Diagnosis, Treatment, and Coping with Psychosis (Psychotic State)
The emergence of psychotic symptoms, particularly during the first psychotic episode, can be confusing and distressing for both the individual experiencing them, their family, and the people around them. In the following article, we will review the options available for the patient and their families, from diagnosis to the variety of treatment programs. We will outline practical tools for managing symptoms and present the innovative approaches emphasizing the goal of recovery and resuming gradual significant functioning. This approach is based on a perspective that views the individual as an active and leading partner in the recovery process and highlights the importance of family and community support as part of this journey.
Diagnosis
Diagnosis involves a comprehensive evaluation, including a detailed questioning regarding the medical and psychiatric history, assessment of the current mental state (mental status), and a physical examination. Currently there are no clinically based laboratory tests or imaging specifically for diagnosing psychotic disorders. However, since some of the symptoms can indicate other medical conditions, the patient may be requested to undergo further diagnostic tests to exclude physical reasons for the current episode.
It is worth remembering that since psychosis is, essentially, a symptom and not a disease, it is crucial to find out whether another factor requiring treatment is causing it.
Early treatment facilitates better recovery
Early treatment facilitates better recovery
Studies have shown that the average period between the first symptom and the initiation of treatment is between 12 and 18 months. This is a relatively long period, which is likely due to the concerns of the individual and their family to recognize the symptom as part of a possible development of a psychotic mental disorder and a fear of stigmatization. However, it is important to note that the shorter this period is, the better the prognosis, and vice versa.
Designated programs for an early intervention
To reduce the time between the onset of psychotic symptoms and the initiation of the treatment, designated programs have been developed worldwide for early interventions for patients who experienced their first psychotic episode.
do These programs include a variety of early treatment interventions, characterized by the use of low-dose antipsychotic medications and supportive and recovery-oriented care, with careful consideration of the individual’s wishes and abilities.
These early treatment interventions also involve setting personal goals, using cognitive and behavioral techniques, enhancing motivation, fostering family involvement and support, and supporting employment and education rehabilitation. Consequently, alongside medication, psychological and social treatment, there is also a personalized therapeutic approach. There is no magic solution; what is effective for one individual may be ineffective for another, and vice versa.
Effective treatment requires collaborative efforts from a multidisciplinary team comprised of specialists from various areas, including psychiatry, social work, psychology, occupational therapy, nurses, community mental healthcare, expressive arts therapy, and other health professions. The roles of the team members are clearly defined, and it is facilitated through once-a-week meetings, ongoing communication, and collaborative work.
Alongside symptom treatment, an emphasis is put on enhancing the individual, providing support for their recovery efforts from the turmoil they have undergone, overcoming social stigma, rehabilitating their sense of identity, and helping them to re-establish valued social roles. Effective treatment also includes involving and enhancing the individual’s natural support circles: family, friends, and community, as well as other individuals who have shared similar experiences, so that they take an active role in the recovery process.
The Navigate Program
One of the well-studied therapeutic interventions is the Navigate Program. This community program is designed for young adults aged 18 to 40 who have experienced a psychotic episode for the first time in their lives. It offers comprehensive mental health support in the early stages of the influence of symptoms on the individual’s functioning. The program integrates designated medication therapy with psychosocial, personal, and family support.
The program’s main goals are to provide patients and their families with prompt and multidisciplinary support in a variety of aspects, including functional, emotional, and symptom management. The program supports the individual’s re-engagement in their natural environment, according to their wishes, such as in returning to education or employment, while developing skills to best manage the existing symptoms and to improve their life functions and promote the recovery process.
The treatment, delivered within the community as part of the program, aims to provide the patient with a personalized solution in their natural environment as early as possible after the onset of the psychosis.
The program is implemented in Israel since 2015 and currently operates at eight centers throughout the country: The Governmental Mental Health Clinic in Kiryat Yovel (The Jerusalem Mental Health Center, Qiryat Yovel), the Outpatient Clinic at the Mazor Governmental Mental Health Center (The Mazor Mental Health Center), the Lev Hasharon Outpatient Clinic of the Lev Hasharon Governmental Mental Health Center (the Lev Hasharon Mental Health Center), the “Enosh” Program in Bat Yam, Bnei Zion Medical Center, Haifa, the Geha Mental Healthcare Center, Petach Tikva, and the Shalvata Mental Health Center, Hod Hasharon. A clinic is opening these days in the Merchavim Mental Health Center, Be’er Ya’akov.
Coping with a psychotic state
Coping with a psychotic state poses considerable challenges both to the individual experiencing it and to those around them. The main goal is to be alert and to identify the symptoms as soon as possible and to support the family member or close person who is experiencing an acute episode perceived as intimidating and threatening. Moreover, due to the psychotic episode, the individual’s ability to explain to their surroundings what they are going through is limited, and their behavior does not reflect their emotional state.
Therefore, it is essential to try and contain the difficulty, to avoid conflicts, to refrain from validating delusional beliefs and hallucinations, and not to confront the person about them. Additionally, avoid whispering and giggling around them, as they are likely to think that others are talking about them and plotting against them. However, it is crucial to address the person’s emotions, behavior, and function as they perceive them at that moment as a result of the psychotic episode. For example, if, due to the psychosis, the individual believes they are being chased, do not validate the content of their delusions, but address the underlying fear. We should try and calm the fear and let the person feel we are there for them. Alongside patience, empathy and containment, it is also vital to maintain clear boundaries, receive help, and share the treatment obligations.
It is important to know that during acute psychotic episodes, sleep, eating, and daily routine habits can be disrupted. Therefore, it is essential to ensure that the individual maintains these habits. For example, to maintain sleep hours without lying in bed all day, to ensure that the individual is not dehydrated and eats properly. Additionally, it is advised to maintain a consistent routine, avoid excessive stress, and ensure medication intake, if prescribed.
It is recommended to seek professional help as early as possible. Often, the individual is unaware of their condition; therefore, they may not be cooperative. Professionals are familiar with these kinds of situations; therefore, it is advisable to motivate them to get the help they need. Many times, individuals avoid seeking early treatment due to the difficulty and the fear in recognizing the problem. In reality, this can lead to a delay in receiving necessary treatment and may result in further deterioration. As coping can be difficult for the caregiver as well, it is important for caregivers to also contact the medical center to ask for help. Caregivers can contact the counselling centers and can also participate in support groups for families.
It is important to point out that if you or a loved one have experienced psychotic symptoms or a first psychotic episode, it is advisable to take a professional evaluation promptly. If necessary, it is recommended to initiate an appropriate treatment as quickly as possible to optimize recovery chances and proper functioning in various areas of life. Worldwide studies have demonstrated that the early intervention approach successfully results in improvement in symptoms, enhanced quality of life, improved function, reduced hospitalizations, and facilitated recovery.