Early Psychosis

Early psychosis is an abnormal mental condition that is often accompanied with delusions, hallucinations and disorganised speech. The thoughts, emotions and feelings of people suffering from early psychosis are frequently out of touch with reality. If early psychosis is identified in its initial stages and treated properly, it will be possible to minimise the disabilities that it causes and prevent serious complications from developing.

The condition may affect individuals in any age group, and Hong Kong’s demographic makeup indicate that 13,00 new early psychosis cases occur every year.

Footnotes:

1. The global incidence of early psychosis (the percentage of individuals who are experiencing or have experienced this mental state) is estimated to be 1%.
2. The annual incidence of new cases is estimated to be 5 in 10,000 (i.e. 5 new cases among every 10,000 people every year)
   

Evidence from international and local studies suggest that early detection and intensive comprehensive intervention during the initial critical period after the onset of psychotic illness associate with better outcome.

Early Intervention Service for early psychosis aims to improve the prognosis by reducing the mortality and preventing progression or worsening of the disorder and to minimize the distress, morbidity, comorbidity, disability and costs associated with chronic form of illness. Treatment is more effective if early psychosis is detected at its initial stage. Furthermore, the treatment experience will be less traumatic, and the patient will be more likely to make a full recovery and be able to resume normal life.

On the other hand, if detection and treatment are delayed, the patient's condition may develop into a mental illness that will require a longer period of treatment. The patient will also be more likely to exhibit negative symptoms that may make it more difficult for him/her to resume normal life after recovery.

Early psychosis refers to a group of symptoms or abnormal mental health conditions. These symptoms may have different causes such as sleep deprivation, other physical conditions, alcohol or drug abuse and brain damage. Early psychosis itself is not a diagnosis but a clinical syndrome consists of the above mentioned symptoms. 

 The symptoms of Early Psychosis include:

1. Disorganised speech
   Incoherent and disorganised speech that is incomprehensible to other people.
2. Delusions
   False and unshakable belief that is out of touch with reality. For example, a person may firmly believe he or she is being closely monitored and/or persecuted.
3. Hallucinations
   Perception that is unrelated to any external stimuli. A person may see or sense non-existent objects or hear imaginary voices and perceive these to be real.
4. Other symptoms of early psychosis
   Self-neglect, social isolation and withdrawal, and lack of motivation to work or study.

There are two main treatment methods for early psychosis: pharmacological and psychosocial.

Pharmacological
Medicine plays a more fundamental role in the treatment of early psychosis and the prevention of its recurrence in the initial stage than other treatment methods. It can effectively reduce the psychotic symptoms, as well as the anxiety and depressive symptoms associated with them. People, who seek treatment at an earlier stage, will require relatively smaller medication dosages, leading to better recovery.

Psychosocial
Patients need to be able to count on others to give them support and share their worries during the initial stage of early psychosis. They also need to talk to people who will help them to solve their problems. That is why psychosocial intervention is so important in early psychosis treatment. Different forms of supportive counseling and psychological interventions are tailored to meet the individual needs of patients at a particular stage of their conditions. Both individual and group psychotherapy can be used. The underlying concepts of the therapy can be integrated into the daily lives of patients in order to assist their recovery. For instance, patients are encouraged to return to their studies or work, where they can interact with more people and remain in touch with reality. Such services can be provided by multidisciplinary team including the psychiatrists, intervention officers, psychologists, occupational therapists, medical social workers as well as social workers and health care workers from various community Non-government Organization Services.

Support and encouragement from family and friends are most important for recovery from their first episode psychosis. Most patients at the stage of early psychosis are treated as outpatients and do not need to be hospitalised. Receiving treatment in the community enables them to enjoy the support and encouragement of their family members and friends, and this helps their recovery. At the same time, they can learn more about their conditions and receive regular assessments in outpatient clinics. However, some patients with early psychosis do need to be hospitalised for detailed assessment and intensive intervention. The hospital setting also provides them with a more comfortable and relaxed environment in which they can experience a stronger sense of security and stability.

Early Psychosis can be co-existed with other mental health conditions such as schizophrenia, mania and delusional disorders , etc.

Besides undergoing comprehensive treatment and gaining support from family members and friends, the patients themselves have a key role to play. They should actively involve in their treatment plans, learn more about early psychosis and its recovery process, and understand how they can help themselves resume a normal life. They should therefore plan their own treatment in partnership with psychiatric professionals. Sometimes, early psychosis can disrupt their development in various aspects including personal, social, academic or occupational. So it is important to consider the details of how they will resume their normal studies and careers afterwards, as well as how they should handle the worries and stress caused by their condition. Psychiatric professionals will then able to help them understand their rights and responsibilities, while encouraging them to seek relevant professional advice.