By Dr Ananya Mandal, MD
The treatment approach to psychosis depends on the underlying cause of the condition, which may involve another disorder such as schizophrenia, bipolar disorder, major depression or drug abuse.
Some of the treatments for psychosis include:
Use of anti-psychotic medications - Antipsychotic medication is the first-line treatment for psychosis. These agents may be given orally as pills or via injection when a person is admitted to hospital. Antipsychotics are also termed neuroleptics. They act by blocking the effects of dopamine in the brain and can reduce anxiety and aggression within a few hours of taking the medication.
Other psychotic symptoms such as delusions and hallucinations may take days or weeks to improve. Earlier forms of antipsychotics were fraught with side effects but more recent agents are associated with less risk for adverse effects.
Treatment of specific disorders
Bipolar disorder is treated with mood stabilizers such as lithium and anticonvulsants, along with cognitive behavioral therapy. Schizophrenia is treated with antipsychotic medications such as haloperidol, olanzapine and risperidone. Psychosis arising from drug and substance abuse focuses on de-addiction and rehabilitation.
Use of psychological or talking therapies
Family therapy and cognitive behavioral therapy (CBT) have been shown to be effective adjuncts to antipsychotic medications. CBT helps a person understand how psychosis and impaired perceptions are causing them distress.
The aim of the procedure is to identify the negative thoughts that are causing unwanted feelings and behaviours and replace them with more helpful and balanced thoughts. CBT can be combined with family therapy to help both an individual and their family cope with the condition.
Electroconvulsive therapy or electric shock therapy is mostly ineffective except when used to relieve the symptoms of underlying major depression.
The first episodes of psychosis are dealt with by an early intervention team who diagnose the condition and prescribe medication and other psychological treatments. The team also provides social, occupational, familial and educational support.
Aggression and violence is uncommon among patients with psychosis. However, mental healthcare workers are trained to deal with aggressive behaviour and reduce the risk of a person harming themselves or others. If someone who is having an aggressive outburst fails to calm down with talking, they may have to be restrained in a secluded room. This is called physical intervention. Medication is often then administered to calm the person.
Reviewed by Sally Robertson, BSc