How to Coach Yourself and Others Coaching and Counseling in Difficult Circumstances | Page 14
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1. About the First Episodes of Psychosis
Early identification and evaluation of the onset of psychosis is an important health concern. Early detection and
intervention improve outcomes. Psychosis may be transient, intermittent, short-term or part of a longer-term
psychiatric condition. It is important to understand the range of possibilities, both in terms of possible diagnosis
associated with psychosis and the prospects for recovery. This NAMI website is a resource guide for your
increased understanding of assessing, treating and living with new onset psychosis, including strategies to help
the return to school, work and daily life.
What Is Psychosis?
Psychosis (psyche = mind, osis = illness) is defined as the experience of loss of contact with reality, and is not
part of the person’s cultural group belief system or experience. Psychosis typically involves one of two major
experiences:
A. Hallucinations can take the form of auditory experiences (such as hearing voices); less commonly, visual
experiences; or, more rarely, smelling things that others cannot perceive. The experience of hearing voices has
been matched to increased activity in the auditory cortex of the brain through neuro-imaging studies. While the
experience of hearing voices is very real to the person experiencing it, it may be very confusing for a loved one
to witness. The voices can often be critical (i.e. “you are fat and stupid”) or even threatening. Voices also may
be neutral (i.e. “the radio is on”) and may involve people that are known or unknown to the person hearing the
voices. The cultural context is also important. For example, in some Native American cultures, hearing the
voice of a deceased relative is part of a healthy grieving process.
B. Delusions are fixed false beliefs. Delusions could take the shape of paranoia (“I am being chased by the
FBI”) or of mistaken identity (a young woman may say to her mother, “You are an imposter—not my mother”).
What makes these beliefs delusional is that these beliefs do not change or modify when the person is presented
with new ideas or facts. Thus, the beliefs remain fixed even when presented with contradicting information (the
young woman continues to believe her mother is an imposter, even when presented with her mother’s birth
certificate and pictures of her mother holding her as a baby). Delusions often are associated with other cognitive
issues such as problems with concentration, confused thinking and a sense that one’s thoughts are blocked.
These experiences can be short lived ( e.g. after surgery or after sleep deprivation) or periodic (as when
associated with a psychiatric condition or persistent like bipolar disorder or major depression).
Some typical and early warning signs of psychosis include
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Worrisome drop in grades or job performance;
New trouble thinking clearly or concentrating;
Suspiciousness/uneasiness with others;
Decline in self-care or personal hygiene;
Spending a lot more time alone than usual;
Increased sensitivity to sights or sounds;
Mistaking noises for voices;
Unusual or overly intense new ideas; and
Strange new feelings or having no feelings at all.
These signs are particularly important when they are new or have worsened in the last year and if the individual
has a close relative that has experienced psychosis. Learn more about psychosis risks by visiting the Centre for
Early Detection, Assessment and Response to Risk.
Behaviour and thought processes are often impacted by delusions or hallucinatory experiences. People
experiencing new onset psychosis may report trouble organizing their thoughts, feeling as if they are dreaming
while awake or wondering if their minds are playing tricks on them. Hallucinations can distract a person’s
attention and executive functioning (the ability to prioritize tasks and make decisions) may also be impacted.
Agitation or withdrawal often accompanies these experiences, which can be experienced in a variety of ways
but are often anxiety-provoking or terrifying. At times, people experience these altered perceptions of reality
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