Treatment

Treatment for psychosis involves a combination of antipsychotic medicines, psychological therapies, and social support.

Your care team

Your treatment is likely to involve a team of mental health professionals working together. If this is your first psychotic episode, you may be referred to an early intervention team.

Early intervention teams

An early intervention team is a team of healthcare professionals set up specifically to work with people who have experienced their first episode of psychosis.

Depending on your care needs, early intervention teams aim to provide:

• a full assessment of your needs
• medicine
• psychological therapies
• social, occupational and educational interventions

Read more about mental health services

Treatment for psychosis will vary, depending on the underlying cause. You'll receive specific treatment if you've been diagnosed with an underlying mental health condition as well.

Antipsychotics

Antipsychotic medicines are usually recommended as the first treatment for psychosis. They work by blocking the effect of dopamine, a chemical that transmits messages in the brain.

However, they're not suitable or effective for everyone, as side effects can affect people differently. In particular, antipsychotics will be monitored closely in people who also have epilepsy, a condition that causes seizures or fits.

People who have cardiovascular disease – conditions that affect the heart, blood vessels, or circulation, such as heart disease – will also be closely monitored.

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

Antipsychotics can be taken by mouth (orally) or given as an injection. There are several slow-release antipsychotics, where you only need an injection every 1 to 4 weeks.

Side effects

Antipsychotics can have side effects, although not everyone will experience them and their severity will differ from person to person.

Side effects can include:

• drowsiness
• shaking and trembling
• weight gain
• restlessness
• muscle twitches and spasms – where your muscles shorten tightly and painfully
• blurred vision
• dizziness 
• constipation
• loss of sex drive (libido)
• dry mouth 

Tell a GP or mental health worker if you have side effects that are becoming particularly troublesome. There may be an alternative antipsychotic medicine you can take that causes less side effects.

Never stop taking medicine prescribed for you unless advised to do so by a qualified healthcare professional responsible for your care.

Suddenly stopping prescription medicine could trigger a return of your symptoms (relapse). When it's time for you to stop taking your medicine, it will be done gradually.

Psychological treatment

Psychological treatment can help reduce the intensity and anxiety caused by psychosis. There are several possible psychological treatments.

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) for psychosis is based on an understanding of how people make sense of their experiences and why some people become distressed by them.

A CBT therapist may encourage you to consider different ways of understanding what's happening to you. The aim is to help you achieve goals that are meaningful and important to you, such as reducing your distress, returning to work, education or training, or regaining a sense of control.

Family intervention

Family intervention is known to be an effective form of therapy for people with psychosis. It's a way of helping both you and your family cope with your condition.

After having an episode of psychosis, you may rely on your family members for care and support. While most family members are happy to help, the stress of caring for somebody can place a strain on any family.

Family therapy involves a series of meetings that take place over a period of 3 months or more. Meetings may include:

• discussing your condition and how it might progress, plus the available treatments  
• exploring ways of supporting someone with psychosis 
• deciding how to solve practical problems caused by psychosis, such as planning how to manage future psychotic episodes 

Self-help groups

If you're experiencing episodes of psychosis, you may benefit from being around other people who've had similar experiences.

For example, the mental health charity Mind has more than 150 local Mind networks, which may be able to put you in touch with a support group in your area, as well as provide a range of other useful services.

Mental Health Act (1983)

If you're experiencing a particularly severe psychotic episode and it's felt you present a significant danger to yourself or others, you can be compulsorily detained at a hospital under the Mental Health Act (1983).

The mental health charity Mind has more information about the Mental Health Act (1983).

If you're detained under the Act, every effort will be made to obtain your consent to treatment.

However, treatment can be carried out without your consent if it's required.

Violence and aggression

Acts of violence and aggression are fairly uncommon in people with psychosis. They're more likely to be victims of violence than those being violent.

However, there may be times when your behaviour places yourself or others at risk of harm. Mental health staff have been trained to deal with aggressive behaviour.

They will try to help reduce any distress, agitation and aggression, but it may be necessary to hold you down without hurting you. This is known as physical restraint. You may then be moved to a secluded room.

In some cases, you may need to be given medicine that will quickly make you very relaxed.

You'll be offered the medicine voluntarily, in the form of tablets, but you can be treated against your consent if you refuse. This may involve giving you an injection of a tranquilliser (rapid tranquillisation).

It's important to stress that these methods are only used in extreme circumstances and are not routinely used to treat psychosis.

Advance decisions

If you're at risk of having psychotic episodes in the future and there are certain treatments you do not want to have, it's possible to pre-arrange a legally binding advance decision, previously known as an advance directive.

An advance decision is a written statement about what you'd like health professionals and your family or friends to do if you experience another psychotic episode. You may also want to include the contact details of your care team.

To create an advance decision, you need to make your wishes clear, in writing, and ask a witness to sign it. You should include specific details about any treatments you do not want and specific circumstances in which they may apply.

However, an advance decision can be overruled if a person is subsequently detained under the Mental Health Act.

Although doctors will try to take your wishes into account when deciding on treatment, they may decide it's in your best interests not to follow the advance decision.

Yellow Card Scheme

The Yellow Card Scheme allows you to report the suspected side effects of any medicine you're taking. It's run by a medicines safety watchdog called the Medicines and Healthcare products Regulatory Agency (MHRA).

Page last reviewed: Sat Dec 2022 Next review due: Wed Feb 2020