While psychosis can be terrifying, recovery is possible. For some people, especially people who receive early treatment, recovery can mean never having another psychotic episode. For others, recovery means living a productive and meaningful life. By better understanding what psychosis is, and what psychosis is not, you can make better choices for coping and treatment.
Psychosis is NOT an illness. Psychosis IS a symptom, or a collection of symptoms, of an underlying illness. The underlying cause can be psychiatric (such as schizophrenia or bipolar disorder), neurological, neurodevelopmental, or a medical condition. Sleep deprivation, some prescription medications, and substance abuse (including alcohol abuse and marijuana abuse) can trigger psychosis.
A person suffering from psychosis experiences some level of detachment from reality
Psychosis affects the way the brain processes information and blurs the line between what is real and what is not real. Thoughts and emotions can become detached from reality.
During a psychotic episode, a person may experience delusions (false beliefs), hallucinations (seeing or hearing things that others do not see or hear), be incoherent (disordered speech or disordered thinking), or act erratically or inappropriately. Psychosis can be accompanied by depression, anxiety, disordered sleep, social withdrawal, lack of motivation, and overall difficulty functioning.
Psychosis symptoms are experienced on a spectrum, with different people experiencing different symptoms at different levels of intensity. If you or somebody that you love experience some of the symptoms of psychosis, early assessment by a psychiatrist and rapid treatment is associated with better outcomes.
Early treatment for psychosis makes a difference
People tend to experience better results when they receive effective treatment as early as possible. The shorter the "duration of untreated psychosis" (that is, the shorter the gap between the time when symptoms first appear and the start of treatment), the better the results from treatment. Without treatment, serious mental health symptoms tend to spiral – including suicidal thoughts. Functioning tends to deteriorate for people experiencing psychosis. Eliminating or reducing social interactions leads to isolation, aggravating depression and anxiety. There is some evidence that delays in the treatment of psychosis can cause greater neurological damage, leading to more intense symptoms and greater difficulty in treatment (4).
Delaying treatment tends to increase the chances of substance abuse, legal difficulties, strained family relationships, job loss, school disruption, loss of friends and social support, hospitalizations, and homelessness.
Early diagnosis and faster delivery of appropriate treatment increase the chance of never having another psychotic episode or having a more fulfilling life.
Psychotherapy as a complement to medication
For many people suffering from psychosis, pharmacological interventions (medication) serve as a foundation for effective, evidence-based psychotherapy. A multi-pronged approach combining pharmacological and psychosocial treatments have "demonstrated potential for recovery from psychosis" (2).
The contemporary understanding of schizophrenia, and many of the mental illnesses that underly psychosis, is that the illness is a biologically based disorder that can be alleviated by coping strategies that can be learned and practiced. This empirical approach tends to emphasize therapies that increase adaptability and are sort-term such as Cognitive Behavioral Therapy or Dialectical Behavior Therapy (1).
Cognitive Behavioral Therapy can help you understand and change your thinking patterns
Dialectical Behavior Therapy can help you better manage emotions and control anger
Mindfulness can help you accept distressing thoughts without criticizing yourself and to tolerate self-destructive urges.
There is strong evidence for cognitive-behavioral therapies to reduce the intensity of symptoms, and for psychoeducative family interventions that include skills training to reduce relapse and repeat hospitalizations (3).
Not everybody responds to treatment in the same way
Choose a psychiatrist who can provide both psychotherapy and medication. There is no uniform reaction to treatment. In most cases, there will be a period of trial and error, as you and your psychiatrist mix and match different treatment combinations.
"Different people respond to treatments differently. Therefore, if one treatment does not help, try adding the other. Research shows that psychotherapy can be helpful even for people who do not respond well to medications." - Clinical Practice Guidelines, American Psychological Association (click here)
Your first step should be working with a psychiatrist to conduct a comprehensive assessment of your needs and determine if psychosis is indeed the correct diagnosis.
If medication is called for, your psychiatrist can prescribe medications and monitor progress. Your psychiatrist should balance giving psychotherapy and/or medication. The best clinical guidelines call for a combination of therapy and medication to provide the best outcomes, but not all people benefit from the same mix.
In my practice, I will not always propose medication and I will not push the same therapeutic approach on all clients. We will work together to find the mix that works for you.
About Dr. Hermiz
Dr. David Hermiz lectures at UCLA on bipolar disorder and trained with Dr. Michael Gitlin at the world-famous UCLA Mood disorders clinic. He is board-certified in psychiatry and neurology. He practices in Los Angeles and is available for online consultations and in-person sessions (when feasible).
References
(1) Eells T. D. (2000). Psychotherapy of Schizophrenia. The Journal of psychotherapy practice and research, 9(4), 250–254.
(2) Haram, A., Fosse, R., Jonsbu, E., & Hole, T. (2019). Impact of Psychotherapy in Psychosis: A Retrospective Case Control Study. Frontiers in psychiatry, 10, 204. https://doi.org/10.3389/fpsyt.2019.00204
(3) Lincol
n, T. M., & Pedersen , A. (2019). An Overview of the Evidence for Psychological Interventions for Psychosis: Results From Meta-Analyses. Clinical Psychology in Europe, 1(1), 1-23. https://doi.org/10.32872/cpe.v1i1.31407
(4) Mckenzie KJ. How does untreated psychosis lead to neurological damage?. Can J Psychiatry. 2014;59(10):511-512. doi:10.1177/070674371405901002
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