Psychosis is a precursor to schizophrenia

Psychiatry, Psychosomatics & Psychotherapy

Psychoses - phases and course

Both secondary psychosis The course and prognosis depend on the underlying cause - with a good prognosis if the underlying disease can be treated or, for example, drug abuse that led to psychosis is stopped. Even with chronic psychoses, improvements are possible with adequate treatment.

A primary psychosis is not an incurable disease, it takes a favorable course for many of those affected. The course of psychosis can be divided into phases:

  • The prodromal phase (Precursor phase) is the period from the beginning of the first psychological changes and / or negative symptoms to the continuous occurrence of psychotic positive symptoms. The average duration is around two to five years.
  • The phase of untreated psychosis describes the period from the continuous occurrence of psychotic symptoms to the start of treatment. The average duration is around six to twelve months.
  • In the acute phase there is a complete onset of the disease with hallucinations, delusions and thought disorders. In this time window, those affected may have difficulty understanding that they are ill.
  • In the long-term phase - After the acute symptoms have disappeared and the condition has stabilized, negative symptoms can persist for a varying length of time. This phase can last for many years, sometimes with relapses into the acute phase.

For schizophrenia, it is known that about a third of patients heal the psychosis after a single episode of illness. Another third have several psychotic attacks over a longer period of time with symptom-free sections in between. Only about a third develop the chronic form with constant symptoms. For other psychotic disorders like that persistent delusional disorder or the schizotypic disorder the symptoms are more chronic. In the acute transient psychotic disorder the course is favorable because the duration of the illness is usually less than three months.

Psychoses change the lives of those affected to different degrees depending on the type and severity of the disorder. In addition to the actual psychotic symptoms, drive disorders and so-called cognitive disorders, i.e. disorders of concentration, memory and attention, can occur, which can bring more restrictions in everyday life than the core psychotic symptoms of madness and hallucinations.

In severe cases, people suffering from psychosis can be affected by long-term incapacity for work or early retirement. Therefore, in the case of acute and chronic psychoses, rehabilitation measures for occupational rehabilitation are usually necessary in addition to medical (curative) treatment. In the case of chronically or severely affected people, in addition to medical and rehabilitative treatment, social therapeutic treatment measures are often indicated that serve to reintegrate into everyday life, e.g. using social psychiatric centers.

To make matters worse, psychotic disorders are frightening or disturbing for the people around them, so that those affected are often exposed to considerable stigmatization, which can significantly impair reintegration at work, especially for chronically or severely affected people. The fight against the stigmatization of the mentally ill in the population is therefore also an important element in alleviating the effects of psychotic disorders on those affected (see also the Mental Health Alliance).

Technical support: Prof. Dr. med. Wolfgang Gaebel, Priv.-Doz. Dr. med. Jürgen Zielasek, Düsseldorf (DGPPN) and Prof. Dr. med. Anita Riecher-Rössler, Basel (SGPP)