Sentiens Health

The exact treatment that an individual will receive differs from person to person, and also differs according to the phase of the psychosis that is being experienced.  Treatment has gradually moved from an acute inpatient setting, to more holistic, community-based treatment programs which encompass not only the biological model of psychosis treatment (ie. medication), but also psychosocial issues such as family and other relationships, employment and other things that impact on function and quality of life. In general, treatment will usually include the following steps.

1. Assessment

The first step in any treatment plan must be accurate assessment and to accomplish this the patient will have a series of interviews with a mental health professional such as a psychiatrist, clinical psychologist or mental health nurse. The specialist will need to spend some time getting to know the person and his/her circumstances. A vital part of such assessment, especially so when the illness is a psychotic one, is for the professional to talk to talk to key family members at the earliest possible stage. This ensures they get as much accurate information as possible about what has been occurring and what symptoms have emerged and when. Often blood tests and x-rays will be ordered to rule out the possibility that the psychosis has occurred because of a physical illness.
The information that is obtained from the assessment usually leads to the development of a list of possible diagnoses as to the nature of the psychosis, what might have caused it, and how best to help the person experiencing the illness.

2. Medication

Medication is a fundamental part of the treatment of psychotic illness. The medications used to treat psychosis are called anti-psychotics because they help control the symptoms of psychoses such as hallucinations, delusions and thinking problems. There are a number of antipsychotic medications available and the amount and type of these taken varies from illness to illness and from person to person. The treating doctor will provide the patient and the family with information about how much and when to take the medication. The doctor may very well try several different medications or combinations of medications before the one most suitable for the individual is found. Injections may be used instead of tablets.
The anti-psychotics that have been in use the longest are called 'typical' anti-psychotics. Although they are very effective, they can cause troubling side effects, including problems with movement and posture. Some of these anti-psychotics include:

• Haloperidol;
• Thioridazine;
• Trifluoperazine; or
• Chlorpromazine.

It is becoming more common for doctors to prescribe newer, so called 'atypical' anti-psychotics, because they tend to have fewer side effects. These medications are called 'atypical' because they work in a different way from conventional anti-psychotics and are less likely to cause distressing side effects affecting movement. Some of the newer, atypical anti-psychotics available in Australia include:

• Risperidone;
• Quetiapine;
• Olanzapine; or
• Clozapine.

Regardless of which medication or combination of medications is decided on its use will be monitored and, if any side effects develop, the doctor may make changes to the amount or type of medication being taken. It is most important that the individual and his/her family report any side effects, real or imagined, to the doctor so that steps can be taken to eliminate or reduce these. It is common for people to stop taking their medication because of unpleasant side effects. Good communication with the doctor about side effects is vital to ensure that people don't stop taking the medication prematurely, or through stopping too abruptly, cause themselves further unnecessary and unpleasant withdrawal or discontinuation effects.

3. Psychological therapy or counselling

While the individual is experiencing acute psychotic symptoms, therapy will normally involve simply trying to help the person to understand what is happening, and letting him/her know that there is somebody available to talk with who understands what he/she is experiencing. At this time the major therapeutic effort may well be with the closer family members. Supporting families and educating them about the illness, helping them understand its causes and the things that help it or don't help it, instructing them about medication, and explaining to them what to expect and what their role may be as caregivers, is an absolutely vital part of psychological therapy. Such family therapy, with or without the ill person, should start at the earliest point in time and should not wait for the sick person to have recovered.
With the sick individual, when acute symptoms have subsided, therapy will often involve the following:

• dealing with the fear and stigma often associated with the experience of a psychosis;
• helping with feelings of depression or anxiety that usually arise;
• assisting with the identification of potential triggers for the illness, and identifying its early warning signs;
• making an 'action plan' that covers how future help can be obtained and who should be asked for help if early warning signs are experienced or observed;
• helping individuals to decide who to tell about their abnormal experiences and what precisely to tell them;
• assisting with the day-to-day management of specific symptoms; and
• teaching stress management and relaxation techniques.

4. Education

It is very important to educate the individual and the family about psychotic illness and about the treatment available for psychosis. This is essential for them to begin to make sense of what has happened, to take steps to prevent relapse, and to promote a return to normal routines. Mental health professionals will provide individuals and their families with information such as:

• what a psychosis is;
• what causes a psychosis;
• what is known of future outcomes and what determines these;
• the effects of non-prescribed drug use on psychotic illness;
• how a specified psychosis is treated;
• how relapse can be prevented; and
• how to work towards recovery.

The need for close ongoing care, with good communication, will be emphasized, and so to will be the vital importance of continuing to take medication, even after the symptoms have improved. This educational process will also include discussions on what individuals and families can expect how individuals can help themselves, and how family members can help.

5. Day programs

Often treatment will also require the individual to participate in day programs. Day programs are small group programs or individual therapies that run for a number of days per week, for several weeks, usually under the guidance of an occupational or other therapist. Day programs are selected to meet the individual's particular set of needs and are very useful for assisting the return to normal daily routines, as well as providing activities that are fun and relaxing. For instance some day programs involve physical activities to 'get fit'; others involve creative activities such as painting, drawing or pottery; and other programs involve more work-related activities, such as using computers. Some day programs aim to help the individual get back to work or to study.

6. Practical assistance

Another aspect of treatment involves helping with practical things such as sorting out finances, claiming social security benefits, dealing with legal matters, or finding accommodation.  These therapies are designed to educate the person with a psychotic illness about ways to live life in an independent and self-sufficient manner.  These programs can improve self-esteem and confidence, and provide people with a sense of empowerment: that they can regain some control over their lives and are able to live productively and with a good quality of life in an independent manner, if appropriate.