Treatment and support
There is no "standard" route to recovery in psychosis. There are a number of treatment and support options available, and recovery will be about finding out what works for you. These treatment approaches are not exclusive, and most people benefit from a combination of different treatments and therapies.
These web pages will give you more information on the different sorts of treatment available. There is also a section entitled "wider support" which contains information on the kinds of support available for issues relating to such things as housing, employment and benefits.
1. Talking therapies
Cognitive Behavioural Therapy (CBT)
Social Skills Training
2. Involving Families
Other types of drug
How do they work?
4. Wider support
1. Talking Therapies
Many people find it important to have someone to talk to. If you are experiencing acute psychotic symptoms it sometimes helps to know there is someone who can understand your experiences and provide reassurance that you will recover.
As recovery progresses, you may ask "why me?" You might like to learn practical ways to hasten your recovery and prevent relapse. Things such as stress management, what to say to friends and family about what has happened, and planning a return to "normal" activities are often discussed.
Talking therapies can take place as individual, group or family sessions depending on your preference.
- Cognitive Behavioural Therapy
Cognitive Behavioural therapy (CBT) is used to help you, your family and friends learn to cope with your illness and reduce stress. It can help you cope with voices, strange and distressing thoughts, anxiety, depression and problems with motivation. It is especially useful for helping with any symptoms that your medication may not have removed. It is usually offered by team members or by a clinical psychologist.
Various members of your care team, including community psychiatric nurses (CPNs) and social workers offer counselling. Counselling provides an opportunity for you to talk about your condition, its symptoms and how it makes you feel. It can help you to organise and gain control over your thoughts, and to explore and express your emotions.
- Social Skills Training
Psychosis can make it difficult for a person to relate to others and to mix socially. Social skills training helps you to learn skills to help you cope in social situations.
2. Involving Families
A first episode of psychosis can be very confusing for family members as well as the person suffering. Often, psychosis as an illness is not well understood, and family members may think you are simply going through a "phase". They may attribute your illness to drugs/alcohol, problems at school/work or a desire to be independent of the family. They can be totally unaware you are going through a first psychotic episode.
For this reason, services try to seek out families and work with them. Caring for people with psychosis is stressful for family members, often leading to disruption in their own lives. They frequently benefit from education, gaining knowledge and skills to help care for their relative and increasing their ability to cope. If you agree, members of the team will be able to offer this kind of support to your family.
With the right information and an understanding of how they can be of assistance to you, families are often a fantastic source of support and greatly help recovery.
3. Medication - Antipsychotic drugs
The drugs used to treat the symptoms of psychosis and to prevent relapse are known as antipsychotic or neuroleptic medications. They are available in tablet, syrup or injection form.
Antipsychotic drugs have greatly improved the treatment of psychosis. Over the past 40 years, research has significantly increased both the range of medications and our knowledge of how they work.
Types of Antipsychotics
There are many different antipsychotic drugs, and it can take time to find the one that suits you best.
Antipsychotics are divided into two categories:
The older, typical antipsychotics, including:
The newer, atypical antipsychotics, including:
The newer antipsychotics tend to have fewer side effects than the older antipsychotics and are therefore usually the drug of choice for the treatment of first episode psychosis.
Usually you will initially be prescribed a low dose of one of the atypical antipsychotics. The medication's effects will be monitored over the next few weeks, during which time the dosage may need to be increased or decreased. If symptoms don't seem to be reducing or if you experience side-effects, medication may be changed to a different antipsychotic.
Remembering to take your medication
It is important to be patient when taking medication as it can take some time for all the effects to be felt. It is also important to remember to continue taking your medication even after your symptoms have gone. It is believed that those people who continue to take their prescribed medication for 1-2 years after the onset of psychotic symptoms are less likely to suffer a relapse and are more likely to achieve a return to a normal lifestyle.
- Other types of medication
Sometimes, depending on the nature of your problems, other types of drug are also prescribed.
A group of drugs called benzodiazepines are sometimes prescribed for a short period to help people feel calmer and get a good night's sleep. Dugs of this type include lorazepam and diazepam.
If fluctuations in mood are a major part of your problem, a mood stabilising drug such as valproate, carbemazepine or lithium may be suggested.
Antidepressant drugs are also sometimes useful if you feel very low during or after a psychotic episode.
- How do they work?
Antipsychotic drugs affect the communication between nerve cells in the brain. This communication occurs when chemicals known as neurotransmitters move from one cell to the next.
In psychosis, it is believed that there may be too many neurotransmitters travelling from one cell to the next, producing signals that should not be there. The two most common neurotransmitters linked with psychosis are dopamine and serotonin. It is believed that anti-psychotic drugs "block" these neurotransmitters and thereby decreases the communication between cells.
Psychotic symptoms are thought to involve excessive activity of the dopamine neurotransmitter system, resulting in thoughts and experiences that aren't based on reality (a kind of overactivity of the imagination). Damping down the activity of this system will therefore reduce the psychotic symptoms.
As with most medications, those used for the treatment of psychosis may cause side effects. Different drugs have different side effects and not everybody will develop them. Side effects are more common with the older medications, which is why they are not the drugs of preference. At the Early Intervention Service, we take side effects very seriously, and it is important to let your care team know if you think you are experiencing them.
Side-effects from antipsychotics fall into three categories:
Movement disorders, including
- Stiff muscles or muscle spasms
These side-effects are more common with the older typical antipsychotics. They are usually fairly mild and can be treated with the addition of extra medication, or by changing the drug.
A more severe but less common side effect is tardive dyskinesia. This involves uncontrolled muscle movements that can affect the lips, tongue, and sometimes other parts of the body. This usually only develops after a long period of treatment with the older typical antipsychotics. In rare cases, it can be severe and disabling.
Physical side effects, including
- Dry mouth
- Skin sensitivity to light
Side effects that affect quality of life
- Weight gain
- Sexual problems
Finding out more
We can provide you with much more information about all these types of drugs if you need it. A useful website with lots of information on medication is: www.rethink.org/information/med
A helpful book is Psychiatric Drugs Explained by David Healey (ISBN 0-443-07018-0)
4. Wider Support
Psychosis is very often tied up with life difficulties of a broader nature. For example, service-users may have no permanent residence, they may have financial difficulties, or they may be asylum-seekers trying to obtain leave to remain in the UK.
These kinds of issues will have a profound impact on a person's mental wellbeing, and their chances of recovering from psychosis. It is therefore essential to address them during the course of treatment. Whilst we do not have specialists working in all the domains listed below, we can give people guidance and support as well as put them in touch with organisations who can help.
At the Early Intervention Service we endeavour to help our clients with problems relating to things such as:
Finance and benefits
Employment and education
Police and the law