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| Recognising Psychosis |
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| | Symptoms / What to expect | Causes | Treatment / Help available | |
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Psychosis is not a specific illness, rather it is a syndrome. The central characteristic of psychosis is a loss of reality testing, resulting in some degree of impairment of judgement. The psychotic state is evident by the presence of disturbance of perception, such as hallucinations or disturbance of thinking, such as disordered thinking and delusions.
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Symptoms / What to expect
Even before the onset of the florid symptom characteristics of psychosis, a person may show some disturbances during the pre-psychotic or prodromal phase. Some of these symptoms include:
- Perceptual disturbances such as feelings that things around have changed
- Mood disturbances such as anxiety, depression, mood swings, irritability and anger
- Cognitive disturbances such as poor attention and concentration, difficulties in thinking, suspiciousness and unusual beliefs
- Behavioural disturbances such as change in sleep and appetite patterns, social withdrawal, loss of interest in things, deterioration in occupation and academic functioning
Different people will probably interpret these disturbances differently. Some may see them as symptoms of stress, especially if the changes are associated with some stressful life events. Others may see them as part of the person’s personality. Cultural influences may also play a part in how the symptoms of psychosis might be interpreted. Psychotic symptoms are often attributed to supernatural causes rather than biological causes. The personal understanding of the disturbances will determine the help seeking behaviour. Even for those who suspect that it may be a mental condition, the stigma of seeking psychiatric help may deter them from consulting a psychiatrist. It is not surprising that there is often a long delay, sometimes even a few years, before the person reaches professional help.
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Causes
General practitioners and counsellors may be the first contact point for the person or his family to raise concerns about the person’s change in behaviour and functioning. It is important to have a high index of suspicion in order to pick up cases of possible psychosis and refer them early for further evaluation and treatment. This is especially so if the person exhibiting prodromal symptoms has these associated risk factors:
- A positive family history of schizophrenia or psychotic disorder, especially among first degree relatives
- · Vulnerable personalities such as those with schizotypal personalities
- · History of occasional brief symptoms of hallucinations or delusions
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Treatment / Help available
One of the components of the programme is to provide psychiatric assessments for individuals who have symptoms of psychosis or possible psychosis. The initial assessment is done by a psychiatrist, together with a case manager, who may be a psychologist, a medical social worker or a nurse.
If the individual is accepted into the programme, the case manager and psychiatrist will continue to take care of the patient. Besides medication, counselling, psychoeducation, psychotherapy, patient support groups and family support/psychoeducation are integral parts of our treatment.
Currently, we run our Early Psychosis Screening Clinics at the following locations:
EPIP also maintains a hotline (DID 9017 8212) between 9 am to 5 pm, Mon to Fri. The duty case manager will make a quick assessment over the phone and arrange for an assessment at one of the outpatient clinics if necessary.
Besides outpatient clinics, we have inpatient services at Woodbridge Hospital. We run the various support groups and day activities at Club EPIP in Woodbridge Hospital. For more information, please visit EPIP's website at www.epip.org.sg
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