Treatment for psychosis involves using a combination of antipsychotic medicines and psychological therapies.

Antipsychotics

Antipsychotics are usually recommend as the first-line treatment for psychosis. Antipsychotics work by blocking dopamine's effects on the brain.

There are two main types of antipsychotics:

• typical antipsychotics - the first generation of antipsychotics that were developed during the 1950s, and
• atypical antipsychotics - a newer generation of antipsychotics that were developed during the 1990s.

Atypical antipsychotics are usually recommended as they have less potential to cause side effects. However, they are not suitable, or effective, for everyone.

Antipsychotics can usually reduce feelings of anxiety or aggression within a few hours of use, but they may take several days or weeks to reduce other psychotic symptoms, such as hallucinations or delusional thoughts.

Antipsychotics can be taken orally (as a pill) or given as an injection. There are several 'slow release' antipsychotics, where you only need to have one injection every two to six weeks.

Depending on the underlying cause of your psychosis, you may only need to take antipsychotics until your psychosis subsides. However, if you have a condition such as schizophrenia or bipolar disorder, their long-term use may be recommended in order to prevent further episodes of psychosis.

Both typical and atypical antipsychotics have side effects, although not everyone will experience them and their severity will differ from person to person.

The side effects of typical antipsychotics include:

• drowsiness,
• shaking,
• trembling,
• muscle twitches, and
• spasms.

Side effects of both typical and atypical antipsychotics include:

• weight gain,
• blurred vision,
• constipation,
• lack of sex drive, and
• dry mouth.

You should tell your GP if side effects are becoming particularly troublesome because there may be an alternative antipsychotic that you can take.

Psychological treatment

Psychological treatment, such as counselling or cognitive behavioural therapy (CBT), can help to reduce the intensity and anxiety caused by psychosis.

CBT is based on the assumption that most unwanted thinking patterns and emotional and behavioural reactions are learnt over a long period of time. The aim is to identify the unhelpful thinking that is causing your unwanted feelings and behaviours, and to learn to replace this thinking with more realistic and balanced thoughts.

The Mental Health Act

If you are experiencing a particularly severe psychotic episode, and it is thought that you present a significant danger to yourself or others, you can be compulsory detained at hospital or a psychiatric clinic under the Mental Health Act.

Although every effort will be made to try to obtain your consent for treatment, treatment can be carried out without consent if it is felt that you do not have the mental capacity to understand the issues surrounding treatment.

An independent panel will regularly review your case and your progress. Once they feel that you are no longer a danger to yourself and others, you will be able to leave the hospital or clinic. However, your care team may recommend that you remain in hospital or in the clinic on a voluntary basis.

Advance directive

If it is felt that there is a risk of future psychotic episodes occurring, you may want to write an advanced directive.

An advanced directive is a series of written instructions about what you would like your family or friends to do in case you do experience another psychotic episode. You may want to also include the contact details of your care team and social worker.