Psychosis - Treatment 

Treating psychosis 

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Phil’s brother Simon has a mental illness. The brothers explain how mutual support has helped them to cope with the illness.

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Reporting side effects

The Yellow Card Scheme allows you to report the suspected side effects of any medicine that you are taking. It is run by a medicines safety watchdog called the Medicines and Healthcare products Regulatory Agency (MHRA). See the Yellow Card Scheme website for more information.

Driving

If you have psychosis, it could affect your ability to drive. It is your legal obligation to inform the Driver and Vehicle Licensing Agency (DVLA) about a medical condition that could have an impact on your driving ability. See the GOV.UK website to find out how to tell the DVLA about a medical condition.

Prescription costs: make savings

How you can save money on prescription costs if you have a long-term health condition, including how to claim for free prescriptions and how to buy a prescription charge "season ticket"

Treatment for psychosis involves a combination of antipsychotic medicines, psychological therapies and social support.

Your care team

Your treatment is likely to be co-ordinated by a team of mental health professionals working together. If this is your first psychotic episode, you may be referred to an early intervention team.

Early intervention teams

An early intervention team is a team of healthcare professionals set up specifically to work with people who have experienced their first episode of psychosis.

Some early intervention teams only focus on a certain age range, such as people who are 14 to 35 years old. Depending on what is necessary for your care, early intervention teams aim to provide:

  • a full assessment of your symptoms
  • prescriptions for medications
  • psychological services
  • social, occupational and educational interventions

See NHS mental health services for more information about different healthcare professionals who may be involved in your treatment and services that are available.

Treatment for psychosis will vary depending on the underlying cause  for example, your treatment may be slightly different if you have been diagnosed with an underlying mental health condition as well.

For example:

Psychosis related to drug or alcohol intoxication or withdrawal may only require a short course of antipsychotics or tranquilisers (which have a calming effect). Referral to an addiction counsellor may then be recommended. 

Antipsychotics

Antipsychotic medicines, also known as neuroleptics, are usually recommended as the first treatment for psychosis. Antipsychotics work by blocking the effect of dopamine (a chemical that transmits messages in the brain). However, they are not suitable or effective for everyone as side effects can affect people differently.

In particular, antipsychotics will be monitored closely in people who also have:

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 given as an injection. There are several 'slow release' antipsychotics, where you only need 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 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.

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:

  • 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.

In addition long-term use of antipsychotics can lead to complications such as weight gain and diabetes. Read more about these types of complications.

You should inform your GP if your side effects are becoming particularly troublesome because there may be an alternative antipsychotic medicine you can take.

You should never stop taking medication prescribed for you unless advised to do so by a qualified healthcare professional responsible for your care. Suddenly stopping prescription medication could trigger a return (relapse) 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 reduce the intensity and anxiety 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 distressed by them.

The aim of CBT is to identify 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.

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 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 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)

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 you do not have the mental capacity to understand the issues surrounding treatment.

An independent panel will regularly review your case and progress. Once they feel 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 you remain in hospital or in the clinic on a voluntary basis.

Dealing with violence and aggression

Acts of violence and aggression are actually uncommon in people with psychosis. They are more likely to be victims of violence than perpetrators.

However, there may be time when your behaviour places yourself or others at risk of harm.

Mental health staff have received special training in dealing with aggressive behaviour.

If you fail to respond to requests to calm down, it may be necessary to hold you down without hurting you. This is known as a physical intervention. You may then be moved to a secluded room to calm down.

In some cases it may be necessary to give you a medication that will cause you to become very relaxed in a short space of time. This is known as rapid tranquillisation.

You will be asked to take the medication voluntarily but if you refuse you can be treated against your consent. This may involve giving you an injection of a tranquiliser.

It should be stressed that the methods described above are only ever used in extreme circumstances and are in no way a routine part of treating psychosis.

Advance decisions

If there is a risk of future psychotic episodes occurring, and there are certain treatments 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 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, make your wishes clear in writing and have it signed by a witness. Include specific details about which treatments you do not want, and specific circumstances in which they may apply.

The NHS Choices Carers Direct section has more information about advance decisions and about how these can be used.

Page last reviewed: 28/05/2012

Next review due: 28/05/2014

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The 2 comments posted are personal views. Any information they give has not been checked and may not be accurate.

chatsubo said on 29 May 2012

Dear Sean - glad you found CBT helpful

For blogs/chatrooms you may want to give this a go:

http://mhealthchat.org/information/psychosis.php

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Sean from Lancashire said on 15 April 2012

I have been diagnosed with paranoid psychosis, I have been through CBT which was very helpful indeed and I recommend it to anyone.
However I am currently looking for a chat blog which I could talk to others with similar conditions - is there any help out there ?

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