First episode psychosis can appear suddenly or gradually and may include symptoms such as hallucinations, delusions, negative moods, and social withdrawal. Early intervention is important for successful treatment, but many people are afraid to seek help. Correct diagnosis is critical for determining the best treatment, which may include medication, therapy, or hospitalization. The outcome depends on the cause, and some diseases may not be curable.
Prodromal, or first episode, psychosis is the first appearance of psychotic symptoms in an individual. The term “episode” confuses people because it implies a sudden and time-limited experience. Indeed, the first episode of psychosis can emerge quickly or gradually, and the duration depends on the cause and treatment. Research suggests that early intervention often improves outcomes, yet many people are afraid to get help because they fear being labeled ‘crazy’. Patients may deny that they experience deviations from normal thought patterns, but these denials are ineffective when psychotic symptoms are evident and significant.
The symptoms of first episode psychosis depend on causal factors and are not all present together. Doctors might suspect prodromal psychosis if a person reports an inability to remember things, concentrate, or keep thoughts orderly. Other potential evidence of psychosis is several hallucinations involving hearing, seeing, feeling, smelling, or touching things that aren’t there. In some individuals, psychosis is expressed by beliefs that they have secret powers (delusions of grandeur) or feelings that others are in some way trying to harm the individual (persecutory delusions).
Additional symptoms might include strong negative moods such as depression or changes between depression and mania. Even loved ones or caregivers can notice these moods. Another pattern that caretakers often see is the person’s waning interest in any previous activity and severe social withdrawal.
Any sign of first episode psychosis suggests seeking psychiatric help. Diagnosis is important in determining the best way to care for the individual. Some conditions that could lead to psychosis are relatively varied and include: schizophrenia, bipolar disorder, bipolar affective disorder, rare forms of depression, and delusional disorders. Sometimes the psychosis is short-lived and was induced by head trauma, alcohol or drug use, or simply occurs under extreme stress and then never comes back. Permanent brain injury or the gradual deterioration of the brain through diseases such as Alzheimer’s disease can also result in the continued expression of psychosis.
The underlying cause of the first episode of psychosis needs to be determined so that doctors can decide what medications, therapy, or other interventions might best address the symptoms. Correct diagnosis is critical to this process because different diseases require different therapies, and this is especially true of drug therapy of any kind. Some people with first episode psychosis require hospitalization to get symptoms under control and at other times, particularly if the illness is found early, patients with supportive caregivers might stay at home and see psychiatrists and therapists on an outpatient basis .
Treatment outcome may be partially based on early intervention. Numerous studies suggest that the sooner symptoms are recognized and diagnosed as a first episode of psychosis, the better the chances of successful treatment with fewer major interventions such as hospitalization. The result also depends on the cause. Some diseases respond well to medication and psychotherapy, but degenerative diseases may not be curable. Conversely, brief psychosis can be completely cured and never recur, so it can have the most favorable outlook.
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