Treatment for psychosis involves using a combination of antipsychotic medicines and psychological therapies.
Your treatment is likely to be co-ordinated by a special team consisting of a variety of mental health professionals working together (see Psychosis - diagnosis). If this is your first psychotic episode, you may be referred to an early intervention team (see box to the left).
Treatment for psychosis will vary depending on the underlying cause - for example, your treatment may be slightly different if you have been diagnosed with another health condition as well. For more information see:
Antipsychotics
Antipsychotic medicines, also known as neuroleptics, are usually recommended as the first-line treatment for psychosis. Antipsychotics work by blocking the effect of dopamine (a chemical that transmits messages in the brain).
There are two main types of antipsychotics:
- typical antipsychotics – the first generation of antipsychotics that were developed during the 1950s
- atypical antipsychotics – a newer generation of antipsychotics that were developed during the 1990s
Atypical antipsychotics are usually recommended as they have less potential to cause side effects. However, they are not suitable or effective for everyone as the side effects can affect people differently. In particular, antipsychotics will be monitored closely in people who also have:
- epilepsy – a condition that causes seizures or fits
- cardiovascular disease – a condition that affects the heart, blood vessels or circulation, such as heart disease
Antipsychotics can usually reduce feelings of anxiety or aggression within a few hours of use, but they may take several days or weeks to reduce other psychotic symptoms, such as hallucinations or delusional thoughts.
Antipsychotics can be taken orally (by mouth) or they can be given as an injection. There are several 'slow release' antipsychotics, where you only need to have one injection every two to six weeks.
Depending on the underlying cause of your psychosis, you may only need to take antipsychotics until your psychosis subsides. However, if you have a condition such as schizophrenia or bipolar disorder, you may need to take antipsychotics on a long-term basis in order to prevent further episodes of psychosis.
Side effects
Both typical and atypical antipsychotics have side effects, although not everyone will experience them and their severity will differ from person to person.
The side effects of typical antipsychotics can include:
- drowsiness – which may affect your ability to drive
- shaking
- trembling
- restlessness
- muscle twitches
- spasms – where your muscles shorten tightly and painfully
Side effects of both typical and atypical antipsychotics can include:
- weight gain
- blurred vision
- dizziness
- constipation – an inability to empty your bowels
- lack of sex drive
- dry mouth
See the patient information leaflet that comes with your medicine for a full list of possible side effects, or the Medicines information tab above.
You should inform your GP if your side effects are becoming particularly troublesome because there may be an alternative antipsychotic medicine that you can take.
You should never stop taking medication that has been prescribed for you unless you are advised to do so by a qualified healthcare professional who is responsible for your care. Suddenly stopping prescription medication could trigger a relapse (return) of your symptoms. When it is time for you to stop taking your medication it will be done gradually and under close observation.
Psychological treatment
Psychological treatment, such as counselling (a talking therapy), can help to reduce the intensity and anxiety that is caused by psychosis. Some possible psychological treatments are discussed below.
Cognitive behavioural therapy
Cognitive behavioural therapy (CBT) for psychosis is based on an understanding of how people make sense of their experiences and why some people become very distressed by them.
The aim of CBT is to identify the unhelpful thinking patterns and emotions that may be causing your unwanted feelings and behaviours. It is then possible to learn to replace this thinking with more realistic and balanced thoughts.
A CBT therapist may encourage you to consider different ways of understanding what is happening to you. The aim is to help you achieve goals that are meaningful and important to you, such as reducing your distress, returning to work or university, or regaining a sense of control.
See the Health A-Z topic about CBT for more information about this type of treatment.
Family therapy
As family therapy is known to be an effective treatment for people with schizophrenia, it is also sometimes used to treat people who have experienced an episode of psychosis.
Family therapy is a way of helping both you and your family to cope better with your condition. After experiencing an episode of psychosis, you may rely on your family members for their care and support. While most family members are happy to help, the stress of caring for somebody can place a strain on any family.
Family therapy involves a series of informal meetings that take place over a period of six months. Meetings may include:
- discussing information about your condition, such as what treatments are available and how your condition might progress
- exploring ways of supporting someone with psychosis
- deciding how to solve practical problems that can be caused by psychosis - for example, planning how to manage a future psychotic episode
Self-help groups
If you are experiencing episodes of psychosis, a self-help group can be an additional source of support. You may benefit from being around others who have been through similar experiences. For example the mental health charity, Mind, has a network of local Mind associations and shops and you may be able to find a support group in your area.
Mental Health Act (1983)
If you are experiencing a particularly severe psychotic episode, and it is thought that you present a significant danger to yourself or others, you can be compulsory detained at a hospital, or a psychiatric clinic, under the Mental Health Act (1983) (see Psychosis – Diagnosis).
If you are detained under the Mental Health Act (1983), every effort will be made to obtain your consent (agreement) to treatment. However, treatment can be carried out without your consent if it is felt that you do not have the mental capacity to understand the issues surrounding treatment.
An independent panel will regularly review your case and your progress. Once they feel that you are no longer a danger to yourself and others, you will be able to leave the hospital or clinic. However, your care team may recommend that you remain in hospital or in the clinic on a voluntary basis.
Advance decisions
If there is a risk of future psychotic episodes occurring, and there are certain treatments that you do not want to have, it is possible to pre-arrange a legally binding advance decision (previously known as an advance directive).
An advanced decision is a series of written instructions about what you would like your family or friends to do in the event that you experience another psychotic episode. You may also want to include the contact details of your care team and social worker.
To create an advance decision, you need to make your wishes clear in writing and have it signed by a witness. You need to include specific details about which treatments you do not want to have, and the specific circumstances in which they may apply.
See the Carers Direct information about Advance decisions for an explanation about how these can be used.
