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Recognising and managing psychosis

This factsheet discusses how to recognise psychosis, and how individuals, their family and friends, can work together with health care professionals so that psychosis disrupts their life as little as possible. It is very important to seek help as early as possible when psychosis or a relapse of psychosis is suspected. Therefore, it is important to know what psychosis is and how to recognise it. If you haven’t already read it, please ask for a copy of the accompanying leaflet “What is psychosis?”

 

Recognising psychosis

When psychosis is experienced, individuals may react in different ways. They may become suspicious, depressed, anxious, tense, irritable or angry. They may experience mood swings, sleep problems, appetite changes or a loss in concentration. Friends or family may notice them becoming more withdrawn or isolated and as a consequence notice their study, work or social life deteriorate. It is common for others to perceive that something is `not quite right´.

Although each person’s experiences are different, there are a common sequence of events in psychosis:

 

Phase 1: Prodome

The early signs may be vague and hardly noticeable. There may be changes in the way some people describe their feelings, thoughts and perceptions. This may become more

disturbing over time and they may want to withdraw from other people’s company. They may start not taking care of themselves as well as they previously did.

 

Phase 2: Acute Phase

Psychotic symptoms such as hallucinations, delusions or confused thinking are experienced. This is described more fully in the leaflet “What is psychosis?”

 

Phase 3: Recovery

The pattern of recovery varies from person to person depending upon the underlying diagnosis. Psychosis is treatable and most people recover although it is common for some people to have several episodes of psychosis over a lifetime.

 

Why get help early?

Getting help early in a psychotic illness and preventing relapse in those known to have a psychotic disorder is important because:

  • Experiencing psychosis is often unpleasant for the person concerned, as well as for their friends and relatives.
  • A person experiencing psychosis can neglect themselves or be vulnerable to harm from others, and occasionally can be at a higher risk of inflicting harm on themselves or others.
  • The early treatment of psychosis and prevention of further episodes of psychosis can improve the outcome of those who suffer from psychotic disorders. 

It is common for those who are experiencing psychosis not to recognise that they are unwell and sometimes others such as friends or family are involved in seeking help for them.

Sometimes, if the illness is particularly severe and the person is at risk and is refusing appropriate treatment, the Mental Health Act may be used to get them the treatment they need.

 

Diagnosis

It may be difficult to make a diagnosis in the early stages of psychosis as there are no specific tests to show the cause. However, based on physical investigations, history taken from the individual and a person who knows them well, and the characteristics of the illness, over time the diagnosis becomes clearer.

Managing the early stages

Management in the early stages of psychosis may take place in the community or in hospital after a discussion between the person, family and health care professionals. In addition to starting medications and any talking therapies, management also involves ensuring safety and stopping contributing factors such as street drugs or alcohol.

Management later on

Some individuals who suffer from a psychotic disorder may need support in managing their disorder in the longer term in the community. These disorders include bipolar disorder, schizophrenia, schizoaffective disorder, psychotic depression and delusional disorder. Support is given via a care coordinator who is a member of a community mental health team. Workers in community mental health teams include psychiatrists (mental health doctors), psychiatric nurses, occupational therapists, psychologists and social workers.

Treatments used in psychotic disorders include medications, talking therapies as well as assistance in developing skills of independent living and employment. Medications known as anti-psychotics alleviate psychotic symptoms. They are also prescribed in the longer term to prevent further psychotic episodes, even though the individual is not currently experiencing psychotic symptoms. Other medications may be prescribed depending upon the individual and how the disorder affects them.

Talking therapies include cognitive behavioural therapy (CBT) and family therapy. CBT aims to reduce the distress that symptoms can cause and provide the person with strategies and skills to cope in everyday life. Information on medications and talking therapies is available. 

Further information

If you have not done so, it will be useful at this point to read the accompanying leaflet “What is psychosis?”