What Are the Evidence-Based Treatments for Psychosis?
As stated in our What Is Psychosis? page, a number of effective treatments for psychosis exist. The evidence base broadly supports a comprehensive, person-centered approach to helping individuals manage their symptoms to a point where they no longer interfere with their functioning. SPIRIT lab faculty contributed to the most recent systematic review of pharmacologic and psychosocial interventions for adults with schizophrenia spectrum disorders, published by the Agency for Healthcare Research and Quality. Many of the recommended treatments identified in that review are listed below.
Everyone’s recovery journey is unique, and different people may prefer certain treatments over others, or may find some more effective for them. That being said, international guidelines suggest that the best care offers access to many of the treatments listed below simultaneously. After reading this list, to find out more about where to access treatment for psychosis, click here.
Treatment can be broadly divided into two categories: medication and psychosocial treatments.
Medication
For many people experiencing psychosis, medication can be a helpful part of recovery that helps them return to the activities they enjoy. Antipsychotic medications can reduce or relieve symptoms of psychosis, such as delusions (false beliefs) and hallucinations (seeing or hearing something that is not there). Formerly known as neuroleptics, antipsychotic medications are the main class of drugs used to treat people with schizophrenia. They are also used to treat people with psychosis that occurs in bipolar disorder or depression.
Psychosis is believed to be caused, at least in part, by overactivity of a brain chemical called dopamine, and antipsychotic medications work in part by blocking this dopamine effect. This blocking helps to make the symptoms of psychosis—such as voices and delusions—less commanding and preoccupying, but it does not always make them go away completely. People may still hear voices and have delusions, but they are more able to recognize what isn’t real and to focus on other things, such as work, school or family. Antipsychotic medications can help to control symptoms, but they do not cure the underlying condition. When taken over a longer term, antipsychotic medications can help to prevent further episodes of psychosis.
Antipsychotic medications can help to calm and clear confusion in a person with acute psychosis within hours or days, but they can take up to four or six weeks to reach their full effect. Antipsychotic medications are generally divided into two categories:
- Atypical (second generation) antipsychotics
- Typical (first generation) antipsychotics
The main difference between the two types of antipsychotic medications is that the first generation medications block dopamine and the second generation medications block dopamine and also affect serotonin levels. People respond differently to medications, both in terms of benefits and potential side effects. Finding the optimal regimen for a person can take some time and a person may need to try different antipsychotic medications before finding the one that works best for them.
Antipsychotic medications can cause unpleasant side effects, especially when a higher dose of medication is used. Side effects vary depending on the medication. Some common side effects include:
- Abnormal Movements: May include tremors, muscle stiffness and tics. The higher the dose, the more severe these effects.
- Dizziness
- Weight gain
- Diabetes: Schizophrenia is a risk factor for diabetes. Antipsychotic medications can increase this risk.
- Agitation
- Sedation
Check the information given to you by your doctor or pharmacist to find out the specific side effects of the medication you have been prescribed. If you are troubled by any of these effects, it is best to continue to take your medication as prescribed and let your doctor know as soon as possible. Your doctor may adjust your dose, prescribe other medications to help control side effects, or change your medication.
Medications are most commonly administered as daily pills, but long-acting (depot) injectable forms of many antipsychotic medications are available; these are administered every few weeks or months depending on the specific medication.
The main advantage of depot injections is that you do not have to remember to take pills every day.
Antipsychotic medications need to be prescribed by a healthcare provider, ideally a psychiatrist or other healthcare provider with expertise in mental health. The decision about when to take medication, or what medication to take, is very personal, and it is not uncommon for people experiencing psychosis, their loved ones, and even their healthcare provider to have differing opinions on which (or how much) medication to use. It is important to have open, honest conversations with your healthcare provider about the potential risks and benefits of medication, as well as your (or your loved one’s) goals in order to see how medication might fit into recovery.
Taking care of your physical health is especially important if you take antipsychotic medication. Both schizophrenia and the medications used to treat it can increase the risk of diabetes and other serious health problems. Getting regular medical care can help you to have good physical health. Eating a nutritious diet, exercising regularly and getting enough sleep can also help you to get and stay well.
More information about antipsychotic medications can be found at:
https://www.mind.org.uk/information-support/drugs-and-treatments/antipsychotics-a-z/overview/
https://www.nimh.nih.gov/health/topics/mental-health-medications/index.shtml#part_149866
Psychosocial Treatments
Many people are not aware that medications are far from the only treatment available to help people experiencing psychosis live meaningful, fulfilling lives. A variety of psychosocial treatments have been shown in rigorous clinical trials to improve symptoms and quality of life for people distressed by their experience of psychosis. There is quite a variety of psychosocial treatments but, generally, all involve talking with a psychologist, psychiatrist, social worker, or other mental health professional who uses proven strategies to provide education, teach skills, or otherwise help someone move towards the life they want to be living.
Some examples of psychosocial treatments shown to be effective are listed below:
- Providing education about psychosis to the person experiencing it, as well as to their families or other important people in their life. This particular kind of education is often called “psychoeducation.”
- Cognitive Behavioral Therapy for psychosis, or CBTp, a certain kind of “talk” therapy in which people learn to make sense of their experiences, learn skills to manage upsetting symptoms, and implement strategies to move towards the life they want to be living. If you want to learn more about CBTp in particular, click here.
- Interventions for families or other important people in the life of someone experiencing psychosis that provide information about how best to support recovery, communication strategies, and problem-solving skills. You can learn more about some of the family interventions for psychosis being implemented by the SPIRIT Lab here.
- Cognitive remediation, in which someone increases cognitive skills like planning or memory via structured practice and the implementation of learning strategies.
- Supported employment and education, a particular kind of program in which a consumer’s education or professional goals are identified and a trained professional helps them pursue those goals at every step of the process, from finding work to on-the-job coaching and support.
- Peer support services, in which someone who is experiencing psychosis meets with someone who has had similar experiences and is living their own journey of recovery. Peer counselors are often trained and certified by the state and involved in broader peer and advocacy networks.
- Manualized wellness management and recovery interventions, which are a variety of different kinds of workbooks and curriculums that provide easy to understand information about mental illness and coping skills and help people define recovery for themselves. These are often delivered by therapists, peer support specialists, or in family support groups, and some common examples are Illness Management and Recovery (IMR) and Wellness Recovery Action Plan (WRAP).
For certain eligible people, teams of different kinds of mental health professionals provide various medication and psychosocial treatments simultaneously; these teams have themselves been studied and shown to be more effective for their target population than standard treatment. Two examples of these kinds of teams that the SPIRIT lab supports in Washington state are listed below:
- Teams that specialize in working with people newly experiencing psychotic symptoms, called First Episode Psychosis teams.
- Teams that provide support in the community to people living with psychosis who have high service needs and have had many encounters with the mental healthcare system, called Assertive Community Treatment teams.
If you think one of these kinds of teams sounds like a good fit for your or a loved one’s needs, please click the links above to learn more about them.