Emerging Psychosis and the Family

Schizophrenias hold a special position among psychotic disorders. Schizophrenias often start in early adulthood and bear considerable psychosocial risks and consequences. Several years of nonpsychotic clinical signs and symptoms and growing distress for patient and significant others may pass by before definite diagnosis. Young males in particular often experience their first episode while still living in their primary families. Thus, the whole family system is involved. In worldwide initiatives on early detection and early intervention, near-psychotic prodromal symptoms as well as deficits of thought and perception, observable by the affected person himself, were found to be particularly predictive of psychosis. Various psychological and social barriers as well as ones inherent to the disease impede access to affected persons. Building trust and therapeutic alliance are extremely important for counseling, diagnostics, and therapy. The indication for strategies of intervention differs from the early to the late prodromal stage, depending on proximity to psychosis. For psychotherapy versus pharmacotherapy, the first evidence of effectiveness has been provided. A false-positive referral to treatment and other ethical concerns must be weighed against the risks of delayed treatment. 1. Introduction The term “psychose” was coined in 1841 (C. F. Canstatt), and its meaning has changed several times since then. With the introduction of the present classification systems of ICD-10 and DSM-IV, the definition became more precise. Today, the term “psychosis” means disorders which center around delusions, hallucinations, or “severely disorganized behaviors.” Delusions are defined as impossible beliefs, which the affected person holds on to without an option for correction. Hallucinations refer to “perceptions without an object” in any sensory modality. The category that is most difficult to define concerns the “disorganized behaviors,” that make no sense (like in hebephrenia), are erratic, or inadequate for a particular situation. Psychotic symptoms occur in schizophrenia as well as in affective, substance-related, and organic mental disorders. Diseases of the central nervous system, however, are a rare cause for psychotic symptoms in young people (e.g., in single cases of multiple sclerosis). Brain imaging and other additional diagnostics are nevertheless necessary in first psychotic episodes but mostly without pathological results. The most frequent disorders with psychotic symptoms in this age group belong to the group of schizophrenias or are induced by