Treatment for Psychosis

Psychosis can be a symptom of several mental health conditions. It's a lot more common than people often think—according to the National Institute of Mental Health, it affects about 100 out of every 100,000 people each year. But that doesn't mean it isn't an intense and sometimes frightening experience. Fortunately, it's also something that is treatable with the right combination of therapy, medication, and support.

What Is Psychosis and Psychotic Conditions?

Psychosis is a condition characterized by the presence of delusions (false conceptions about what is happening or who you are) and/or hallucinations (seeing or hearing things that are not there). When someone is experiencing psychosis, they are unable to distinguish between what is real and what is fantasy.

Treatment usually includes a combination of psychotherapy, case management, and medication. Typically, antipsychotic medications are the medications of choice, sometimes combined with mood stabilizers or antidepressants. 

Therapy for Psychotic Disorders

Often, many psychosocial (the combination of psychological factors and their intersection with social factors) methods are used when treating psychosis since it can be very overwhelming to both an individual going through it and their loved ones.

Cognitive-Behavioral Therapy

Cognitive-behavioral therapy (CBT) is most often used in the treatment of psychosis. In fact, there is a specific protocol known as cognitive-behavioral therapy for psychosis (CBTp).

Key tenets of this protocol are learning how to understand the psychotic symptoms, normalizing the experience to reduce stigma, and accepting the symptoms to reduce the distress resisting their causes.

Individualized Resiliency Training (IRT)

IRT is another modality specifically designed for those dealing with a recent psychotic episode. It is part of the Navigate Program, an early treatment program for those experiencing psychosis.

IRT contains 14 modules on topics such as relapse prevention planning, developing resilience, and improving social functioning. Therapy typically lasts somewhere between six and 24 months.

Other Therapies

Here is a list of other therapies that may be used to treat psychosis:

• Case Management: A case manager may work with someone who has experienced psychosis to help them stick to their treatment plans, including helping them problem-solve when something interferes with their treatment or if they are in crisis. A case manager, in some ways, is a liaison between the person experiencing psychosis and their clinical team. 
• Psychoeducation: This teaches those dealing with psychosis and their families about the condition so that they may understand it better. As psychotic disorders significantly impact most areas of life, psychoeducation helps patients learn about the condition and its treatment, including teaching them how to cope with the condition. 
• Cognitive adaptation training: Cognitive adaptation training is a method used to treat the cognitive deficits associated with psychotic disorders, such as memory, attention, and executive function. The training focuses on helping people with psychosis accomplish their activities of daily living, such as basic grooming/hygiene and medication adherence.
• Treatment for co-occurring disorders: Up to 70% to 80% of those dealing with schizophrenia may also have a substance use disorder. Historically, psychotic disorders and substance use disorders were treated separately. However, new research supports treating both types of disorders at the same time through integrated treatment, which may include motivational interviewing, cognitive-behavioral techniques, and harm reduction methods. 
• Support Groups: For those who have experienced psychosis or live with a psychotic disorder, these conditions may feel isolating if nobody in their life has experienced them. Peer support groups have been proven to help because those with psychosis can increase social support and quality of life.

Medications for Psychotic Disorders

Treatment of psychosis and psychotic disorders associated with it is usually grouped into acute treatment and longer-term treatment and is a combination of medication and therapeutic elements.

Acute Phase

Acute agitation can be managed with an antipsychotic, either with or without a benzodiazepine. There are a variety of options available, but one such combination is the antipsychotic Haldol (halperidol) and the benzodiazepine Ativan (lorazepam), which is considered highly effective. Thorazine (chlorpromazine) may also be used.

Generally, antipsychotics are preferred for patients who are known to have psychosis, but there is no specific "gold standard" to manage this, so the types that are used vary widely among individual providers and hospital systems.

Long-Term Treatment

For ongoing treatment, there are several options—first-generation antipsychotics, second-generation antipsychotics and long-acting injections. Typically, second-generation antipsychotics are newer medications with fewer side effects than first-generation ones. 

Second-generation antipsychotics include Risperdal (risperidone) and Clozaril (clozapine). While Clozaril is generally superior to other antipsychotics for treatment-resistant schizophrenia, substance use, aggression, and more, it is less utilized in the United States due to the bloodwork monitoring involved.

Side Effects of Medications

Like many medications, antipsychotic medications do carry a risk of certain side effects that you and your doctor will want to weigh before you choose one.

Some side effects from first-generation antipsychotic medications may include:

• Akathisisa (a total inability to sit still)
• Muscle stiffness
• Dyskinsia (involuntary movements of the face, arms or legs)
• Constipation
• Blurred vision
• Dry mouth
• Sedation 

Side effects from second-generation antipsychotics may include:

• Weight gain
• Headache
• Lightheadeness
• Dizziness
• Vertigo
• Fatigue 
• Insomnia 

A lot of research and attention is paid to addressing antipsychotic side effects, and many of them can be managed to improve the quality of life for patients with schizophrenia.

Complementary Alternative Medicine & Over-the-Counter Medications

While medication is almost always indicated when someone is dealing with psychosis, certain treatments are effective alongside pharmacological treatment, including exercise and diet.

Below are some complementary alternative medicines (CAM) and over-the-counter (OTC) medications that can be used in the treatment of psychosis:

• Repetitive transcranial magnetic stimulation (rTMS): This treatment, which uses pulses of a magnetic field over the scalp to treat cognitive dysfunction in psychosis, is currently being studied.
• Avatar therapy: This novel treatment is for those who are experiencing persistent auditory verbal hallucinations. People who are hearing voices interact with a digital representation of said voice, facilitated by the therapist, to help the avatar become less powerful to the person.
• Yoga: In a study using yoga as a treatment, one participant said it "reduced the clutter in my mind."
• Vitamin D supplementation: People experiencing psychosis are often deficient in Vitamin D. Supplementation may help to alleviate their symptoms.
• DASH anti-inflammatory diet: This diet was originally developed to treat high blood pressure, but since it reduces inflammation, it may also help treat schizophrenia.

How to Make Your Treatment Most Effective

Your treatment may sound daunting to you or you might be afraid it won't work, but taking small steps can lead to you feeling better.

• Stick to your treatment plan: Be sure to stick to your treatment plan even when your symptoms seem to be better.
• Know your warning signs: Having a grasp on what typically happens to precede a psychotic episode may help you catch them earlier and get treatment faster.
• Take care of your physical health too: Exercise, eating nutritiously (or even just sticking to a regular eating schedule is a great start), and avoiding drugs and alcohol are all helpful. 
• Find ways to reduce/manage stress in your life: Finding ways to manage your emotions with things like yoga, tai chi, or meditation can all help keep you emotionally regulated.

Takeaway

Psychosis may be scary to deal with—either for the one experiencing it or for their loved ones—but there are many treatments for it. The earlier you seek medical attention for symptoms of psychosis, the better your prognosis will be.