About the First Episodes of Psychosis

National Alliance on Mental Illness ~ Early identification and evaluation of the onset of psychosis is an important health concern. Early detection and intervention improve outcomes. Psychosis may be transient, intermittent, short-term or part of a longer-term psychiatric condition. It is important to understand the range of possibilities, both in terms of possible diagnosis associated with psychosis and the prospects for recovery. This NAMI website is a resource guide for your increased understanding of assessing, treating and living with new onset psychosis, including strategies to help the return to school, work and daily life.

What Is Psychosis?

Psychosis (psyche = mind, osis = illness) is defined as the experience of loss of contact with reality, and is not part of the person’s cultural group belief system or experience. Psychosis typically involves one of two major experiences:

A. Hallucinations can take the form of auditory experiences (such as hearing voices); less commonly, visual experiences; or, more rarely, smelling things that others cannot perceive. The experience of hearing voices has been matched to increased activity in the auditory cortex of the brain through neuroimaging studies. While the experience of hearing voices is very real to the person experiencing it, it may be very confusing for a loved one to witness. The voices can often be critical (i.e. “you are fat and stupid”) or even threatening. Voices also may be neutral (i.e. “the radio is on”) and may involve people that are known or unknown to the person hearing the voices. The cultural context is also important. For example, in some Native American cultures, hearing the voice of a deceased relative is part of a healthy grieving process.

B. Delusions are fixed false beliefs. Delusions could take the shape of paranoia (“I am being chased by the FBI”) or of mistaken identity (a young woman may say to her mother, “You are an imposter—not my mother”). What makes these beliefs delusional is that these beliefs do not change or modify when the person is presented with new ideas or facts. Thus, the beliefs remain fixed even when presented with contradicting information (the young woman continues to believe her mother is an imposter, even when presented with her mother’s birth certificate and pictures of her mother holding her as a baby). Delusions often are associated with other cognitive issues such as problems with concentration, confused thinking and a sense that one’s thoughts are blocked. These experiences can be short lived (e.g. after surgery or after sleep deprivation) or periodic (as when associated with a psychiatric condition or persistent like bipolar disorder or major depression).

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Mental illness runs in Nathaniel Fujita's family, aunt testifies at murder trial

By Evan Allen

Photo by Associated Press

BOSTON.COM ~WOBURN -- Mental illness runs in Nathaniel Fujita's family, and Fujita himself had slipped into a deep depression in the months before his former girlfriend was slain, his aunt testified Thursday as the first witness for the defense. 

"Nathaniel was withdrawn and seemed depressed,"said Joyce Saba in Middlesex Superior Court. "There was an extreme change in his behavior."

Fujita, 20, is accused of beating, strangling and slashing to death 18-year-old Lauren Astley, on July 3, 2011, and dumping her body in a Wayland marsh. He faces first-degree murder and other charges.

Prosecutors say he was humiliated and angry over their breakup; his defense lawyer says his client was suffering a brief psychotic episode.

Prosecutors closed their case on Thursday morning, after two weeks of testimony. The last witness prosecutor Lisa McGovern called was Astley's mother, Mary Dunne, who spoke about her daughter's love of her friends, a fight Astley had with Fujita in June and the last time she saw her alive. 

Saba testified that until 2011, she would have described Fujita as "sweet, honest, athletic, quiet." But in the spring and summer of his senior year of high school in 2011, she said, he had stopped going out with friends or being social, and no longer was the confident and happy young man she knew.

Two of Fujita's great uncles, said Saba, suffered from paranoid schizophrenia. One uncle, who Saba said had been a police officer, believed that the CIA was listening to him through the television. Fujita's younger sister was hospitalized in a child psych unit in 2010, Saba testified.

On the day Astley was killed, Fujita attended a barbecue at the Saba home. Other family members have testified that Fujita seemed normal, and watching TV and playing the keyboard with his cousin, and chatting about football with his uncle.

Saba testified that before that party, she told family members to try to keep Fujita positive.

"I was reminding my husband and my daughters that Nathaniel was going through a difficult time and this was important to keep it upbeat," she said. "Don't go into an area asking questions about his breakup. Talk about future things. A little coaching session."

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'Black Swan': Psychiatrists Diagnose Ballerina's Descent

By SUSAN DONALDSON JAMES

ABC News~ Black Swan, a new psycho-drama anchored in the competitive world of ballet, is getting as much analysis on the psychiatrist's couch as it is Oscar buzz.

The Golden-Globe nominated film takes viewers deep into a ballerina's descent into madness in a frightening portrait of psychosis that doctors say resonates realism.

Nina Sayers, a fragile and repressed ballerina, played by Natalie Portman, strives for the lead in Tchaikovsky's "Swan Lake," a role that will require her to play both the gentle white and the seductive black swans.

But in the process, she will have to shed her "sweet girl" persona and embrace her darker side to fully embrace the role and to please her demanding and sexually aggressive director.

Her metamorphosis is so complete, that Nina eventually develops webbed feet, bird-like legs and sprouts feathers and wings to actually become the black swan.

"It was intense and disturbing and fascinating and mysterious," said Nadine Kaslow, vice-chair of the department of psychiatry at Emory University and psychologist to the Atlanta Ballet. "What was a hallucination and what was real? When people are psychotic, it's difficult, even as a therapist, to know what's real and what's not."

Nina, who constantly strives for perfection, lives with her controlling mother Erica, played by Barbara Hershey, who gave up dance to have her daughter. They live in a tiny New York City apartment, cluttered with her mother's narcissistic paintings.

When the ballet's artistic director decides to replace the aging prima ballerina for the new season production of "Swan Lake," Nina is his first choice. But she has competition in new sexually open dancer Lily, played by Mila Kunis.

After securing the role, Nina is asked to "lose herself" to play the black swan, and so she does.

In visual hallucinations, she sees a black-clad version of herself across the subway platform and again in the maze of hallways at Lincoln Center. Even the pink stuffed animals that adorn the bedroom she shares with her neurotic mother seem to come alive and mock her.

She conjures up an array of fantasies and delusions, including a lesbian love scene with Lily.

"As a movie fan, it held my attention," said Dr. Steve Lamberti, professor of psychiatry at University of Rochester Medical Center. "It was poetic in a way, showing this transformation gone wrong."

But speaking as a psychiatrist, Lamberti said the film did not accurately depict schizophrenia, as has been widely speculated, but "does present a reasonable portrait of psychosis."

"People tend to be scared of things they don't understand," he said. "If you have never treated or observed a person with psychosis, it's upsetting."

Psychosis is a loss of contact with reality that usually includes false beliefs or delusions, and seeing or hearing things that are not there.

Like a fever, psychosis is a symptom rather than a disease, and can be caused by a variety of triggers: exposure to mercury (the hats of the Mad Hatter were impregnated with the heavy metal), drugs like amphetamines, epilepsy, a brain tumor, dementia or psychiatric disorders like schizophrenia.

Psychosis Usually Involves Auditory Hallucinations

But unless psychosis is due to neurological causes, patients normally have auditory, rather than visual hallucinations.

"In terms of cinematography, it's much easier to portray the visual," he said. "Whispers are not nearly as dramatic as seeing something."

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