First-episode psychosis: signs, getting help early and treatment in the UK

The NHS describes psychosis as when people lose some contact with reality. This may involve seeing or hearing things that other people cannot see or hear (hallucinations) and believing things that are not actually true (delusions). It may also involve confused, disordered thinking and speaking. The Royal College of Psychiatrists says that when someone is experiencing psychosis their thoughts and feelings change so dramatically that they find it difficult to recognise what is real and what is not, and that it is far more common than many people think.

A first episode is the first time this happens. Experiencing the symptoms is often called having a psychotic episode. The NHS says how often a psychotic episode occurs and how long it lasts can depend on the underlying cause.

First episodes matter because the way services respond in the first weeks and months shapes recovery. The Royal College of Psychiatrists says Early Intervention in Psychosis (EIP) services were set up to make sure that people who are, or might be, experiencing psychosis get the right care quickly.

The NHS lists three main symptoms: hallucinations, delusions, and disordered thinking and speaking. A common hallucination is hearing voices; a common delusion is believing there is a conspiracy to harm you. The combination can cause severe distress and a change in behaviour.

The Royal College of Psychiatrists gives more detail. Delusions are beliefs that are very real to the person but are not shared by others, such as feeling you are being watched or harmed, that things on TV or radio are sending you personal messages, or that your thoughts are being controlled or broadcast. Hallucinations are most commonly auditory, where you hear sounds, a voice or voices that others cannot, and the voices may be frightening, neutral or even comforting. Thinking may be confused so that other people find it hard to follow what you are saying.

It also notes that you are unlikely to experience these symptoms all of the time, and that people in psychosis may find it hard to realise that they are unwell, which can make it difficult to seek help.

The NHS says it is sometimes possible to identify the cause of psychosis as a specific mental health condition, such as schizophrenia, bipolar disorder or severe depression. Psychosis can also be triggered by a traumatic experience, stress, drug misuse, alcohol-use disorder, side effects of prescribed medicine, a physical condition such as a brain tumour or dementia, head injury or childbirth.

This is why assessment looks widely. The Royal College of Psychiatrists says the professional assessing you should find out about your mental health, whether you are using drugs or alcohol, any medications, any physical health conditions, your relationships and support networks, any traumatic experiences, your education and employment history and your quality of life.

The NHS says you should see a GP immediately if you are experiencing symptoms of psychosis. The GP may ask some questions to help work out what is causing it and should refer you to a mental health specialist for further assessment and treatment. If you are worried about someone else, you can contact a GP for them, or their mental health worker if they are receiving support. If the symptoms are severe enough to need urgent treatment and could place the person at risk, the NHS says you can take them to the nearest A&E if they agree, call their GP or out-of-hours GP, or call 999 and ask for an ambulance.

Early intervention in psychosis (EIP or EIT) teams provide intensive support to people with a first episode of psychosis. Rethink Mental Illness says they accept referrals from you or your friends or relatives, aim to see you within 2 weeks of referral, and that NICE recommends EIT teams should be open to people of all ages, even though some services say they only treat people aged 35 or under. You can find your local team by searching online, calling NHS 111 or asking your GP. Other teams you might be referred to include a community mental health team or a crisis team.

The NHS says treatment depends on the cause but usually involves a combination of approaches. Different things can help at different times, and the Royal College of Psychiatrists notes that some services are not always available across the whole of the UK or may not be available straight away.

• The NHS says some people are recommended to take antipsychotics on a long-term basis, while others may gradually reduce and stop if there is marked improvement. It warns not to stop prescribed medicines suddenly, as this could trigger a relapse.

• Rethink says people experiencing psychosis are at higher risk of physical health problems such as being overweight, coronary heart disease and diabetes and should have regular physical health checks, and that social services can carry out a care assessment if you need help with day-to-day tasks.

The NHS says people with a history of psychosis are more likely than others to have drug or alcohol misuse problems, or both, and that substances can make psychotic symptoms worse. It also says people with psychosis have a higher than average risk of self-harm and suicide, advises seeing a GP if you are self-harming, and mentions the Samaritans as a free service for support. If someone is at immediate risk, call 999 or go to A&E.

The Royal College of Psychiatrists says that people who receive help quickly are more likely to recover and to recover quickly. Rethink points to charities and peer support groups that can help people who have experienced psychosis, and the NHS describes annual health checks at the GP surgery for people with severe mental illness.

On the NHS, first-episode psychosis is assessed by a GP and an NHS specialist team, most often an early intervention in psychosis service, with medicines, therapies and care coordination provided free at the point of use. Crisis teams and inpatient care are available where needed.

Some people also see a private psychiatrist for assessment or a second opinion. Because early specialist input is the aim, it is generally sensible not to delay NHS referral while arranging a private appointment, and to ask any private clinician to liaise with your GP.