A qualitative study of emotional experiences during the pre-psychotic period

Abstract

Psychosis typically emerges after a heterogeneous range of premonitory symptoms. This has been labelled the ‘pre-psychotic period’ (PPP). Emotional disturbances are prominent features of this state and have shown to be risk factors for psychosis. The present study had two interrelated aims: to explore in-depth the experiential nature of the emotional changes that occur during the PPP; and to examine whether there are similarities between these pre-psychotic emotional changes and the concept of delusional atmosphere. Twelve men experiencing first-episode psychosis with delusional thought content were recruited for the study. Information regarding their emotional experiences during the PPP was gathered using a semi-structured interview format. Corroborating information about observable changes in the men’s behaviour during the PPP was also gathered from a family member or friend of theirs who had close contact with them during this time. The data was analysed using interpretative phenomenological analysis. A variety of strong emotional changes were reported during the PPP, including depression, anxiety, anger, and guilt, as well as love and happiness. Negative emotions were prominent during this time, but positive emotions were also found to be a feature of this state for some people. Overall, the PPP was characterised by an increase in distress over time. Features of delusional atmosphere that were evident during the PPP included: experiences of derealisation and the environment feeling different; anxiety and confusion and a drive to find and explanation for the changes that were being experienced; and a sense of apprehension that something significant was about to happen. The relevance of these findings to researchers and clinicians working in this area is discussed.