# Psychosis Info – Health Professionals Gps – Signs and Symptoms of Psychosis – Information on the identification causes treatment and recovery from psychosis from a health professional GP perspective

GP Referral

- Psychosis Questionnaire
- Prodromal Questionnaire
- The importance of early intervention Identifying psychosis is comparable to other serious illnesses such as breast cancer or meningitis where early detection is crucial. However, the signs and symptoms of psychosis may be difficult to elicit. Patients experiencing early psychotic symptoms may deny or conceal such experiences but if it is your clinical opinion that a psychotic illness is emerging, please refer to local community mental health services.
- Here are some of the signs to look for if you think someone is developing a psychotic illness:
  - Thinking
    - Unusual thoughts/strange ideas.
    - Disturbed perceptions e.g. hallucinations.
    - Poor concentration.
    - Inattentiveness.
    - Jumbled thinking.
    - Confusion.
  - Feeling
    - Depressed Mood.
    - Anxious.
    - Irritable.
    - Suspicious / paranoid.
    - Unable to express emotions both verbal and non verbal.
    - Lack of motivation.
  - Behaviour
    - Being overactive / or less active.
    - Social isolation / withdrawal.
    - Reduced ability to work / go to school.
    - Sleeping or eating poorly.
    - Odd / strange behaviour.
    - Deterioration in personal hygiene.
    - Drug or alcohol abuse.
- Prodromal Symptoms It is even more difficult to identify the earlier warning symptoms of psychosis because prodromal symptoms are non-specific. Common prodromal symptoms include:
  - Deteriorating self-care.
  - Ideas of reference.
  - Suspiciousness.
  - Social withdrawal.
  - Impaired concentration.
  - Decreased motivation.
  - Suicidal thinking.
  - Impaired function at school or work.
  Signs that are indicative of someone being in the prodromal stage can be seen in this first person account; “I found the college exams very stressful at the time and started to feel that nobody at college liked me. I thought that people who used to be my friends were talking about me and I had several arguments with them, which wasn’t usual for me. I couldn’t concentrate at lectures and felt like there was no point going anymore so I stopped attending. I was also very self-conscious thinking that other students were staring at me. Sometimes when at home I thought I heard my name being called, but I was aware that it was just my mind playing tricks with me. I wasn’t sleeping well at this time either because of the worries and anxiety, and I had several panic attacks.”
  The common symptoms of the prodrome to early psychosis are seen in this example including social withdrawal, decreased functioning at work or school, poor concentration, irritability, anxiety, panic attacks, false ideas which aren’t held with full conviction (such as persecutory ideas) and brief hallucinations (for example occasionally hearing a noise or a voice). In this example the early symptoms in the prodrome developed into a psychotic episode which included persecutory delusions (false beliefs) and hallucinations (hearing voices more frequently).
  If your patient has a number of these prodromal symptoms it is advisable to refer to the community mental health services for assessment.
- Interventions Should your patient reside in the DETECT catchment area and are diagnosed with a first episode of psychosis, they will be offered treatment from both the community mental health team and DETECT. DETECT provides Cognitive Behavioural Therapy (CBT), and Occupational Therapy to the patient themselves and an Education Course to the patient's friends, relatives and / or guardians.
- If you refer a patient with suspected psychosis or prodromal symptoms they will notify DETECT and we will make contact with your patient within 72 hours (only community care areas 1, 2 and 10).

GP Referral