Psychiatry & Psychology--General/Symptoms of early psychosis


QUESTION: Hi, I'm wondering if there are any  differences in the symptoms of people who are self aware that there is something wrong with them and people who are not self aware, other than the obvious difference in self awareness. Are the symptoms the same or are there actually some differences? I didn't get a clear answer before. Thanks a lot.

ANSWER: Hi Naomi

Not an easy question to answer clearly with other than "I don't know."  I think you're asking if the nature of the symptoms themselves differ, and I'm not aware of this having been addressed. But, as you seem to know, there would be differences not necessarily in the symptomatology but in the concomitants of the extent of the person's grounding. That is, the unaware person may have symptoms that are more severe and bizarre, and their interpretation would also differ, and that of course can feed back into the symptoms themselves.

In short, I think the reason there's no clear and short answer is that it's hard to tease out the "awareness" variable from the other factors that are responsible for the awareness level. Also, with awareness can come cognitive and emotional reactions that can affect the symptoms.

If you think I can help further with this interesting question -- or the reason behind it -- feel free to send a follow-up. In the meantime, thanks for asking us and I hope the reply will be of some use to you.


---------- FOLLOW-UP ----------

QUESTION: Ok I see. Thanks for your reply. I'm asking this for a friend who wants to see a clinical psychologist about some of her concerns. I'm trying to help her sort out her problems. Can a clinical psychologist diagnose psychotic disorders and answer other questions about psychosis that she might have? Should she see a psychiatrist instea, or would a psychologist be enough? Thank you for your reply.


1. Yes.

2.  Psychologists are more accessible, and she wouldn't need a referral from a GP but she'd likely have to pay for the visits.

If she needs any kind of medical treatment (from anti-anxiety medication all the way up to hospitalization) the psychiatrist would be it. But this would certainly be addressed by the psychologist.

Doesn't have to be instead -- could be both.

Needs help with her problems? That's the point, and making a diagnosis is really, often, and likely in this case, quite irrelevant. Giving her mental state a name, a syndrome, a label, will help how?  Naomi, it's not a diagnosis she needs but a competent mental-health professional who will help define her problem and work with her on managing it.

(So I'm not trying to diagnose, but for your interest psychotics don't have questions about psychosis -- nor intact friends who think they can help.)


---------- FOLLOW-UP ----------

QUESTION: She, herself, wants a diagnosis. She thinks that it'll help her understand what's wrong with her and she'll go on from there. I'm just trying to help lessen her suffering by giving her some information about the things that she is worried about so that hopefully she would calm down a bit. I don't know if it's psychosis or not, she just looks very depressed and anxious about everything that has been going on in her life. It's making me worried as well. I'll tell her what you said to me: there doesnt seem to be any noticeable differences in the early psychotic symptoms of people who are self aware and those who aren't, and there isn't a clear answer to that either. Hopefully, she will be less anxious. Yes I do agree that treatment is better. she just seems so anxious. Thanks for your help.

Being depressed and anxious is not a neurosis and has nothing to do with psychosis. Her condition would seem to be what's called (you'll never guess) depression and anxiety. It is common and treatable.

If she's a minor the parents should be involved in her seeking help. If she's at school, the guidance office can be helpful.

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Alan Auerbach


Taught psychology for 30 years, authored four textbooks. Specialize in introductory and industrial/organizational psychology, but will tackle wider range of areas.

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