Psychotic Disorders and Schizophrenia

What is Psychosis and Psychotic Disorders?

Psychosis is used to describe a group of severe mental health disorders that disrupt a person’s perception, thoughts, emotions and behaviour through delusions and hallucinations. Psychosis is characterised by psychotic symptoms that alter the child or young person’s perception, thoughts, mood and behaviour.

Psychosis affects people of all ages but it is most likely to start between the ages of 15 and 35 years. The most common form is schizophrenia – over a lifetime, about 1 in 100 people will develop schizophrenia.

What are the symptoms of Psychosis?

The symptoms of Psychosis are usually divided into positive symptoms that add to a person’s normal state or behavior; including hallucinations and delusions, and negative symptoms that take away from someone’s behaviour or normal self, such as emotional apathy, lack of drive, poverty of speech, social withdrawal and self-neglect.

The main symptoms that characterise Psychosis and Psychotic Disorders are:

  • Hearing voices and sometimes seeing things thatare not really there (called a hallucination).
  • Believing strongly that something is real or true when it is not (called a delusion); for example, some people with delusions may be sure they are being watched or having their thoughts monitored.

Children and young people who develop Psychosis will have their own unique combination of symptoms and experiences, the precise pattern of which will be influenced by their circumstances and their stage of development.

There are different types of Psychosis, and a CAHMS team will try to work out which one the person has. Schizophrenia is only one type. People with bipolar disorder and depression may also present with features of Psychosis.

How do I know if my child has a Psychotic Disorder?

If your child has symptoms of Psychosis, they will usually experience very unusual and sometimes unpleasant thoughts and experiences. They may appear very suddenly making your child feel frightened or confused. Symptoms may also appear gradually and you may start noticing the young person is behaving strangely or differently than usual.

They may experience one or more of the symptoms below:

  • Unusual beliefs or delusions:These are very strong beliefs which are obviously untrue to others, but not to the young person. For example, when they are ill they may think that there is a plot to harm them or that they are being spied on by the TV or being taken over by aliens. Sometimes they may feel you have special powers.
  • Thought disorder:This is when they cannot think straight. Their ideas may seem jumbled, but it is more than being muddled or confused. Other people will find it very difficult to follow what they say.
  • Unusual experiences or hallucinations:These are when they can see, hear, smell or feel something that isn’t really there. The most common hallucination that people have is hearing voices. Hallucinations are very real to the person having them. This can be very frightening and can make them believe that they are being watched or picked on.

Having these strange thoughts and experiences can affect them at school, home or when they are with their friends. They may find it difficult to concentrate and enjoy their usual activities and even affect your sleep and appetite.

Treatment for Psychosis and Psychotic Disorders

Antipsychotics

Medications called ‘antipsychotics’ are an important part of treatment. Second generation Antipsychotics (SGAs) are almost universally used as a first line of treatment. They may need to be taken for a long time in order to stay well. As with medication of any kind, there can be side-effects; the specialist child and adolescent psychiatrist will be able to advise you on these and what can be done to help, and the patient liason officer or mental health nurse will support the family.

Psychological Treatment

Psychological treatments and social interventions have a very important role to play in the management of Psychosis.

Cognitive Behavioural Therapy           

Antipsychotic medication can end new psychotic experiences but they will not resolve established delusional systems or the memory of past psychotic experiences. For this reason, a cognitive approach is essential and especially relevant when working with young people.

Cognitive Behavioural Therapy (CBT) is a psychological therapy that aims to reduce feelings of distress, to help people cope with symptoms and to support people in carrying out everyday tasks. It helps people by making links between their thoughts, feelings and behaviour and their current or past symptoms and can help people to re-evaluate their beliefs, feelings or behaviour in relation to their illness.

There is a strong evidence base for CBT in adults with Psychosis. This approach can be successfully adapted for adolescents. CBT is very helpful for challenging belief systems arising from primary psychotic experiences.

Family interventions

Family intervention is a psychological therapy that supports families to work together to help the young person with Psychosis or schizophrenia and to reduce stress in family members. It aims to help family members develop communication, problem solving, information sharing and coping skills as well as increasing family members’ knowledge and understanding.

There is a longstanding evidence base showing how family intervention can greatly benefit the young person and their family.

Psychological interventions are more effective when delivered in conjunction with antipsychotic medication.

At the Camali Clinic, we employ a method of shared decision making which helps the family and clinical team come to a joint conclusion of what the best route of medication and treatment should be, given the young person’s circumstances and background.

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