A lack of knowledge of the disorder means psychosis can go undetected, leading to chronic problems for 15-20 per cent of sufferers. Fiona Tyrrell reports
Psychosis affects three out of every 100 people in Ireland. However, lack of knowledge of the disorder results in late diagnosis and significantly reduced outcomes for those who develop the condition, according to those working in the field.
Psychosis is an umbrella term incorporating a series of disorders. The most common form is schizophrenia; other forms include bi-polar disorder, drug-induced psychosis or psychosis as a result of brain disease.
The disorder usually develops early in life (late adolescents and early 20s) and can, without proper treatment, go on for decades.
An estimated 1,900 people under the age of 18 develop the condition every year in Ireland with a further 70 new cases under the age of 13, according to Dr Blanaid Gavin from Lucena Clinic Services in Dublin.
Symptoms vary but include delusions, hallucinations, disorganised thinking and lack of motivation. Because the disorder usually presents during the crucial developmental stage when young people are laying the foundations for their personal, academic and economic advancement, the impact can be far reaching.
Eighty per cent of people with long-term psychosis are unemployed and 5-7 per cent of people with schizophrenia take their own lives. However, many people who develop psychosis do recover and early diagnosis and intervention are crucial to such recovery, says Prof Eadbhard O'Callaghan, a psychiatrist with Cluain Mhuire mental health services in Dublin.
Generally, 15-20 per cent of people affected by psychosis will have just one episode and recover, he says. However, 15-20 per cent will have long-term chronic problems with constant admission and re-admission, often ending up in residential care.
Improvements in anti-psychotic drugs and developments in cognitive behaviour therapy (CBT) mean treatments are becoming more effective. Early and aggressive treatment means patients can get to a maintenance stage where they can return to work, manage a household and sustain relationships between episodes.
Research indicates that people with psychosis are usually unwell for a considerable length of time before accessing effective treatment. One study revealed that sufferers in Dublin wait 23 months between onset of symptoms and effective treatment.
This period is absolutely critical - the longer the illness goes untreated, the greater the risk the person's life will be permanently affected, according to Gavin. It is also during this period that adolescents will suffer in terms of academic and social development. They may start using drugs and alcohol as a form of self-medication or turn to self-harm and suicide.
The relationship between psychosis and drugs, particularly cannabis, continues to be hotly debated. What we do know, says O'Callaghan, is that 30-40 per cent of people with psychosis are substance misusing, he says.
As GPs are usually the first port of call, GP education about the disorder is very important, according to Prof Fiona McNicholas, consultant child and adolescent psychiatrist at Lucena Clinic Services.
The speed with which patients are picked up from the routine waiting list hinges on how serious the GP considers the problem. Early diagnosis is also jeopardised with a seriously under-resourced child psychiatric services in Ireland. There are 3,000 children waiting for psychiatric treatment and these services are not covered under the National Treatment Purchase Fund, according to McNicholas.
The Lucena Clinic is establishing the Early Assessment of Risk in Lucena youth (Early) programme to target children attending the clinic who present with risk symptoms, which include family history, neurological difficulties, odd social behaviour or gradual decline in social or academic function.
To date there is only one specialised service in this country which facilitates the early diagnosis of young people with psychosis. The Dublin East Treatment and Early Care Team (Detect) is a pilot project operating through adult mental health services in south Dublin and Wicklow.
Detect offers a 12-week group-based CBT programme to people who have experienced their first psychotic episode. CBT teaches people to become aware of their thought processes and the impact those thoughts have on how they feel and behave, explains Liz Lawlor, psychologist with the Detect project. Psychosis is very traumatic and a group session has a very beneficial normalising effect, she explains.
The fact that the outlook for people with psychosis has improved considerably in recent years and the current medical thinking that the disorder is not a result of bad child-rearing practices are stressed at the sessions.
An information session for carers and families of adolescents with psychosis will be held on Tuesday, June 20th at the Lucena Clinic in Dublin in conjunction with the Association of Child and Adolescent Mental Health (ACAMH). For further information tel: 01 4923596.