Psychosis

Prevalence rate

Lifetime prevalence of psychotic disorders varies across studies. According to the Hong Kong Mental Morbidity Survey, approximately 2.5% of the Hong Kong Chinese adult population have a lifetime diagnosis of psychotic disorder.

Gender ratio

An almost equal sex ratio.

Age of onset

The onset is mostly from 20 to 30 years old.

There is no single explanation for the disorder. Nevertheless, medical findings have revealed that the aetiology of the condition is related to such factors as genetics, environmental stressor, brain pathology and misuse of substances.

Family inheritance

Family inheritance is a major risk factor for psychosis. Taking schizophrenia (a common diagnosis related to psychosis) as an example, statistics show that the general population has about 1% risk of developing the disorder in their lifetime, but if a person has a biological parent with schizophrenia, the risk increases to 17%, and if both biological parents have developed schizophrenia, the risk further increases to 46%.

On the other hand, when looking at identical twins who have almost the same genes, the risk of one sibling developing schizophrenia is only at 48% when the other sibling has developed the disorder. This shows hereditary factor does not single-handedly determine whether or not a person would develop psychotic disorders like schizophrenia.

Environmental stressors

Various kinds of life demands, such as study, work and personal pursuits, produce different degrees of mental stress. Failing to manage such accumulated stress effectively may induce psychosis. There is risk of developing psychosis, despite the absence of related family history.

Other risk factors

Traumatic brain injury, brain related diseases and drug abuse (e.g. using cannabis, “ice” i.e. methamphetamine hydrochloride) that cause neurological damage to the brain sometimes also lead to symptoms of psychosis.

The symptoms of psychosis are believed to involve the dysfunction of neurotransmitters, for example dopamine, in the brain. Common symptoms included: 

If you find these symptoms in your family members or friends, they may suffer from psychosis. Seek advice from doctors for assessment as soon as possible.

Medication

Antipsychotics can re-establish the balance of the neurotransmitters, such as dopamine in the brain. 
They can relieve the psychosis symptoms and prevent relapse.

Psychotherapy

Psychological treatment often goes together with medication. It helps the person to cope with the symptoms and alleviate psychological distress.

Family intervention

Family intervention is significant. The therapist will help patients to discover and analyse their problems, educate them about the coping strategies and provide relevant mental health information.

For more details, please visit: https://www3.ha.org.hk/cph/imh/doc/information/publications/2_17.pdf 

and https://www.who.int/news-room/fact-sheets/detail/schizophrenia

and https://www21.ha.org.hk/smartpatient/SPW/en-us/Disease-Information/Disease/?guid=efc1ca62-8742-4bd4-9554-d75b43138f77

Early detection of psychosis enhances the chance of getting better treatment results

Treatment is more effective if psychosis is detected at its initial stage. However, when detection and treatment are delayed, the patient's condition may deteriorate and will require a longer period of treatment. They will also be more likely to suffer from strain and damage to the brain, which will further reduce the effectiveness of treatment.

People suffering from early psychosis may be unwilling to receive treatment. They may believe that their symptoms will spontaneously disappear or deny the seriousness of the symptoms. They therefore feel skeptical or worried about undergoing therapy. Other common concerns include how people will perceive them, and a fear that others will discover they are undergoing psychiatric treatment. Therefore, family members’ care and encouragements for their help seeking become particularly important.

Fully support sufferers to get through the hardship

The recovery process varies between different patients. Some may recover within a short time, while others may take longer. Generally speaking, the duration from the onset of illness to recovery may last for a few months. However, if the psychotic symptoms persist, the recovery process will be prolonged.

Patients may feel depressed if their symptoms are not under control. During the recovery process, patients may worry that their condition is incurable and feel anxious for their future. We need to understand they are struggling with their illness and may be vulnerable, and persistent supports to them are critical during this time.

Tips for caregivers:

Encourage proactive treatment:

Encourage the patient to take medication and attend therapies regularly to enhance recovery and reduce risk of relapse.

Watch out for early signs of relapse:

such as anxiety, insomnia, appetite change, loss of interest, social withdrawal, depressed mood, feelings of being teased or referred, being excessively insistent.

Accept their behaviours:

Stay calm. Do not be argumentative or critical towards patient’s symptoms and behaviours. Do not argue with patient about the genuineness of their hallucinations or delusions. May help them to focus on something else from their symptoms, such as encouraging them to talk or do things that they are interested.

Communicate and encourage:

Listen patiently to them first, pay attention to their positive changes, improvements or merits. Talk in simple and direct ways and be encouraging.

Provide regular life:

Set a structured timetable for sleep, work and interest. Engage them in normal daily life as far as possible.

Encourage social interactions:

Encourage patient to attend social rehabilitative service to enhance their social life.

Take care of yourself:

Supporting patients suffering from psychosis is a long-term challenge. So carers need to look after their own physical and mental health, to rest and regenerate, and then to accompany patients to get through the troubled time. Ask for help when necessary.