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First Episode Psychosis, Schizophrenia Spectrum Disorder or Bipolar I

First Episode Psychosis (FEP)

Psychosis affects about 3 in every 100 adults, with typical onset in late adolescence or early adulthood (16– 22 years old). Early psychosis, also known as first-episode psychosis (FEP), is often frightening, confusing and distressing for the person experiencing it and difficult for his or her family to understand.

Early psychosis or a first episode is the most important time to connect with the right treatment. Doing so can be life-changing and radically alter a person’s future. So, while it can be difficult to tell the difference between the early warning signs of psychosis and typical teen or young adult behavior, if you are concerned, don’t delay in getting help.

Psychosis involves loss of contact with reality, such as hallucinations (seeing or hearing things that others do not) or delusions (beliefs that are not based in reality). Symptoms of psychosis can also include speech that does not make sense, difficulty thinking clearly, lack of self-care, withdrawal and odd or inappropriate behavior.

The Prodromal Period

Early psychosis rarely appears spontaneously or with rapid onset. Usually, a person has gradual, non-specific changes in thoughts and perceptions, but is unable to identify what is occurring. This period is called the “prodromal period” — when signs of a problem are apparent, though the illness itself has yet to emerge. Early warning signs can be difficult to notice or to distinguish from typical teen or young adult behavior, and include the following:

• An unexplained drop in grades or job performance
• Changes in cognition such as difficulty thinking clearly or concentrating
• Suspiciousness or uneasiness with others
• A decline in self-care or personal hygiene
• Isolating, loss of contact with friends
• Strong, inappropriate emotions or having no feelings at all
• An increased use of marijuana, alcohol, and other substances.

Signs of early or first-episode psychosis

Determining exactly when the first episode of psychosis begins can be hard, but these signs and symptoms strongly indicate an episode of psychosis:

• Hearing, seeing, tasting or believing things that others don’t
• Persistent, unusual thoughts or beliefs that can’t be set aside regardless of what others believe
• A sense of confusion, difficulty expressing thoughts and ideas in a coherent manner
• Strong and inappropriate emotions or no emotions at all
• Withdrawing from family or friends
• A sudden decline in self-care
• Trouble thinking clearly or concentrating

If you or someone you know is experiencing these warning signs, contact us or another first-episode psychosis program. Early action keeps young lives on track.

Schizophrenia Spectrum Disorders

Schizophrenia is a serious mental illness that dramatically disrupts one’s ability to think clearly, participate in daily life, and trust one’s own sense of reality, all of which can persist long-term.

Previously, schizophrenia was organized into different categories (catatonic, disorganized, paranoid, and undifferentiated). The current view that experts take is viewing schizophrenia as a spectrum disorder since symptoms tend to overlap throughout the natural history of the illness.

A common experience among those who live with a schizophrenia spectrum disorder is psychosis. Psychosis is the state at which impacts perception, thinking, speech, behavior, and one’s ability to function on a day-to-day basis.

Common symptoms include the following:

• Hallucinations: Sensory experiences that appear real but are actually created by one’s own mind. Hallucinations can occur in any of the five senses, such as seeing or hearing things that are not there.
• Delusions: Mistaken but firmly held beliefs, like thinking one has superpowers, is a famous person, or people are out to get you.

Types of Schizophrenia Spectrum Disorders
• Schizoaffective disorder: Has features of schizophrenia and features of a mood disorder (either major depressive disorder or bipolar disorder), including psychosis, depression, and mania. The person must experience psychosis for at least two weeks when they are not having a depressive or manic episode. Depressive or manic episode symptoms are present over half of the duration of the condition.
• Delusional disorder: The person has experienced at least one delusion for at least one month but has never met the criteria for schizophrenia. Functional impairment is due to the delusion only and not experienced outside of it.
• Brief psychotic disorder: An episode of psychotic behavior with a sudden onset lasting less than a month, followed by complete remission. Another psychotic episode in the future is possible.

In all cases, studies show that the best predictor of recovery and relapse prevention is early intervention with coordinated specialty care combined with opportunities for social engagement.

Bipolar I

Bipolar Disorder, once called manic depression, is characterized by unusual and out of character shifts in mood, energy and activity levels, concentration, and the ability to complete daily tasks. Bipolar I alone affects about 2.8% of the population. In order to meet criteria for Bipolar I, one must have had a manic episode, which may be preceded or followed by a hypomanic or major depressive episode. A manic episode is defined as “abnormally and persistent elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy.” The duration of this episode must last at least one week and be present for most of the day, nearly every, though this is not the case if the individual requires hospitalization. The following are some additional symptoms of a manic episode.

  • Inflated self-esteem or grandiosity
    • In a manic episode, one often believes that they may be special or particularly gifted in ways that are not necessarily accurate nor based in reality, such as believing that they are close friends with a celebrity or are the smartest person in the whole world, despite evidence to the contrary.
  • Decreased need for sleep
    • Not to be confused with insomnia, which is when one has difficulty falling or staying asleep. While someone with insomnia may only get 4 hours of sleep and feel dreadful in the morning, someone experiencing mania may get 4 hours of sleep and feel quite rested.
  • More talkative than usual or pressured speech
    • Speech is often rapid and almost compulsive. Meaning that it is difficult to interrupt, even by oneself, at times aimless, and does not take into account the desire the other person to engage in the conversation.
  • Flight of ideas
    • Individuals experiencing a manic episode often describe their thoughts as “racing.” Thoughts move through one’s mind faster than they can be articulated through speech and as a result can be observed as talking continuously and then abruptly shifting topics. At its worst, individuals may be seen as incoherent and disorganized.
  • Distractibility
    • This is not simply having difficulty focusing. Distractibility in this severe form is often a struggle with ignoring anything unrelated to the task or conversation at hand, such as background noise, furniture in the room, or passersby.
  • Increase in goal-related activities or psychomotor agitation
    • Although an increase in goal-related activities may sound beneficial, if is often characterized by planning and acting on multiple activities, including sexual, occupational, social or academic, but without necessarily being succesful in completing any. Furthermore, one may also display restlessness and purposeless activity, and doing multiple things at once or pacing.
  • Poor decision making and risky behavior
    • A person experiencing mania is at-risk for engaging in behaviors with significant consequences, such as reckless driving, spending, poor investment/business choices, or sexual behaviors including infidelity, and indiscriminate encounters without regard to health and interpersonal consequences.

The difference between a manic and a hypomanic episode is the severity of the impairment. A manic episode results in a marked impairment in various domains of functioning and may result in hospitalization to prevent harm to self or others, or may include psychotic features.

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