Treatment of psychosis

Medication is an essential part of treating psychosis and is effective in most people, as it reduces symptoms and prevents them from recurring. But psychotherapy is also very important, as it can help you understand the symptoms and know how to act, regulate stress, improve social relationships and learn to prevent relapses.

There is often a delay of months or even years between the onset of psychotic symptoms and the seeking of medical help, and therefore the initiation of appropriate treatment. A prolonged delay in treatment can worsen symptomatic and functional recovery, i.e. worsen the prognosis. Therefore, it is important to seek help as soon as possible.

In first person

"The trust and respect of professionals towards me has always been a key piece for me to get involved with the treatment in general. In the end, it is a matter of self-responsibility and if the protagonist is not well informed and integrated into the process, there is no story."

Pharmacological treatment

Antipsychotic medications, also known as neuroleptics, are usually recommended as the first-line pharmacological treatment for treating the symptoms of psychosis. These medications help reduce or stop/eliminate the frequency and intensity of the symptoms of the disorder.

Antipsychotics, within a few hours, usually reduce anxiety and agitation, but to reduce symptoms such as hallucinations and delusional thoughts, the medication must be taken for a longer period of time. Two out of three people experience a reduction in symptoms with the first medication they are prescribed within a matter of days or weeks. It is important to note that antipsychotics are very effective in terms of positive symptomatology (hallucinations, delusions, disorganized thinking and language, etc.), but in other symptoms such as negative (emotional and social withdrawal, emotional indifference, etc.) and cognitive symptoms they have shown very little or no efficacy.

Most antipsychotics are taken orally, and, depending on the type and dose, one or more tablets will need to be taken a day. In recent years, antipsychotics have also been developed that can be administered intramuscularly, as if it were an injection, and more spaced out in time (the frequency can vary between two weeks and three months, depending on the prescription). There are a large number of antipsychotic medications; one person may respond to one antipsychotic and another person to a different one. In addition, it is possible that at different times in the evolution of psychosis different antipsychotics are prescribed depending on the effectiveness and whether or not side effects appear.

It is important to never stop taking prescribed antipsychotic medications unless advised to do so by a healthcare professional. Antipsychotic medications play an important role in preventing relapse and stopping the medication can lead to a reoccurrence of symptoms. The medication can be stopped gradually and under the supervision and observation of a healthcare professional. If there is good symptom control and a good evolution, you can start considering reducing the medication in a gradual and controlled manner.

Psychosis, in some people, is associated with other symptoms such as depression or anxiety, problems with emotional regulation or sleep disorders, among others. In these cases, it will also be necessary to take other types of medication, such as antidepressants, mood stabilizers, anxiolytics, sedatives or hypnotics.

Side effects of antipsychotic treatment

Antipsychotics, like almost all medications, can have side effects. Not everyone will experience them and their severity will vary depending on each person.

The most common side effects may be the following:

• Drowsiness/sedation.
• Motor problems: tremors, restlessness, rigidity, slowness of movements, tension...
• Increased fatigue
• Increased hours of sleep
• Emotional indifference

• Weight gain
• Concentration difficulties and memory errors
• Loss or decrease in sexual desire
• Depression
• Increased or decreased salivation

It is important to inform your healthcare professional (family medicine, psychiatry, nursing) if you experience side effects that are particularly problematic for you. It is possible that the antipsychotic medication can be changed to another with a side effect profile that you tolerate better.

You should never stop taking your prescribed medications unless advised to do so by a qualified healthcare professional responsible for your care.

Stopping the medication suddenly can cause the symptoms to reappear (relapse). When professionals assess that treatment can be reduced, they will do so gradually and under close observation.

Psychological treatment

There are different types of psychological therapy, depending on the needs of the person and the family, and also on the phase of psychosis in which the affected person is.

Mutual aid groups (MAG)

Mutual aid groups (MAG) can also be a good option. Being with other people who have had similar experiences, sharing and exchanging experiences and everyday problems, expressing emotions and feelings, etc., can have a very positive effect on the recovery of the person with psychosis.

Psychoeducation

Education about psychosis, its treatment and prognosis is also a very important part, as it allows the person and their family to understand the experience and know what they can expect from the recommended treatments.

Psychoeducation about psychosis is a tool to empower the person and help them learn more about their disorder and better understand their experience. This makes it easier for the person to actively participate in their treatment and in shared decisions.

Psychosocial therapy

Psychosocial therapy facilitates the social and occupational rehabilitation of the person so that they can be effectively reintegrated into society, through the promotion and development of various skills such as:

• Stress and emotion management
• Relaxation techniques
• Problem solving and management
• Goal setting
• Promotion of a healthy lifestyle
• Finding social support
• Relapse prevention
• Social skills training
• Substance abuse counseling
• Cognitive rehabilitation

Many of these psychological therapies can take place individually or in a group.

Relaxation techniques

Relaxation techniques aim to reduce the stress and anxiety that a person experiences and return them to a state of calm, reducing psychophysiological overactivation. These techniques provide the person with the skills and tools to do so autonomously when they find themselves in similar situations in the future. They also aim to make the person aware of what is happening at that moment, facilitating the reduction of body tension and mental burden.

Family intervention

Family support is key in the recovery process from psychosis. For this reason, family therapy is an effective treatment for people affected by this disorder.

The family also goes through a process of acceptance and, therefore, may also need support to cope with it in the best possible way. During this process, doubts will arise about how to manage certain situations, such as possible relapses, or how to manage the stress generated by being a caregiver, among others. Therefore, having tools to be able to give the best possible support to the affected person will be key in the recovery process and will also be important to improve the well-being of the person and the family.