Psychosis - Complications of psychosis

Someone experiencing a psychotic episode may self-harm. Suicidal thoughts and an increased risk of suicide are also common.

Self-harm

Self-harming behaviour is a relatively common complication in people with psychosis. A study found that 1 in 10 people with psychosis also had a history of self-harm.

The risk of self-harm is thought to be highest in people who are experiencing their first episode of psychosis who aren't receiving treatment.

See your GP if you're self-harming. You can also call the Samaritans on 08457 90 90 90 for support. The mental health charity Mind also has some useful information and advice.

Read more about getting help if you self-harm.

If you think a friend or relative is self-harming, look out for signs of unexplained cuts, bruises or cigarette burns, usually on the wrists, arms, thighs and chest. People who self-harm may keep themselves covered up at all times, even in hot weather.

A person who's self-harming may feel deep shame and guilt, or they may feel confused and worried by their own behaviour. It’s important to approach them with care and understanding.

They may not want to discuss their self-harming behaviour with you, but you could suggest that they speak to their GP or a counsellor on a support helpline.

Suicide

People with psychosis also have an increased risk of suicide.

It's estimated that 1 in 5 people with psychosis will attempt suicide at some point in their life, and 1 in 25 people with psychosis will kill themselves.

If you're feeling suicidal you can:

call the Samaritans support service on 08457 90 90 90
go to your nearest accident and emergency (A&E) department and tell the staff how you're feeling
contact the NHS 111 service
speak to a friend, family member or someone you trust
make an urgent appointment to see your GP, psychiatrist or care team

Read more about getting help if you're feeling suicidal.

If you're worried that someone you know may be considering suicide, recommend that they contact one or more of the organisations above and encourage them, in a non-judgemental way, to talk about how they're feeling.

If the person has previously been diagnosed with a mental health condition, such as depression, you can speak to a member of their care team for help and advice.

Antipsychotics

Using antipsychotics on a medium- to long-term basis can cause a number of complications. Some of the more common complications are discussed below.

Weight gain

Weight gain is a complication of many commonly used antipsychotics.

There are two main reasons why weight gain is thought to occur. Antipsychotics can:

lead to an increase in appetite
make you less active

You'll probably be advised to take more exercise to help burn off the excess fat.

Read about getting started with exercise and how to lose weight safety.

Metabolic syndrome

Metabolic syndrome is a term describing a number of related conditions linked with weight gain, such as:

These health conditions can also increase your risk of developing type 2 diabetes, heart disease and, most seriously, heart attack or stroke.

Due to the risk of metabolic syndrome, you'll usually need to have regular blood tests and blood pressure tests while taking antipsychotics.

If your test results show you have an increased risk of developing a condition such as heart disease, a number of preventative treatments, such as statins, are available to help lower cholesterol levels.

Tardive dyskinesia (TD)

Tardive dyskinesia (TD) is another common complication of long-term antipsychotic use.

TD is a movement disorder where a person experiences involuntary movements, such as twitching, tics, grimaces, tremors and spasms.

It usually starts in the face and mouth before spreading to the rest of the body.

Mind estimates that one in five people who've been taking an antipsychotic for four years or more will develop TD.

In some cases, stopping taking an antipsychotic will provide relief from TD symptoms, but in other cases it makes the TD symptoms worse.

However, stopping medication isn't always safe and has to be balanced against the risk of having a relapse.

In some cases, TD can be a permanent condition.

There are also a number of treatments that can sometimes improve the symptoms of TD, including:

clonazepam – a medication that's used to treat epilepsy (a condition that affects the brain and causes seizures or fits)
vitamin E supplements – check with the doctor in charge of your care before taking vitamin supplements because they're not safe or suitable for everyone