Early Recognition Of Psychosis
The key to early recognition is to keep the possibility of psychosis in mind when treating young
people experiencing persistent changes in behaviour and functioning, especially in the presence of other risk factors. Maintain a high index of suspicion. In bold below the common signs and symptoms are described. Regarding the bottom half of the list, * is used to denote factors of
particular concern. These signs are not necessarily early warning signs of developing Psychosis,
they can be caused by other disorders or be temporary reactions in adaptive functioning and loss
of peer relationships in a young person is a key indicator for further assessment.

Preliminary Assessment - Interviewing Strategy
Ask about symptoms suggesting psychological vulnerability, such as irritability, feeling uneasy, constant tiredness, suspiciousness, and social withdrawal. If you suspect Psychosis, ask more
about changes in social functioning, such as problems in relationships with friends; cognition (such
as poor concentration or memory); mood (such as feeling depressed, anxious or irritable); and
thought content (such as preoccupation with strange thoughts or ideas that seem hard to ignore)..... for example the interviewer could ask :have you felt lately that people are talking about you, or trying
to harm you?”

Ask about drug misuse. although there is no compelling evidence to suggest a casual role for drug misuse in first episode psychosis, drug misuse can cause prolonged and more severe symptoms. However, referral for assessment for psychosis should not be delayed just because, for example
there is cannabis use.

Look for evidence of poor personal hygiene, delusions or bewildered mood, abstract or vague speech, or outburst of anger or irritation, these also suggest psychosis.

Psychosis rarely presents in neat parcels, and symptoms are rarely volunteered spontaneously.
You may need to see the patient more than once to gain a full picture. The first interview provides an opportunity to begin to form a therapeutic alliance with the patient so it is important to establish
rapport and trust. The interview should not be viewed as purely an information-gathering excercise.
On the next page a simple preliminary assessment screening tool is offered.

Positive Psychotic Symptoms
• Thought disorders
• Delusions
• Hallucinations

General Signs & Symptoms
• Suspiciousness
• Depression
• Anxiety
• Tension
• Irritability
• Anger
• Mood swings
• Sleep disturbance
• Appetite changes
• Loss of energy or motivation*
• Difficulties with memory or concentration
• Perception that things around them have changed*
• Belief that thoughts have speeded up or slowed down
• Deterioration in work or study*
• Withdrawal and loss of interest in socialising*
• Emerging unusual beliefs*

Risk Factors
If a change in behaviour or functioning has been noticed, the presence of risk factors should be assessed. Risk factors for psychosis can be divided in three main groups:

• Age: adolescence and young adulthood.
• Trait risk factors: family history of psychotic disorder, vulnerable personality (e.g. schizoid,
schizotypal), poor pre-morbid adjustment, history of head injury, low I.Q, history of obststric
complications/perinatal trauma+,season of birth+. N.B.- the + items are ‘weak’ risk factors.
• State risk factors: life events, perceived psychosocial stress, drug abuse, subjective and
functional change in the person (duration and degree?)

Flowchart

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