Mental Health Centre Amager, Gammel Kongevej 33, Copenhagen, Denmark.
Faculty of Medical Sciences, University of Copenhagen, Blegdamsvej 9, Copenhagen, Denmark.
Psychiatr Q. 2021 Jun;92(2):549-559. doi: 10.1007/s11126-020-09833-3.
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.
目前对于促使精神病患者寻求帮助的因素知之甚少，也不清楚精神病如何使寻求帮助的过程变得复杂。本文旨在探讨这一过程的步骤，以及精神病理体验可能如何影响和干扰这一过程。在这项定性研究中，我们采访了 9 名首发精神病患者。根据主题分析的原则，使用归纳和演绎方法对访谈进行了转录和分析。寻求帮助行为的关键步骤似乎是让患者确定自己面临的问题类型。他们中没有人清楚地将自己的精神病或其他异常体验识别为精神障碍的症状，而且大多数人并没有认真质疑这些体验的现实状态。对大多数患者来说，是无法承受的社会状况促使他们寻求帮助。当他们确实寻求帮助时，大多数人最初并没有联系精神科服务。对于首次出现精神病症状的患者，期望他们能够明确无误地将其识别为正是这些症状，并相应地寻求精神科帮助，这似乎有些矛盾，因为对疾病的洞察力降低是精神病的一个固有特征。然而，“双重记账”的现象似乎为寻求精神科帮助提供了一个机会，尽管洞察力受损。这一观察结果应该纳入日常临床工作和未来的宣传活动中。
