Title: Signs and symptoms of acute psychoses
Course: Non-Communicable Diseases, Emergency Care and Mental Health Part 2 - Ethiopia (Full)

Signs and symptoms of acute psychoses

People with acute psychoses may hear voices when no one is present, and they may behave in an odd or aggressive way. They may for instance loudly express rather odd beliefs, or exhibit socially unacceptable behaviour. While this can be very disturbing for family and neighbours, it is important to remember that it is also extremely distressing for the person. A psychotic person is likely to be confused and frightened by the distorted situation they find themselves in, further disorientated by the inability to understand that what they are experiencing is not real.

Keep this in mind as you read the case study of Mr Goitom, whose experience is typical of people suffering from acute psychosis (Case Study 13.1).

Case Study 13.1 Mr Goitom's story

Mr Goitom is a 27-year-old man who was happily married and a respected member of the community until he suddenly started to behave strangely. He began to say and do the oddest things, neglected his responsibilities and his wife (who tells you that 'he just isn't the same man any more') and stopped eating and sleeping.

After 10 days without food or sleep, during which his behaviour to others became increasingly aggressive, his wife took him to the holy water, hoping this would cure him. However, this failed to work, with Mr Goitom shouting and screaming at his wife and others. Unable to cope with this behaviour and fearful for his wife's safety, relatives carried him home and tied him with rope to a stake to keep him under control.

Neither Mr Goitom nor his family have any understanding of psychotic illness. Mr Goitom himself thinks he may have been bewitched by one of his neighbours. This seems believable to his wife, as she remembers he had a bitter disagreement about land ownership with this neighbour shortly before he became ill. Since then he has been obsessed by this neighbour, shouting loudly that he aims to get revenge by attacking his assumed persecutor.

From your life or work experience, have you ever come across a case like that of Mr Goitom? What kind of behaviour was involved? How did the family respond to this?

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If you have experienced such a situation before, it may be that, just like Mr Goitom's case, the family did not realise that the patient had a mental illness. It could also be that, because of the strength of traditional beliefs, the family, neighbours and others in the community accepted a supernatural — rather than a medical — explanation.

Clearly, Mr Goitom's behaviour posed some risk to himself, to his neighbour, and possibly to others – including his wife. However, the best way to manage these risks would be for the family to acknowledge that Mr Goitom is ill and needs to see a doctor for assessment and appropriate treatment. This would be far more effective than tying him to a stake — a practice likely to increase the risk by further distressing him. Later in this study session, you will reflect on what you can do to tackle the negative aspects of traditional beliefs and increase community understanding of psychotic illnesses in situations like that of Mr Goitom.