Preventing Psychosis Before It Starts

Psychosis may start insidiously in adolescence and young adulthood with a few early episodes and then blossom into a full-blown psychotic disorder.

When a person experiences psychosis, he typically loses touch with reality and may experience delusions or false beliefs about events or people. She may hallucinate, that is, see, feel, or hear things that are not actually there.

Psychotic individuals may also be disorganized in their thinking and speaking. Psychosis may cause personality changes and it may make it hard for people to carry out daily life activities including self-care, work, social interactions, and school.

Engaging the entire family in treatment is a key to success.

The causes of psychosis range from medication side effects, to drug use or toxin exposure, to physical and psychiatric diseases, to injuries, and stress. Psychotic episodes may be short-lived or short term, or they may be part of a broader psychiatric condition such as bipolar disorder or schizophrenia.

It is likely there is an interaction of environmental triggers and genetic predisposition in the onset of some types of psychosis. Psychosis is usually treated with medications and therapy but can be a chronic and debilitating condition.

Some teens and young adults are more vulnerable to developing overt psychosis than their peers because of their genetic or mental health histories. Recent research has focused on efforts to prevent or decrease the occurrence of psychosis in these young adults who are at high risk for this condition.

The researchers used data from prior studies to identify particularly vulnerable individuals. This group included people who had already shown early or intermittent psychotic symptoms, those who had certain types of personality disorders (schizotypal) known to be associated with later onset of psychosis, those with a family history of psychosis who had recently deteriorated in their own functioning, those with a first degree relative with psychosis (increased genetic load).

It is likely there is an interaction of environmental triggers and genetic predisposition in the onset of some types of psychosis.

The hope was that if appropriate intervention was employed during the period of vulnerability, they might be able to delay or prevent the onset of clinical psychosis and prevent a major mental health burden on the individuals and their families.

Extending findings from previous research, the investigators chose a family focused therapy program (FFT). They wanted to test the idea that the way in which family members respond to early psychotic symptoms has a major impact on the progress of the symptoms.

It might be possible, the researchers reasoned, that altering the family dynamic and responses around early symptoms could change the course of the condition. For example, if family members were hostile, critical, or overprotective, the individual might be more likely to deteriorate from the stress of dealing with their family's negative responses.

Alternatively, if families were supportive and helped to become knowledgeable about coping skills and management strategies, the individual would have a better chance of improving.

The family focused intervention took place in 18 visits over six months during which family members learned coping, communication, and problem solving skills designed to help them help their vulnerable family member.

Family members learned coping, communication, and problem solving skills designed to help them help their vulnerable family member.

The first six sessions focused on identifying stressors that caused symptoms and then on developing effective coping strategies, such as recreational outings, scheduling pleasant events, or getting exercise, rest, or adequate nutrition.

The next six sessions helped families learn to communicate better — such as expressing positive feelings, using techniques of active listening, giving constructive feedback on behavior, expressing negative feelings in a meaningful and nonthreatening way.

The final sessions aimed at problem solving. Family members learned how important it is to break large problems down into smaller challenges, and how to generate, implement, and assess solutions in a constructive manner.

In contrast, the control group received a family educational intervention (EC) that consisted of three weekly sessions in which clinicians helped the individual and the family members to develop a personalized prevention plan for psychotic symptoms.

What was being tested was the idea that involving families would boost the impact of therapy, and that the FFT group would have both fewer symptoms of early and developing psychosis and would also function better at school, in the workplace, socially, in the community and in the family, over the six-month study period.

The family focused therapy did help prevent the development of psychosis in high-risk individuals, the study found. Compared to the control group, the FFT group showed greater improvement in early and ongoing symptoms and far fewer developed psychotic symptoms.

Over 10% of the youths in EC (control) group developed a psychotic episode, while only 1.8 % of the children and adolescents developed a psychotic episode in the family therapy (FFT) group.

The FFT group showed greater improvement in early and ongoing symptoms and far fewer developed psychotic symptoms.

Both groups showed improvements in their psychosocial functioning over the six-month study period.

Family focused therapy's effectiveness may be because it increases the amount of positive communication in families, while cutting down on distressing negative feedback, the researchers suggest. This can buffer the at-risk individual from being more stressed by negative family interactions that occur as a result of their symptoms.

The interpersonal and family communication strategies that are taught may help the individual in managing workplace and peer relationships as well.

The study contributes to a growing body of evidence suggesting that early psychosocial interventions benefit individuals at risk for psychosis and that engaging the entire family in treatment is a key to success. Families with teens and young adults who are experiencing psychotic episodes or who are showing deteriorating function at home, school, or work may wish to contact their mental health care provider and discuss the options for family therapy.

The study is published in the Journal of the American Academy of Child & Adolescent Psychiatry.