A diagnosis for psychosis can be scary, especially when it’s unexpected, but a new approach to predicting early onset psychosis may offer a reliable way to remove surprise from the equation and allow patients and families to prepare for treatment – in some cases, before symptoms of early onset psychosis appear.
The reason a diagnosis of psychosis scares people derives from stigma around the word psychotic, the word psychosis, and the phrase psychotic symptoms. Representation of people with psychosis, early onset psychosis, or disorders with psychotic symptoms in film and television skew toward stereotypes that promote misunderstanding that leads to harmful stigmatization. Most examples portray people with these disorders as either categorically dangerous and violent or hopelessly lost. But here’s something important to understand:
Decades of evidence show neither of those things are true.
Nevertheless, stigma persists. It’s primarily based on poor information and a lack of knowledge about what psychosis really is and how psychotic symptoms manifest. We’ll discuss those symptoms in moment. Before we do that, we want to introduce the study that could represent a significant shift in the way we diagnose early onset psychosis.
Published in the peer-reviewed academic journal Nature: Molecular Psychiatry, the article “Functional Dysconnectivity of Visual and Somatomotor Networks Yields a Simple And Robust Biomarker For Psychosis” explores a new way to detect psychosis before the onset of symptoms.
The research team tested the hypothesis that magnetic resonance imagery (MRI) can identify structural patterns of connectivity in the human brain – a.k.a. functional biomarkers – associated with symptoms of psychosis. If the research confirms the hypothesis, and subsequent research teams confirm its accuracy and reliability, this new development has the potential to improve outcomes for people with mental health disorders with psychotic symptoms, such as personality disorders, schizophrenia, schizoaffective disorder, and some mood disorders.
Before we share the results of that study, we’ll take a moment to discuss the symptoms of psychosis.
Psychosis and Early Onset Psychosis: What are the Symptoms?
Mental health experts from the National Institute of Mental Health (NMH) indicate the symptoms of psychosis manifest in two forms: delusions and hallucinations.
Delusions are thoughts, beliefs, or ideas that are objectively, provably false or untrue. They appear in four general categories. Delusions of grandeur, persecution, thought, and relationship.
Grandeur
- People with delusions of grandeur believe they have abilities, skills, or powers no one else has.
Persecution
- People with delusions of persecution believe that other people or external entities control their behavior, monitor their behavior, and intend to harm them.
Thought
People with delusions of thought believe other people or external entities control what they think, place ideas in their minds, extract ideas from their minds, and have direct access to what they think.
Hallucinations are things a person sees, hears, tastes, feels, or smells that are not there. Hallucinations manifest in four general categories: visual, auditory, tactile, olfactory.
Visual
These hallucinations involve seeing people that don’t exist, objects that don’t exist, or things that aren’t really happening, such as an object moving or changing in appearance. Sometimes visual hallucinations cause no worry or disturbance, but sometimes they can be extremely frightening and disturbing.
Auditory
These hallucinations involve hearing things – voices, music, cars, wind, random noises – that aren’t real. People with auditory hallucinations say they may sound like they’re coming from inside their minds or from an outside source. Auditory hallucinations, like visual hallucinations, can feel either harmless or frightening, depending on the nature of the hallucination.
Tactile
These hallucinations involve feeling sensations that aren’t real. People report tingling skin, the sensation of something crawling across their skin, or things moving in their bodies. People also report feeling a tap on the shoulder, or feeling someone hold their hand, when no one is actually there.
Olfactory
These hallucinations involve smelling things that aren’t there. Odors may be pleasant or outright unpleasant. Pleasant olfactory hallucinations include things like floral aromas, fresh-cut grass, or favorite foods. Unpleasant olfactory hallucinations include things like sour milk, rotten food, or garbage.
Based on those definitions, it’s easy to understand why the symptoms of psychosis can scare people: regardless of the nature of the delusions/hallucinations themselves, their presence alone is enough to cause confusion, particularly at initial onset.
Early Onset Psychosis: Are the Symptoms Different?
In some cases, yes. However, most early symptoms are mild versions of delusions and hallucinations people may ignore, or that happen so quickly they may wonder what happened, or question whether they happened at all.
From the outside, a person in the early stages of psychosis will likely show behavioral signs associated with mental illness, in general, which may include:
- Withdrawal from friends and family
- Decreased academic achievement
- Trouble concentrating
- Strong mood swings
- Decreased attention to basic personal hygiene
When a person shows the signs above – and there’s no immediate or obvious explanation for them – it’s important to arrange for a comprehensive psychiatric evaluation administered by a mental health professional.
New Developments in Evaluation: Screening for Early Onset Psychosis with MRI
Assessment and evaluation are exactly where the method examined in this new study has the potential to entirely change the way we diagnose and predict the development of psychosis. The way we diagnose psychosis now is through an in-person interview. A mental health professional asks a series of questions about thoughts, feelings, and experiences, which patients answer the best.
This method is effective, but imperfect. It relies on accurate recall and full transparency from the patient. This introduces several confounding factors. First, it may be difficult for a patient to remember the exact timing and specific details about their symptoms. Second, a patient may not understand their symptoms or realize an experience in their past qualifies as a symptom. Third, if they do recall and understand their symptoms, they may be reluctant to share them. This makes sense. Many of us might hesitate to share the fact we see, hear, feel, and smell things that aren’t there.
However, delaying treatment – a result of delayed or inaccurate diagnosis – can have a negative impact on treatment outcomes. In fact, a recent study describes the consequences of extended duration of undiagnosed psychosis (DUP) as follows:
“Delay was associated with impaired recovery in every symptom dimension, with latent harm appearing rapidly during a critical period soon after transition to psychosis.”
To develop a test that can help patients and providers eliminate or reduce DUP, the research team compared the results of over one hundred MRI assessments from patients with psychosis with the rsuts over fifty MRI assessments from patients without psychosis.
Here’s what they found:
- The group with existing psychotic symptoms displayed hypoconnectivity between the cortex and sensory areas of the brain. Hypoconnectivity means fewer connections than expected.
- The group with existing psychotic symptoms displayed hyperconnectivity between the cortex, the thalamus, the visual area of the brain, and the areas of the brain associated with motor function and movement (somatomotor system).
- The somatomotor/visual hyperconnectivity only appeared in patients with psychotic symptoms, and was unaffected by other factors, such as the presence of other mental health disorders, demographic variables, or stress.
The fact the hyperconnectivity between brain areas – called a biomarker – appeared consistently in patients with psychosis in the presence of a host of variables – demographics, comorbidities – is a significant development in the diagnosis of psychosis.
How This Information Helps Our Patients With Early Onset Psychosis
The lead researcher on the study describes the results as follows:
“A single five-minute scan could potentially improve our ability to predict which at-risk individuals will transition to a psychotic disorder. Establishing such biomarkers could provide a key step in changing how we care for, treat, and offer interventions to people with psychosis.”
A clear and objective biomarker exclusive to psychosis can help us eliminate inaccurate diagnoses and missed diagnoses, which can result in mismatched and/or delayed treatment, and impair overall long-term outcomes.
In other words, the ability to detect the presence of that biomarker – if subsequent research confirms these results – can help our patients by:
- Ensuring accurate diagnosis
- Determining correct treatment
- Reducing time between onset of symptoms and treatment
- Eliminating uncertainty about diagnosis and treatment
All these things can improve long-term outcomes for our patients. Keep a close eye on this blog for new developments on this topic. We’ll share any new developments here as soon as they’re available.
Gianna Melendez
Jodie Dahl, CpHT