Even if patients with psychosis are not currently experiencing an acute episode, mood and anxiety can fluctuate greatly over the course of a day, rocketing up and eventually getting so out of hand that those affected need medical treatment.
It would therefore be important for therapists and patients to know and avoid triggering and reinforcing factors.
However, such factors must be determined individually, as they may even have opposite effects on individual patients.
This is indicated by data from several studies presented by Professor Inez Myin-Germeys at the Congress of the German Society for Psychiatry, Psychotherapy and Neurology (DGPPN) in Berlin.
The psychiatrist from the University of Maastricht and her colleagues have provided psychosis patients with a diary containing detailed questionnaires on moods, emotions and anxieties.
On six consecutive days, patients should complete such a questionnaire ten times daily at randomly chosen times. Based on the information, the strength of the psychosis symptoms could be mapped on a scale.
The result: in many of the patients, but not all, the more stress they felt, the more paranoia was. The stress was usually preceded by the increase in paranoia symptoms.
A more detailed analysis showed that especially patients with early childhood traumas were sensitive to stress. The environment was also important. Most patients showed more symptoms when they had strangers around them.
Even this could not be generalized: in an evaluation of about 150 psychosis patients, the symptoms only increased in mild and moderate afflicted in a foreign environment, in the highly psychotic patients, however, they decreased. The connection between fears and symptoms could also be very different.
In two-thirds of patients, anxiety increased with the symptoms of psychosis, half of which were preceded by the fears of psychosis and the other by others.
In about a third of the anxiety went against it with the psychosis symptoms. It seems, Myin-Germeys said, that these patients used psychosis to relax.
Accordingly, it was observed that in some of the patients the symptoms increased when they relaxed, in another part they decreased.
The conclusion of the psychiatrist: For each patient, one should first examine very closely how stress, relaxation and the respective environment affect the symptoms, then one could also try to use such factors purposefully in order to control the psychosis.