Early Psychosis

Psychosis can be defined as a temporary loss of contact with reality characterized by hallucinations (seeing or hearing things that others don’t), delusions (unusual or false beliefs that impact functioning), and disorganized speech or thinking. Each individual will have a unique combination of experiences and symptoms which means that careful and thorough assessment is important.

It is important to note that psychosis exists on a continuum and that many of the experiences associated with psychosis occur in the general population. This continuum ranges from an absence of any psychotic-like experiences through to fully psychotic symptoms that impact behavior and functioning. At one end of the continuum are psychotic-like experiences common in the general population including magical thinking (making links between two unrelated events), low level perceptual abnormalities (hearing your name called when no one is around), and suspiciousness and paranoia (unfounded negative beliefs about friends or colleagues). These experiences are typically fleeting and easily dismissed by the individual. Further along the continuum these experiences may become more meaningful to the individual and they may begin to experience them with an increased frequency, higher distress, and find them harder to dismiss. At this point the individual may be experiencing ‘attenuated psychotic symptoms’ and may be at an elevated risk for developing full psychosis. A number of factors are associated with this increased risk including stress, trauma, sleep deprivation, substance use, and changes in brain anatomy.

Attenuated symptoms are considered to have reached the threshold for ‘full psychosis’ when they negatively impact on an individual’s functioning and the individual has full conviction as to the reality of their experience.

This continuum approach to psychosis is important as it allows:

1. Normalization of psychotic symptoms helping individuals to understand that full psychosis is an extreme state of normal human psychological functioning
2. Earlier detection of individuals who may be at-risk for developing psychosis
3. Provision of interventions to individuals at-risk of developing psychosis to prevent or delay a transition to full psychosis
4. Implementation of recovery-oriented interventions to address factors that may have influenced progression along the continuum
5. Promotion of hope optimism for recovery