Article Index
How is treatment obtained for people with psychotic disorders?
What are the goals of treatment?
Why is early intervention important?
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There are a number of methods which individuals and their families can use to obtain treatment. The methods people use often differ depending on how troubling and disruptive symptoms are, and how familiar the person might be with the signs of a developing psychosis. In the prodromal (or early) phase, when behavioral changes are starting to appear, individuals and their families usually feel that 'something isn't right' but they may not know what the problem is. This is particularly true if an individual hasn't experienced a psychotic illness before. Other individuals and their families might recognize the early warning signs as those of a developing psychosis. During an acute phase, families usually know that there is a problem, but may be unsure of where to seek assistance. The following people will be helpful for the individual and/or their family to talk to:

• A school psychologist or counselor. Because the first episode of a psychosis usually occurs during young adulthood, many people will have psychologists or counselors at their school that they can talk to. These professionals can help to make a decision if specialist assistance is required, and can help make referrals to appropriate professionals.
• The local or family doctor. The local doctor will also be helpful to talk to. If the doctor believes that the individual is experiencing early warning signs or more obvious symptoms of a psychosis, they can assist by making a referral to a mental health professional (usually a psychiatrist).
• The local mental health clinic, community hospital or mental health/psychiatric emergency teams. These are also valuable resources if the individual, or the family, feels that 'something isn't right' but isn't sure what the problem is. They may also notice signs that they know from past experience, indicate that a psychosis is developing or is being experienced. Phone numbers for these clinics are available in the phone book and through telephone help-lines.
• Mental health professionals such as psychiatrists or clinical psychologists. If the individual is already seeing a mental health professional, then these individuals will be in a good position to assess if any troubling symptoms or changes in the person's behavior are signs of a developing psychosis or not. They will also know where to direct the person and their family for further assistance.
• Telephone help lines. The local telephone directory will have some telephone numbers for local telephone help lines that specialize in mental health or welfare issues. These help lines can be very useful in directing individuals and their families to appropriate services.

Sometimes it can take several contacts with the above professionals before a referral is made. Individuals and their families need to be patient and persistent. It is advisable to keep a diary of troubling behavior, and to write down the troubling behaviors in a clear and objective way. For example, the diary might contain the following information about the sufferer.

• What is the 'typical' day like, and is this different from usual?
• When did behavior begin to change?
• What is the state of such things as sleeping, eating and self-care?
• Are unusual things being said or done? If so, what?
• How is the sufferer managing their social, financial and work/study responsibilities?

A diary will help inform the health professional about important information relating to the development of the illness, and it will also help to determine what the next step, if any, might be.

What are the goals of treatment?

The goals of treatment during an acute psychotic episode are usually:

• to ensure the safety of the individual and others, and to decrease the risk to the individual and to those around them;
• to decrease psychotic symptoms such as hallucinations, delusions and thinking problems as a matter of urgency;
• to use appropriate medications and to minimize their side-effects;
• to engage the family as well as the patient in treatment, education and support; and
• to develop a management plan to promote recovery from the acute episode.

As the individual begins to recover, treatment goals also include:

• continuing to keep the individual, and those around, safe;
• reducing the occurrence of problems that can go hand-in-hand with a psychosis, such as depression or anxiety, or alcohol and other drug use;
• preventing relapse;
• enhancing the individual and his/her family's quality of life; and
• returning the individual to usual life including daily routines (rehabilitation).

Why is early intervention important?

Whether this is a first episode of a psychosis or not, or whether a person has experienced a psychosis before or not, it is imperative to seek assistance as soon as the person or the person's family notices the 'early warning signs'. The individual, the family and close friends can all play a part in becoming aware of these personal 'early warning signs' and encouraging the sufferer to seek treatment when they appear. Adopting a 'wait and see' approach is never a good idea, as a psychotic illness always requires treatment, and the earlier that treatment is obtained the better. Some of the reasons why early intervention is important are:

• The earlier treatment is obtained the better the outcome will be for the individual with the illness.
• If psychotic symptoms are left untreated, sufferers can start to feel very bad about themselves, and very worried about their future. This can result in lowered self-esteem and a loss of confidence.
• The experience of psychotic symptoms greatly increases the likelihood of becoming depressed and anxious - sometimes severely so. Strange and distressing symptoms can lead a feeling of terror or great agitation, with added hopelessness, sadness, worry and pessimism. Signs of depression always need to be taken seriously because of the great suffering they induce in the patient and the ever-present danger of self-harm. People are at particular risk if they hear voices that command them to hurt themselves.
• Experiencing psychotic symptoms puts one at greater risk of abusing alcohol and/or other drugs. Sometimes people use these substances to try to feel better, or in an attempt to block distressing symptoms.
• Psychotic episodes can put great strain on family relationships and friendships. The earlier help is sought and the psychotic symptoms brought under control, the less disruption that will occur to important relationships.
• Psychotic symptoms have a negative impact on the ability to function well at work or study. This puts people at risk of losing a job or of performing badly in studies.
• Often the first episode of a psychosis occurs during young adulthood when the victim is just discovering where they belong in the world, with important social relationships in the process of being formed. An untreated psychosis will interfere greatly with these important tasks of young adulthood.
• Similarly, if left untreated, symptoms of a psychosis will interfere with the process of developing parenting skills.
• People are easier to manage in their usual environments. Failure to seek intervention at an early stage can lead to unnecessary hospitalization because symptoms become more severe and difficult as time progresses and this can happen quite quickly over a period of a day or so

What are some of the barriers to early intervention?

Clearly it is important to receive treatment as early as possible if a psychotic episode is developing. Unfortunately a number of factors arise that can interfere with getting urgent and appropriate help. It is important to be aware of some of these potential barriers to early intervention. Recognizing them is the first step to overcoming them and getting necessary help. Some barriers to early intervention are:

• People are often worried about the stigma which may attach to seeing a mental health professional or about what it means to be experiencing psychosis. Fears of 'madness' abound. These notions frequently lead to severe delays in getting help.
• People worry that a history of suffering from a psychosis, consulting a psychiatrist or being hospitalized for treatment of a psychotic illness will interfere with their jobs or with their studies or otherwise lead to their personal disgrace. In fact the earlier treatment is obtained the less will be the disruption that will occur in these aspects of life.
• Family members, co-workers and friends of the person suffering from a psychotic illness may not understand the changes that are taking place in their loved one's behavior, and may believe that they are 'just going through a phase,' and that the symptoms will go away by themselves.
• Frequently families are reluctant to seek help on their loved one's behalf because they feel that this is a betrayal of their confidence, or means they are being disloyal, or that they are doing things that will be hurtful to their loved one's feelings. These reactions are common and are well-intentioned, but they are contrary to the best interests of the ill family member. There is no doubt whatsoever, given the potentially serious consequences of untreated psychotic illness, that securing early and effective professional care is the single most important thing that a family can do to ensure the recovery and future wellbeing of the person they love.

Often the symptoms experienced by the individual make it unlikely that they will seek assistance for themselves. Some symptoms that present very real barriers in this connection include:
feeling suspicious or afraid that others, including family, friends and health professionals, are 'out to get' them (paranoid conditions);

• lack of insight or awareness that anything is wrong(most psychotic conditions);lack of motivation and energy (especially in depressive psychoses);
• difficulties with concentration and remembering to do things;
• difficulty in thinking clearly and reasonably; and
• in some psychotic states feeling that one is perfectly and abundantly well and more intelligent than anyone else (mania or hypomania).

When these symptoms are present, families and loved ones have a particularly important role to play in assisting/supporting/persuading the individual to seek treatment as the patient is more likely to listen to family members than to strangers.