Early recognition of psychoses and bipolar disorders

Why early recognition of psychoses?

bildPsychoses or bipolar disorders do not occur abruptly in almost all cases, but begin gradually, slowly and stealthily. Before the start of the first psychotic symptoms, psychic and social changes such as depression, anxiety or social withdrawal exists mostly over several years. The mostly still young person behaves “somehow curiously”; he /she is “simply no longer his / her old self” Often, it becomes increasingly clear that he / she can no longer fulfil his / her hitherto roles in school, profession, partnership and family – a so-called “kink in the lifeline” results.

Unfortunately, many persons afflicted are given specialized treatment only after a great delay. On average, two to five years pass from the start of the first symptoms to the first treatment.

The following causes can lead to this delayed start of treatment

  • The first psychic changes in the course of a psychosis are not recognized as such and for example attributed to puberty, a simultaneous use of drugs or alcohol or mere laziness or arrogance.
  • Relatives quite understandably attempt to compensate for all commencing psychic and social problems through increased support.
  • Persons afflicted and their relatives frequently are suspicious of psychic disorders and especially of psychiatry. Correspondingly, persons afflicted frequently first and foremost seek “inappropriate” remedies which cannot correctly classify the commencing psychic problems.
  • The knowledge about early warning signs of a psychosis in the medicinal but to some extent also psychiatric / psychological system is frequently not sufficient, so that clear early warning signs can be overlooked.

bildAll of these reasons are not incomprehensible. Normal and particular development crises cannot be completely separated. Many persons develop impressively also without any special help. And psychiatry is not completely innocent of the still existing prejudices.

The reason why you should arrange for appropriate help as soon as possible is because a delayed start of treatment may be associated with numerous consequences – for the disorder, for your own perspective of life and for the strain on your family. It is important to understand however that despite these consequences the success of the treatment is significantly determined by other factors, above all also by your willingness to take part in the treatment. Even after a long time without treatment help can be successful. It is never too late for a treatment. To make the ways easier we wish for more flexibility – on the part of the persons treating you.

Possible consequences of a delayed start of treatment
... for the psychotic disorder
  • More frequent suicide attempts prior to the start of treatment
  • Increased risk of addictive substance use prior to the start of treatment
  • Increased risk of delinquency prior the start of treatment
  • Greater seriousness of the symptoms at the start of the treatment
  • Worse quality of life at the start of treatment
  • Worse response to antipsychotic drugs with the necessity of higher doses
  • Delayed and incomplete improvement of the symptoms including cognitive abilities
  • Reduced willingness to take part in therapy
  • Higher hospital re-admission rate
  • Worse prognosis of the disorder
... for efficiency and productivity
  • Worse efficiency and productivity at the start of treatment
  • Interruption or quitting of school, interruption or loss of training place or job
  • Impairment of the social development
  • Worse efficiency / productivity in the course of the disorder
... for family, friends and children
  • High psychic and social stress
  • Development of own psychic disorders (e.g. so-called adjustment disorders) on account of the disorder
... for society
  • Higher treatment costs
  • Higher indirect costs (e.g. through loss of capacity for work)



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