Schizophrenia

What is a psychotic disorder (schizophrenia)?

Psychosis describes when a person loses contact with reality and experiences severe instability (unpredictable changes) in thinking, emotions, and behaviour. It can make people have strange ideas and behave oddly. The main psychotic disorders are schizophrenia and drug-induced psychosis.

What are the signs and symptoms of a psychotic disorder?

Psychosis can have physical (the body), psychological (the mind), and behavioural (the way people act) signs and symptoms.

The physical signs may include:

• not eating well, or eating too much
• having less energy and motivation.

The psychological signs may include:

• experiencing hallucinations (person sees, hears, smells, tastes, or feels something that isn’t there)
• experiencing delusions (having strong false beliefs)
• having mixed up thoughts
• not being able to concentrate
• can only express a limited range of emotions
• becoming suspicious (doubtful/untrusting) about certain people, situations, events, or objects
• feeling restless
• feeling irritable or angry
• having thoughts of dying
• feeling anxious
• feeling afraid
• feeling depressed.

The behavioural signs may include:

• disorganised speech (person may constantly ‘go off track’ or switch topics when talking; or their speech may be jumbled or slurred)
• disorganised behaviour (person might have difficulty performing everyday tasks, such as maintaining hygiene; they might dress in an unusual way, such as wearing a scarf and gloves in hot weather)
• reduced social and/or occupational functioning (person may have few friends and is unable to hold a job for a long time)
• not wanting to be around other people
• not sleeping well (maybe walking around all night), or sleeping too much.

It is important to be are aware that the signs and symptoms of psychosis can be different for different cultures. For example, in some Aboriginal and Torres Strait Islander communities, being visited by the spirit of a loved one who has passed away or hearing their voice is normal, so it’s different to psychosis. In other cultures, these experiences may be signs or symptoms of psychosis.

It is also important to be aware that only a qualified and trained health professional, such as a psychiatrist, can diagnose someone with psychosis. Deciding whether someone has psychosis or not depends on the person meeting a strict set of criteria (meaning the person must experience a certain number of signs/symptoms for a certain length of time).

What are the risk factors for a psychotic disorder?

There is no single cause for psychosis – it is normally the result of a combination of factors. Some people are more at risk of developing a psychotic disorder because of:

• a family history of psychosis or other mental illnesses (e.g. parent or grandparent)
• stress
• grief, loss, and bereavement
• too much alcohol and/or other drugs
• poor physical health
• stopping taking alcohol and/or other drugs when they have been needing to use them to get through every day.

There are other factors that can slightly increase the chances of someone developing a psychotic disorder. These factors include having complications at the time of birth or a head injury.

How common are psychotic disorders among Aboriginal and Torres Strait Islander people?

Information about how many Aboriginal and Torres Strait Islander people have a psychotic disorder is not available, but hospitalisation information from 2008-09 shows that Aboriginal and Torres Strait Islander adults were four times more likely to be hospitalised for schizophrenia and delusional disorders than were other Australians.

Research has also found that psychotic disorders are more common among young adult Aboriginal men, especially those who also have substance misuse problems, intellectual impairments, and diabetes.

How do you help someone with a psychotic disorder?

When helping someone who has a psychotic disorder, it is important that you:

• are aware of the different ideas and words to do with psychosis in Aboriginal and Torres Strait Islander communities
• understand that the signs of psychosis may be different from person to person, and can also change over time for some people
• don’t assume that the signs of psychosis will go away on their own.

People who are experiencing signs of a psychotic disorder will sometimes try and keep these physical, psychological, and behavioural changes a secret and not talk about them. If you are talking about these changes with the person, it is important to be caring, non-judgemental, and respectful. You should find a quiet place to talk and ask questions, and use words that are easy to understand.

Other ways to help someone who may have a psychotic disorder is to encourage them to:

• go to their family, Elders, or traditional healers for support
• get help and information from an Aboriginal and/or Torres Strait Islander mental health worker or counsellor
• visit country or take part in enjoyable activities, such as hunting, fishing, or dancing
• get advice and information from a doctor about the medicine to help manage the signs and symptoms of psychosis (antipsychotic tablets are often given out by doctors to treat psychotic disorders)
• avoid alcohol and other drugs, because they can make psychosis worse
• look after their general health, such as healthy eating and exercise.

Everyone can make changes to their health and wellbeing when they are ready, even if it is in small steps, and in their own time.

References and further reading