Psychosis - Treatment
Treatment for psychosis involves:
- a combination of antipsychotic medicines
- psychological therapies
- social support
Your care team
Treatment is likely to involve a team of mental health professionals working together. If this is your first psychotic episode, you may be referred to a mental health team.
The mental health team works with people who have had their first psychotic episode.
Depending on your care needs, the mental health team aim to provide:
- a full assessment of your needs
- psychological therapies
- social, occupational, and educational interventions
Treatment for psychosis will vary, depending on the underlying cause. You'll receive specific treatment if you have a mental health condition as well.
Antipsychotic medicines are usually recommended as the first treatment for psychosis. They work by blocking the effect of dopamine, a chemical that transmits messages in the brain.
They're 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 epilepsy, a condition that causes seizures or fits.
You will also be monitored if you have cardiovascular disease. This is a condition that affects the:
- blood vessels
Antipsychotics can usually reduce feelings of anxiety within a few hours of use. But they may take several days or weeks to reduce psychotic symptoms, such as hallucinations or delusional thoughts.
Antipsychotics can be taken by mouth (orally) or given as an injection. There are several slow-release antipsychotics, where you only need one injection every 2 to 6 weeks.
Antipsychotics can have side effects. Not everyone will experience them. Their severity will differ from person to person.
Side effects can include:
- shaking and trembling
- weight gain
- muscle twitches and spasms – where your muscles shorten tightly and painfully
- blurred vision
- loss of sex drive (libido)
- dry mouth
Tell your GP or mental health worker if you have bad side effects. There may be a different medication you can take that causes less side effects.
Do not stop taking medication unless advised to do so by a GP or healthcare professional.
Suddenly stopping prescription medication could trigger a return of your symptoms (relapse). When it's time for you to stop taking your medication, it will be done gradually.
Psychological treatment can help reduce the intensity and anxiety caused by psychosis.
Cognitive behavioural therapy
Cognitive behavioural therapy (CBT) helps you manage problems by thinking more positively. It frees you from unhelpful patterns of behaviour.
Family intervention is a way of helping both you and your family cope with your condition.
After having 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 meetings that take place over a period of 3 months or more.
Meetings may include:
- discussing your condition and how it might progress
- the available treatments
- exploring ways of supporting someone with psychosis
- deciding how to solve problems caused by psychosis, such as how to manage future episodes
It can be helpful to talk to people who've had similar experiences.
Psychosis is not psychopathy
Acts of violence and aggression are fairly uncommon in people with psychosis. They're more likely to be victims of violence than perpetrators. Psychosis is very different to psychopathy (being a psychopath).
In certain circumstances, you may have to be admitted to hospital against your will. This is called an ‘involuntary admission.’
The Mental Health Act, 2001 brings Irish mental health law into line with the European Convention for the Protection of Human Rights and Fundamental Freedoms. The Mental Health Act includes a number of provisions to ensure that the rights of individuals admitted involuntarily are ensured and respected.
People who are admitted involuntarily will be provided with a solicitor for free-of-charge. The solicitor will help the person to prepare for their mental health tribunal hearing.
An independent consultant psychiatrist will assess the individual admitted involuntarily and will write and submit a report on the assessment. The consultant psychiatrist is independent from the hospital and the mental health service.
Mental health tribunal
A mental health tribunal will review the case of an individual who has been admitted involuntarily and will decide if the involuntary order shall be affirmed (continued) or revoked. The mental health tribunal is made up of 3 people:
- a chairperson (a barrister or a solicitor)
- a consultant psychiatrist
- someone who is not a registered medical practitioner, registered nurse, psychiatrist or solicitor/barrister
All of the above provisions will happen within 21 days of the date of the involuntary admission order. If the situation arises in that the involuntary admission order is less than 21 days, the person who was involuntarily admitted can still request that the mental health tribunal hearing goes ahead. However, this person must write to the Mental Health Commission within 14 days of becoming a voluntary patient to request a hearing.
If an individual disagrees with the mental health tribunal’s decision they may appeal to the Circuit Court. However, this appeal must be made within 14 days of the mental health tribunal’s decision.