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What does it mean to be at-risk for psychosis? 

In order to under what being at risk for psychosis means, you have to know what psychosis is.

Seeing or hearing things that are not there, believing what seems odd or untrue, or feeling confused when trying to think or speak.  Symptoms of psychosis tend to first appear between the ages of 12 and 25. 

 

People with signs of psychosis might report…

 

  • Feeling that “something is not quite right”

  • Having unusual thoughts and confusion

  • Experiencing fear for no good reason

  • Hearing sounds or voices that are not there

  • Declining interest in people, activities and self-care

  • Trouble with communicating and understanding

Meanwhile, family members or friends may observe…

  •  

  • Social withdrawal

  • Odd, unusual behaviors 

  • Decreased motivation 

  • Inability to enjoy activities

  • Mood swings 

  • Pervasive anxiety 

  • Disrupted sleep patterns

  • Changes in appetite and eating

  • Preoccupation with physical symptoms

Being at risk for psychosis means that symptoms are too mild and infrequent to constitute a diagnosis of Schizophrenia. Everyone has the potential to experience mild or temporary symptoms of psychosis. Profound sleeplessness or heavy substance use (e.g., methamphetamine, hallucinogenics) can cause anyone to temporarily hear or see things that are not there. In addition, some physical illnesses can have psychotic features such as Cushing’s syndrome, Huntington’s disease, or advanced AIDS. But people who are at risk for psychosis are more likely to continue experiencing symptoms and see them getting worse over time. 

 

Prevention

 

Today, there are more options for preventing psychosis than were available even a few years ago. Although medical treatment is still an important tool for managing symptoms that become overwhelming or uncontrollable, medicine is not the only choice out there.  Other ways to prevent psychosis include educating oneself about the disease, developing coping strategies that work, and continued engagement with daily routines and future plans. 

 

No matter what combination of services you choose, the key to greater success is catching signs and symptoms early on. Symptoms begin as subtle indicators that “something is not quite right” and then worsen over time. Families that attend to symptoms while they are still early see better outcomes. In other words, some studies suggest that early interventions to manage psychosis can actually stop the progression to more serious disorders, such as schizophrenia or bipolar disorder.  “Catching psychosis early” means working with a professional who has special training in treating psychosis as soon as possible. A specialist can ask the right questions to find out if a person is likely to be developing psychosis. 

Delaware CORE’s staff is specially trained to prevent the development of psychosis and provides a full range of services. These include individual counseling, education, multifamily groups, psychiatry, occupational therapy, and vocational/educational counseling and advocacy. For more information, call 888-284-6030.

 

Prevention Tips 

 

 

Give everyone involved the time and space they need to learn.

Accepting that psychosis is a possibility is a big change for the person who experiences it. Families must keep an open mind when deciding what to do next. For the person who is at risk, the change means taking on new responsibilities for self-care (e.g., attending to sleep and exercise, participating in treatment).

Learn to recognize the symptoms.

Taking care of oneself becomes easier when one can read early signs of a psychotic disorder.  This goes for everyone involved. Sometimes it is the person who is at risk for psychosis who is first to notice changes in mood or attention; other times, it is someone else. In either case, it is important for each person involved to track the kinds of situations (e.g., in large groups) or times of day that tend to trigger changes; using a calendar is often helpful. 

Get and give support.

Another important part of preventing psychosis is learning that you are not alone. Over the course of a lifetime, 9 out of 100 people are at risk of experiencing a psychotic episode. However, because many choose not to share their experiences with others, people at risk for psychosis are left with the impression that they are alone. By reaching out to organizations like Delaware CORE and the National Alliance for the Mentally Ill (www.namidelaware.org), one will find that there are many people who manage risk factors for psychosis, but are able to attend school, go to work, play sports, and spend time with friends.

 

Recommit to personal goals.

Actively preventing psychosis is a big adjustment. The process usually involves some loss and grieving. Sometimes it involves giving up some independence to let others help; sometimes it means putting plans on hold while one deals with the change. Grieving is a natural part of letting go of immediate goals, and it is important to make room for these emotional losses while reconsidering one’s priorities. Yet, giving up some of one’s plans is not the same as giving up entirely. As with any major shift, it is essential not to give up hope for one’s most important goals. In fact, now is the time to take stock of what is most important and recommit to it by finding people who will support one’s efforts to achieve and stay away from those who might argue that your goals are unachievable. Even if progress happens at a slower pace, one must never surrender that which is most important.

 

Self-advocate.

It is common for people who are fighting to prevent psychotic symptoms from getting worse have times when they feel helpless and overwhelmed. When those times make it hard for them to make decisions about treatment, it is sometimes necessary for trusted family members to step in and provide guidance on their decision making.


Be conscientious about medication.

Medicine is sometimes necessary as a defense against overwhelming symptoms, but it is not a cure all. If you are on a trial of medication,  it is critical to track changes in how you or your loved one responds to a drug (e.g., maybe keep a journal) and report back to the doctor or psychiatrist on any side effects. While medicine takes time to work, doctors are not mind readers and depend on patients to tell them when a drug is working or not. No medication is going to address every problem, so some symptoms are likely to persist even when taking medication. Living with some lingering symptoms of a severe mental illness is a reality for many people, but many people are able to manage their residual symptoms by exercising, getting plenty of sleep, learning to relax, engaging in pleasurable activities, or seeking accommodations at work or school. A combination of medication and therapeutic activity is the key to many peoples’ life success.