Psychosis - Treating psychosis

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

Your care team

Your treatment is likely to be coordinated 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 14-35 years old. Depending on your care needs, early intervention teams aim to provide:

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

Antipsychotics

Antipsychotic medicines, also known as neuroleptics, 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). However, 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) and cardiovascular disease (conditions that affect 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 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

Antipsychotics can have side effects, although not everyone will experience them, and their severity will differ from person to person.

Side effects can include:

drowsiness (which may affect your driving ability)
shaking and trembling
restlessness
muscle twitches and spasms (where your muscles shorten tightly and painfully)
blurred vision
dizziness
constipation
loss of libido (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 the complications of psychosis.

Tell your GP if you have side effects that are becoming particularly troublesome. There may be an alternative antipsychotic medicine you can take.

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 relapse (a return of your symptoms). When it's time for you to stop taking your medication, it will be done gradually and under close observation.

Psychological treatment

Psychological treatment 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's 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's 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

Family therapy is known to be an effective form of treatment for people with psychosis.

Family therapy is a way of helping both you and your family to 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 informal meetings that take place over a period of six months. Meetings may include:

discussing your condition and how it might progress, plus the available treatments
exploring ways of supporting someone with psychosis
deciding how to solve practical problems caused by psychosis, such as planning how to manage future psychotic episodes

Self-help groups

If you're experiencing episodes of psychosis, you may benefit from being around other people who've had similar experiences.

For example, the mental health charity Mind has over 150 local Mind networks, which may be able to put you in touch with a support group in your area, as well as providing a range of other useful services.

Mental Health Act (1983)

If you're experiencing a particularly severe psychotic episode, and it's 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) (external link).

If you're detained under the Act, every effort will be made to obtain your consent to treatment. However, treatment can be carried out without your consent if it's felt you don't have the mental capacity to understand the issues surrounding treatment.

An independent panel will regularly review your case and progress. Once they feel you're no longer a danger to yourself and others, you'll be able to leave the hospital or clinic. However, your care team may recommend that you remain in the hospital or clinic on a voluntary basis.

Violence and aggression

Acts of violence and aggression are fairly uncommon in people with psychosis. They're more likely to be victims of violence than perpetrators. However, there may be times when your behaviour places yourself or others at risk of harm.

Mental health staff have been specially trained to deal 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, you may need to be given medication that will quickly make you very relaxed. This is known as rapid tranquillisation.

You'll 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's important to stress that these methods are only used in extreme circumstances, and they're not routinely used to treat psychosis.

Advance decisions

If you're at risk of having psychotic episodes in the future, and there are certain treatments you don't want to have, it's possible to pre-arrange a legally binding advance decision (previously known as an advance directive).

An advanced decision is a written statement about what you'd like health professionals and your family or friends to do if you experience another psychotic episode. You may also want to include the contact details of your care team.

To create an advance decision, you need to make your wishes clear in writing and ask a witness to sign it. You should include specific details about any treatments you don't want and specific circumstances in which they may apply.

However, it's important to remember that the advance decision can be overruled if a person is subsequently detained under the Mental Health Act.

Although your doctors will try to take your wishes into account when deciding on treatment, they may decide it's in your best interests not to follow the advance decision.