How to spot psychosis

I was really happy the other day when someone told me that an old colleague that used to work with us was coming back to the pub. I’ll call him Quito. He’s young at just 21 and a refugee from Venezuela so he hasn’t had the easiest life. But he’s a positive guy and it’s easy to have a laugh with him, an essential when you work in a pub surrounded by morons. At least it used to be. Only Quito isn’t laughing anymore.

From working a couple of shifts with him it’s clear he’s not in a good spot mentally. You can tell that his thoughts are racing and a lot of what he says doesn’t make any sense. He’s simply not the same person anymore. Quito is fine some of the time, and then he snaps into it and the ranting begins. It’s psychotic behavior. One moment you’re fine and the next you believe in Santa Claus.

At the end of our first night shift together I tried to ask him about it and he told me he recently spent three days in psychiatric care after he had a breakdown in a cafĂ© and someone called an ambulance. It didn’t seem to bother him much and it was difficult to make sense of his story. When I asked if he was on medication, he replied that he had the best time playing ping pong in the hospital. He’s clearly in need of help but I’m not sure how to address the issue. It’s really difficult to convince a psychotic person to take medication when they feel just fine.

It also struck me that people without experience can’t spot a psychotic person. When I suggested to a colleague that Quito was psychotic she said I was being harsh. The guy was just a bit strange and probably needed to sleep more. When I had my first psychosis we had no idea what was going on so I don’t find it strange at all that other people can’t see it. 

People just laugh in a helpless way and feel uncomfortable. They struggle with putting a label on the person because they have no clue what’s going on. There are a few very clear signs that a person is in psychosis and Quito is exhibiting all of them:

  • The person is self-centered and conversation revolves around what they want to talk about. They don’t ask any questions about you and there’s a lack of empathy. They take little interest in what you say and the conversation often becomes a monologue. 
  • The person has racing thoughts and tends to rant on about something, often switching over to a different topic mid-sentence as something else pops into their mind. It’s also common with a loss of train of thoughts where the person suddenly can’t remember what they were talking about.
  • The person doesn’t sleep. If there’s one thing you can do to help a psychotic person, it’s to get them something to knock them out and go to sleep. It’s a feedback loop where the lack of sleep increases the psychotic symptoms at the same time as the psychotic symptoms makes it impossible for the person to sleep. I believe that a lack of sleep on its own is enough to trigger psychotic behavior.
  • Depersonalization occurs and it’s like the person you know is longer there. A lot of the time a psychotic person is busy pondering delusions so they can seem very absentminded and lost. 

I’m of the opinion that psychosis should be medicated with anti-psychotics as quickly as possible to avoid the risk of self-harm as well as any potential damage that comes to the brain from living in a form of hyperreality. Now I just need to figure out how to get Quito to share that opinion before something goes seriously wrong. I have a bad feeling about this one.

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