The Paradox of Help-Seeking Behaviour in Psychosis
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The Paradox of Help-Seeking Behaviour in Psychosis Julie Nordgaard 1,2 & Lars Siersbaek Nilsson 3 & Karina Gulstad 4 & Marlene Buch-Pedersen 4
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract
Little is known about which factors actually motivate individuals with psychosis to seek help or how psychosis may complicate the help-seeking process. The aim of this article is to examine the steps of this process and how psychopathological experiences might affect and interfere with it. In this qualitative study we interviewed nine patients with a first episode of psychosis. The interviews were transcribed and analysed according to the principles of thematic analysis using inductive as well as deductive methods. The crucial step in help-seeking behaviour seemed to be for the patients to identify the kind of problem they were facing. None of them clearly recognized their psychotic or otherwise anomalous experiences as symptoms of a mental disorder, and most of them did not seriously question the reality status of these experiences. For most of the patients it was an untenable social situation that caused them to seek help. When they did seek help the majority did not initially contact the psychiatric services. It seems paradoxical to expect patients who experience symptoms of psychosis for the first time to be able to unambiguously identify them as being exactly that and accordingly seek out psychiatric help, as diminished insight into illness is an inherent feature of psychosis. However, the phenomenon of ‘double bookkeeping’ seemed to provide an opening for seeking help from psychiatry in spite of compromised insight. This observation should be included in everyday clinical work and in future information campaigns. Keywords Early detection . Insight . Double bookkeeping . Qualitative . Psychosis
* Julie Nordgaard [email protected]
1
Mental Health Centre Amager, Gammel Kongevej 33, Copenhagen, Denmark
2
Faculty of Medical Sciences, University of Copenhagen, Blegdamsvej 9, Copenhagen, Denmark
3
Mental Health Centre Copenhagen, Edel Sauntes Allé 10, Copenhagen, Denmark
4
Early Psychosis Intervention Centre, Psychiatry Region Zealand, Smedegade 16, Roskilde, Denmark
Psychiatric Quarterly
Introduction Early detection and intervention in psychosis is important to ameliorate the course of the disorder and prevent complications [1–5]. Thus, it is crucial to increase help-seeking behaviour in individuals, who are experiencing early symptoms of psychosis. Early detection programs have been implemented several places in the world [6–8]. These programs typically consist of information campaigns targeting the general population and easy access to psychiatric services [9–12] While this strategy has proven effective, there are still considerable delays in treatment of psychosis [3, 9, 12, 13]. Several barriers for seeking help and getting treatment have been identified. These include lack of knowledge about mental illness, normalization of symptoms, difficulties expressing psychotic ex
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