychosis risk syndrome—now officially dubbed attenuated psychosis syndrome—are tens to hundreds of times more likely to develop schizophrenia and psychosis than the average person. Preventing some of these cases would be a huge boon to the individuals affected and would lift the burden on their families, communities and the mental health system as a whole.
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8 Comments
Add Comment"Preliminary studies, he says, show that individuals who fit the putative criteria for the psychosis risk syndrome—now officially dubbed attenuated psychosis syndrome—are tens to hundreds of times more likely to develop schizophrenia and psychosis than the average person."
Reply | Report Abuse | Link to thisI think this should be rephrased to say, "individuals are ...tens to hundreds of times more likely to BE DIAGNOSED WITH schizophrenia and psychosis than the average person"
Mental health diagnosis are incredibly subjective and changeable. There is no blood test for schizophrenia. It's really just a matter of a "clinician" thinking, "hmmm, seems like schizophrenia" and then the patients whole life can be sent in a different direction. I'm glad the article focused on the dangers of mis-diagnosis. The dangers are even more extreme when talking about diagnosing children who are still in the process for forming their identity. Expectation predicts outcome - both for the client and the psychiatrist.
A highly informative and up-to-date article. The population with "atenuated psychosis" described here may be the "prone to schyzophrenia" people that should never try Cannabis and other abuse drugs. When I first read the comment about "prone to schyzophrenia" advised not to smoke Marihuana, I wondered who was able to describe the traits to identify such people. Now a population subset at special risk for mental disorders when on abuse drugs is finally described by this research. Very practical !.
Reply | Report Abuse | Link to thisEvery US President since Truman has been willing to destroy all human life, via nuclear war, in defense of US interests. Might not accepting this be a sign of insanity? Might not even a willingness to run for that office be an indication of insanity?
Reply | Report Abuse | Link to thisI am not a physician but it is said first be your physician.
Reply | Report Abuse | Link to thisI think the problem could be reduced if we feed correctly the patient. Food supplements are a good choice but kidney and glands problems later might force the patient to cut these supplements. Besides, the good nutritive supplement is another aspect of the problem. The regular prescription is another aspect. The patient should the least and if he or she feels the need. Soon it might become a addiction if not correctly handled. Sometimes he or she likes too much fatty cheese or dairy. It might cover the brain blood capillaries and causes problems. In other aspects the brain needs some fat for proper function and you should take care for each patient separately.
“so-called atypical antipsychotic medications such as risperidone and olanzapine, which help to reduce hallucinations and delusions”.
This is like having a quite room that allows you to have some rest, but does not cure the patient. Of course we have recently the food supplements diseases that should be studied and find out why they are not helpful.
I am one of those psychotic people you love to talk about. I have contracted for a number of years now with a Department of Psychiatry out West, working directly with psychiatrists in that Department and nationally. I even worked to help set up one of these prodromal psychosis programs.
Reply | Report Abuse | Link to thisLet me tell you: they are making this up as they go along. Psychiatrists are being marginalized by their reliance on drugs and on seeing mental illness as a manifestation of brain illness, so the only way they can stay valuable is to expand their territory: hence prodromal youth.
The DSM-V committee was hand picked to produce results consistent with the desires of the psychiatric elite. They are the same people who make the same decisions about medicines and people with mental illness all the time. Even those people with mental illness included on the DSM-V review panel are the usual suspects, comfortable for the psychiatric elite, and bound to be open to the expansion of psychiatry into, to use the word from this article, "aggressive," treatment of youth with antipsychotics.
Most of the review of the DSM-V has taken place in secret, with brief periods of public comment allowed, and then back behind closed doors. Psychiatry is about to spring a doozy on those with mental illness.
As far as prodromal psychosis, I did see young people in the one program who were legitimately ill. But these were people approaching their 20's, around the time psychosis would emerge anyway. The younger people were either drug addicts their parents could not control so they desperately wanted a mental health diagnosis, or right brain thinkers stuck in left brain families.
There is a whole contingent of psychiatrists who now have their professional reputations built around this territory grab into prodromal psychosis, so it is not going to go away. More and more kids are going to be sucking Risperdal like candy. "Johnny, why did you quit soccer?" "Because I can't get off the couch, I gained 30 pounds, got diabetes and drool on myself." "Oh."
Most of what I saw with young people were parents who were so overwhelmed that they saw no way to deal with their child than to say that he or she was sick. Teenagers are weird, moody things. Don't you remember being one? Wouldn't your mother have loved to take you to the doctor to get a pill for you? Nice and compliant, calm and directable - you needed that, didn't you?
Re: Blood test to diagnose schizophrenia.
Reply | Report Abuse | Link to thisI think visual, tactile, and auditory hallucinations are one of the good indicators of schizophrenia in a person who is not on a prescribed or unprescribed medication.
There should be a helluvalot more psychotherapy for such teen-agers and alot less "anti-psychotic" drugs used by psychiatrists who cannot be bothered to spend the time necessary with patients. The basic cause of this deficiency is the payment-system for psychiatrists ie money need ie greed. Psychiatrists themselves have the highest incidence of mental illness of all the medical specialties, and of suicide. But keep in mind that the entire economic system under which they work is literally insane.
Reply | Report Abuse | Link to thisYou sound paranoid. I never take the word of a junky about the impact of their drug of choice so I'm not about to take the word of a psychotic about psychosis.
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