Management of Psychosis

Due to popular demand, I have to write an addendum to my previous article “Beyond the Psychosis”. For an overview of what psychosis really is, you will have to go through that article.

 

I have been asked the question “how can we treat psychosis?” from time to time. It is a question that needs to be answered simply when responding to persons who are not health professionals. I always like to give information to people in a manner that will ensure that they will be able to give other people the same information from an informed perspective.

In mental health service provision, we aren’t so comfortable to use the word “treatment” to qualify what we do or what we should do to make our clients get better. We prefer using the words “management” or “caregiving”.

Stereotypically, people tend to interpret “treatment” as giving medications only.

Management tends to always remind us of the bigger picture of what needs to be done to make the individual get well, return to their previous level of functioning and maintain their recovery. So we always have a “management plan” or a “care plan”.

 I have to emphasize that the management of psychosis is best done by a health professional who is trained to make the right diagnosis, determine the probable cause of the psychosis and draft a management plan.
  • While a multidisciplinary team of mental health professionals is the best option, any qualified health professional should have enough knowledge to be able to offer first aid (in accordance with their training) and refer to a more qualified health professional preferably a medical doctor because they are the ones trained to know what to give and when to give it.

I always remember the wise counsel of my teacher Prof. Roger Makanjuola that, “any fool can prescribe chlorpromazine but it isn’t everybody that can manage a patient”. Management of a patient with psychosis requires a much more detailed and intensive approach than just giving some pills to make someone sleep.

To be able to efficiently manage a psychotic illness, mental health professional needs to conduct a comprehensive assessment of the type of symptoms, the duration of the symptoms and the possible cause of the psychosis.
  • The assessment will also determine the impact of the illness on the person, the family, the job and the other social relationships which might have been affected by the condition.
  • These will guide the multidisciplinary team in sharing out the tasks that will be necessary towards restoring the individual to his previous harmonious and mutual relationship with others. The psychiatrist, the clinical psychologist, psychiatric nurse, medical social worker, occupational therapist/ medical rehabilitation experts, pharmacists, etc., all have their role to play in providing care for the person who is psychotic.
We also work on getting the family and other significant others in the person’s life to be involved in the sustaining the care that we recommend beyond the hospital.

Medication use in psychosis

  1. It isn’t all psychotic patients that will need medications.
    • If the symptoms are fleeting, not sustained and there seem to be stressful life situations ongoing in the individual. It might be appropriate to help resolve such issues before offering medications.
  2. If the primary cause of the psychosis is another illness, then treating the underlying illness is the solution not just treating the symptoms.
    • For instance, a man suffered a head injury from a motorbike accident. Subsequently, he began to talk irrationally. This individual will need to have a brain scan to determine what part of his brain is affected. A neurosurgeon might have to be invited to review and will (probably) carry out a surgical operation on the brain for him to get well. Loading such a man with antipsychotic medication can even kill him if care is not taken!
  3. Medications without other supportive care like social intervention, psychotherapy, lifestyle modification, etc. will almost always not resolve the psychotic illness.
    • Mental health professionals always provide these holistic care options for every client. This cannot be done by non-professionals!
  4. There are now so many different types of medications available for the treatment of psychosis. The psychiatrist is trained to determine which one is the best option for each client.
    • The variables the psychiatrist has to consider are numerous. That is why it takes many years of training and practice to sharpen the skills of knowing what is best for each client.
If you suspect that someone has a psychotic illness, the best thing you can do for them is to get them to visit the hospital.
If you have access to a mental health team, get them to help you assess them. If you do not know how to get a mental health team, ask the hospital close to you to give you a referral.
The cost of early diagnosis and management of psychosis is so minimal.
A delay in seeking help and seeking help from unqualified persons almost always leads to poor outcomes and the exorbitant cost of management of the psychosis.

Stay safe and sane; help others do the same!

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Ola Ibigbami

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5 Responses

    • I agree with you, Sir. The misconceptions are too much. Our goal is to continue to inform. Thanks for always sharing our posts!!

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