University of Basel

Department of
Clinical Research

BEATS - BASEL EARLY TREATMENT SERVICE

The term 'psychosis' refers to a wide range of symptoms that may take different forms, but have one common feature - a different perception and processing of reality compared to most people, and an unbending way of thinking. 

Psychotic symptoms may include auditory or visual hallucinations, delusions or a general change in thinking processes. People with psychosis may feel threatened or persecuted, hear voices, or think that innocuous events have a personal significance for them. In other cases, people may have difficulty in putting their thoughts into order, or behave in ways that are untypical for them and incomprehensible to others. In other people, psychosis may manifest itself with a decrease of performance capacity, loss of interest and social withdrawal.

No universal cause of psychosis has been identified yet, despite extensive research. It is also very rarely the case that one single cause can be determined in an individual patient; in most cases, the illness is assumed to result from a combination of different factors.

Physical and mental stress plays a central role in the manifestation of psychotic symptoms. Stress may not only result from negative experiences, but is also a part of certain critical life phases even when they are positive overall, such as adolescence, or starting college. Hormonal changes (e.g., during pregnancy or postpartum), or use of certain drugs such as LSD may also lead to the emergence of psychotic symptoms.

Every person may manifest psychotic symptoms when exposed to the influence of certain strong causal influences. However, the risk of developing a psychotic disorder generally depends on the interplay between the intensity of stress and the vulnerability of a particular person. Various factors can increase the vulnerability for psychosis, including familial predisposition, early brain damage or serious developmental disorders, traumatic experiences at a young age, growing up in a disadvantaged neighbourhood, or regular use of highly potent cannabis and other drugs at a young age. When vulnerability for psychosis is increased (e.g., because of the existence of several predisposing factors), then a smaller amount of stress may be enough to lead to psychotic symptoms.

It is important to remember that even in the presence of several predisposing factors, a psychotic illness is never a certainty. Moreover, protective factors (such as supporting friendships, or a good coping capacity) may counterbalance negative influences, such that the emergence of psychosis is not inevitable. The goal of early detection and intervention is exactly to minimise negative influences and to support the development of protective factors. 

A psychotic phase can cause a lot of distress and uncertainty and put a strain on significant relationships. Important goals for treatment are a speedy relief from psychotic symptoms, depression and anxiety, as well as the improvement of well-being and functionality with respect to school, work and relationships, and the prevention of future episodes. 

The ideal treatment to achieve these multifaceted goals is integrated, based on mutual respect and trust, adapted to the individual needs of the person, and involves their significant others. There are several treatments:

  • Medication: Antipsychotic drugs protect from sensory overload, are demonstrably the most efficient way to control psychotic crises, and help prevent future episodes. Other types of medication may also be used depending on the symptoms, such as sedatives to combat anxiety and insomnia, or mood stabilisers and antidepressants to treat severe mood swings and depression. 
  • Psychotherapy: Cognitive-behaviourally oriented, individual or group psychotherapy programmes aim to improve the patient's understanding of symptom triggers and coping mechanisms. Other psychotherapy methods may also be indicated, e.g., family therapy, social skills training, or therapy programmes targeting substance abuse.  
  • Psychoeducation: This intervention provides information about the causes and mechanisms that lead to the emergence of symptoms, as well as about treatment possibilities and everyday coping strategies, in order to foster self-management.  
  • Social work addresses problems with school, work or housing, which may follow psychotic episodes, especially when they remain untreated for some time.
  • Cognitive Training: Cognitive abilities such as concentration, attention and memory are trained with the help of computerised exercises to improve performance.

In order to contain psychotic symptoms quickly and to avoid negative consequences such as relationship difficulties or dropping out of school, it is important to use all available treatment possibilities as soon as possible.

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