How is psychosis treated?

What treatment should I be offered?
The National Institute for Health and Care Excellence (NICE) issues guidance on how the NHS should treat different health conditions. The NHS does not have to follow this guidance but is has to take it into account.

There are guidelines on:
•young people with psychosis and schizophrenia
•adults with schizophrenia, psychosis or schizoaffective disorder
•young people and adults with bipolar disorder
•adults with depression

You can find all of the NICE guidelines here.

Early intervention teams

If you have your first episode of psychosis, you should be referred to an early intervention team for initial treatment. NICE guidance states this should be the case no matter what age you are. These specialist teams provide treatment and support, and are usually made up of psychiatrists, psychologists, mental health nurses, social workers and support workers. Early intervention services are run differently in different parts of the country. If there is not a service in your area, then you should have access to a crisis or home treatment team.

Medication

Medication known as antipsychotics can help treat symptoms of psychosis. Your doctor should give you information about the benefits and possible side effects of different antipsychotics. You and your doctor should choose the medication together.

Your medication should be reviewed at least annually.

Cognitive behavioural therapy (CBT)

You should also have access to talking treatments such as cognitive behavioural therapy (CBT). CBT can help you understand your hallucinations and any upsetting and worrying thoughts and beliefs, and discuss new ways of thinking about them and dealing with them. CBT doesn’t necessarily get rid of the symptoms or upsetting experiences, but may help you cope better and lessen the distress that some symptoms can cause.

If you have bipolar disorder and experience psychosis, your treatment may be different. For example, your doctor may prescribe you a different medication to stabilise your mood rather offer you an antipsychotic.

As well as specific treatment, you may also get support from mental health services through the Care Programme Approach (CPA). This usually involves having a care co-ordinator who will develop a care plan with you.

Physical health

Research has found that people with severe mental illness, such as schizophrenia, are at higher risk of being overweight, having coronary heart disease and diabetes, among other health issues. This may be due to genetic factors, lifestyle choices (such as smoking and diet) or side effects from medication.

Because of this, NICE recommends that:
•When you start taking antipsychotic medication, you should have a full range of physical health checks, including weight, blood pressure and other blood tests. These checks should be repeated regularly.
•Mental health professionals are responsible for doing these checks for the first year of treatment. Responsibility may then pass to your GP.
•You should be offered a combined healthy eating and physical activity programme by your doctor or mental health team.
•You should be given help to stop smoking, and given support from a healthcare professional.

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What if I am not happy with my treatment?

If you ever feel unhappy with how your treatment or care is being handled, or feel that the relationship between yourself and a professional is not working well, you could call the Patient Advice and Liaison Service (PALS) at your NHS trust. They can try to resolve any problems or questions you have. You can find your local PALS’ details here.

You might find a general/community advocate helpful if you are unhappy with your treatment. Advocacy can help you understand the mental health system and enable you to be fully involved in decisions about your care. An advocate is someone independent from mental health services who can help to make your voice heard when you are trying to resolve problems. They may be able to help with writing letters for you or attending appointments or meetings. You can find more information about advocacy in our ‘Advocacy’ section.

There may be a local advocacy service in your area which you can contact for support. You can search online for a local service.

If you are not happy with your treatment, you can refer to the NICE guidance to see if you are being offered the recommended treatments.

You could also find out more about getting a second opinion, having a choice in your medication or making a complaint.

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Different views on psychosis

Some people think that what is considered a psychotic belief depends on the society around us. They feel that people with delusions and hallucinations are being targeted because their beliefs are out of step with the rest of society. For example, in some cultures hearing voices is seen as a normal part of life. However, in most western countries it is associated with mental illness. Also, beliefs in aliens, ghosts and conspiracy theories are widely held throughout the world by people who are not considered mentally ill.

Some encourage people with psychosis to embrace their symptoms and understand their meanings. The psychologist Rufus May believes that delusions can be symptoms of deeper psychological distress which people should work through. For example, if someone feels their being is being controlled by outside forces, this might stem from feelings of lack of control in their life.

The Hearing Voices Network believes that voices are not just symptoms but can be messages about how a person is feeling. For example, critical voices are suggestive of someone with very low self-esteem. They believe it is possible for people to accept and learn to live with voices by understanding what they mean.

These sorts of approaches are not as widely accepted as alternatives to the medical approaches we have described above.