Why is psychosis so hard to treat

Many people assume that people experiencing psychosis have schizophrenia. But there are lots of other disorders that have psychotic symptoms, including:. Like lots of mental health difficulties, psychosis is caused by a combination of different things. Things like genetics inherited from parents and a history of tough times like trauma and childhood experiences can make a person more vulnerable to psychosis.

They include:. Psychosis can be frightening, confusing and disruptive, but help is definitely available and with the right help most people get better. The recovery journey is different for everyone. Just like with any illness, recovering from psychosis can be an ongoing process. There can be huge steps forward and things that set a person back. Recovery takes time, support, and effort. The earlier you get help, the better the results and the quicker your recovery.

General Practitioners GPs and clinicians at your local mental health service will be able to provide the help you need. Avoiding drugs and learning better ways to cope with stress can help stop the symptoms from coming back in the future. The headspace Early Psychosis program offers early-intervention services to improve the lives of young people, and their families, who are affected by psychosis. Find out more about the program, and where these services are offered.

It can be frightening to experience psychosis, so try to be calm and supportive. The most important thing is to help the person feel safe and encourage them to get professional help. Encourage the young person to get professional treatment as early as possible. Encourage them to speak to a trusted adult such as their parents, a teacher, or maybe their GP, headspace, or other mental health service.

Acute mental health teams are specially trained to assist people experiencing psychosis in crisis. Supporting a person who is experiencing psychosis can be really tough. If your health is deteriorating in the direction of a psychotic episode, accurate diagnosis and getting treatment early gives you the best possible chance of minimising its effects and avoiding relapse.

Catching psychosis early is ideal, but someone having an acute episode still needs to be diagnosed and treated as soon as possible. Whatever the stage of the illness, professional care helps people experiencing psychosis and their family, friends and carers. Related: Getting better. Psychosis is more often experienced as one part of a complex mental health issue, rather than as mental health issue on its own, so when you seek help you may be diagnosed with one of these conditions:.

Related: Schizophrenia guide. A diagnosis of schizophreniform disorder may be given by a doctor if psychotic symptoms last at least one month and symptoms associated with schizophrenia last less than six months. Bipolar disorder which used to be called manic depression causes extreme mood swings from extreme agitation to deep depression, usually with periods of milder moods in between.

Some people with bipolar may also experience psychosis. Related: Bipolar disorder factsheet. This is a less common diagnosis which has symptoms similar to both bipolar disorder and schizophrenia. The symptoms may change over time — a person may start off with symptoms of bipolar disorder, for instance, then develop symptoms of schizophrenia a year or so later.

Drug-induced psychosis. Psychosis can be induced by the use of drugs like cannabis, cocaine, LSD, magic mushrooms, amphetamines speed, ecstasy and ice and even, in rare cases, alcohol. Most people who experience drug-induced psychosis recover with treatment and by ending their drug use.

In rare cases, women may experience psychosis in the days or weeks following childbirth. People living with BPD experience very intense, hard-to-control emotions, particularly around relationships. They can also struggle to have a strong sense of identity and self-worth. In severe cases, it is possible for people living with BPD to experience psychosis.

Major depressive disorder. Related: Depression. Why your diagnosis can change over time. Understanding a psychotic illness takes time, because the illness itself unfolds over time. Schizophrenia, for example, is only diagnosed after at least six months of symptoms, including at least one month of active psychotic symptoms.

As the illness takes its course, your health professionals will learn more about it — how best to describe it and how best to treat it. Related: What use is a diagnosis? The cornerstone treatment for symptoms psychosis experienced as part of a mental health issue is antipsychotic medication. The Royal Australian and New Zealand College of Psychiatrists emphasise the importance of a recovery-oriented context including peer relationships, social networks, and person-centred support.

There is also growing evidence for the role of psychological and neurological therapies in supporting people with a schizophrenia-spectrum disorder. Treatment should start as soon as possible, and may continue for as long as two to five years.

Antipsychotic medications work by affecting brain chemicals called neurotransmitters to reduce psychotic symptoms such as hallucinations, delusions and disordered thinking, and to prevent them from returning.

Antipsychotic medications can cause side-effects that will need to be managed — experiences can vary a lot from one person to another. Related: Antipsychotic medication factsheet. People with psychosis often experience other mental health issues, like depression, anxiety or mania. So you may be prescribed anti-anxiety medications, anti-depressants or mood stabilisers along with your antipsychotics.

This is relatively common — the medications are often used together. Psychological therapies are becoming an increasingly useful part of treatment for psychosis. Here are some of the most common therapies available. Cognitive behavioural therapy CBT is a therapy that explores the beliefs that influence the way we react to events.

It challenges those beliefs and works with the thoughts and behaviours that reinforce them. Believing the voices are sinister and powerful might mean a more distressing experience, leading you to withdraw from the world or become anxious and afraid.

Cognitive behavioural therapy for psychosis CBTp is an effective treatment for psychosis, in combination with medication. The goal of CBTp is to reduce the amount of distress your symptoms cause you, and to help you improve your quality of life. Family interventions involve family members in formal treatment.

This includes programs where families learn about psychosis and how they can be involved in recovery, and family group therapy which involves both the person with psychosis and their family in therapy sessions. Open Dialogue emphasises conversation between the person who is unwell and their support network, which might include friends, family, neighbours, teachers or colleagues. The idea is to use listening and talking to find new and useful perspectives to aid treatment and recovery.

Open Dialogue may help people experiencing psychosis to better engage in their treatment and reduce use of medication. Open Dialogue is increasingly being recognised and used around the world, but its availability in Australia remains limited.

Cognitive remediation addresses the problems a psychotic illness can cause with thinking, memory, attention, problem-solving and social skills. Repetitive exercises are used to improve skills in these areas. Cognitive remediation can be undertaken with a therapist qualified in cognitive remediation therapy. There are also online programs which can be completed independently. Given the wide ranging symptoms and impacts of psychosis, there are many different therapeutic approaches that may be useful.

Other possibilities include art therapy, music therapy, solution-focused therapy and narrative therapy. Talk to your doctors or case worker about the options available to you. Related: Psychological therapies factsheet. Electroconvulsive therapy ECT can provide short-term improvements for psychosis, especially when it is resistant to medication.

Related: ECT factsheet. Another, newer therapy is repetitive transcranial magnetic stimulation rTMS. During rTMS treatments, the patient is exposed to a controlled and localised electromagnetic current for periods of minutes at a time. The field can be used to stimulate or reduce activity in brain cells. There are a few different options available for clinical treatment. The best choice for you will depend on cost, severity of your symptoms and convenience, but not all services are available everywhere.

For people in rural and remote areas, treatment options can be reduced or involve long travel or alternatively can be delivered through telehealth services. Ask your GP for more information about appropriate support options. Psychosis most often develops for the first time during youth. Identifying young people in the early stages of a psychotic illness and providing them with specialised support and treatment can make a huge difference to their future health.

The largest early intervention organisation in Australia is headspace , including their online service eheadspace. The treatment available through a public community mental health team ranges from acute inpatient care, where you are admitted and stay in hospital, to outpatient treatment in the community.

The type of service provided can differ a lot from state to state and hospital to hospital. Your state or territory Department of Health can help you identify your local community mental health services, or you can use the National Health Services Directory.

To ensure your money is well spent, research the different types of cover available and the treatment programs offered by hospitals in your area. Another option for treatment is a private psychologist or psychiatrist, or both. Your GP can refer you, or the Find A Psychologist and Find A Psychiatrist services can help you find a therapist who has experience working with psychosis. Many community organisations. Talk to your doctor about options or call the SANE counselling services on 18 72 In Australia, there are circumstances where you can be legally hospitalised for a mental illness without your consent.

Involuntary treatment is a possibility. Understanding it helps you know your rights if it happens to you or someone you know. Related: Involuntary treatment factsheet. Living with psychosis can add a layer of challenges to your life.

Those challenges vary from person to person. However, there are many things you can do to stay well and live a life that is meaningful. The best ways to get well, stay well and flourish are to seek help early from a supportive team of health professionals and your trusted family, friends and social networks.

Doctors can provide medication. They can give you recreational activities and advice. But the desire to get better has to come from you. Psychotic illnesses take time to develop, so they also take time to diagnose. Your diagnosis and treatment could change as you and your treating mental health professionals learn more about the form your mental health issues are taking. Consistent, long-term treatment with a support team you trust is so important for schizophrenia recovery.

Stopping medication too soon can make symptoms return. To avoid this, always check in with your GP or psychiatrist before making changes to your medications. Related: Thinking about stopping your medication? Psychosis can interrupt your work or study life, your relationships and your ability to engage with life in general. So an important part of managing life with psychosis is to seek help with getting those things going again — work or study, relationships, your capacity to do things that are meaningful to you.

This is called functional recovery. Studies have shown that an early functional recovery gives you a better chance of long-term recovery than just treating symptoms alone.

So getting on track with work, study, housing, relationships and health is just as important, perhaps even more so, than eliminating positive symptoms such as delusions or hallucinations. Related: Getting back to work. For years I found it difficult to communicate. But working with customers means my confidence has really soared.

Psychosis can take a toll on your physical health as well as your mental health. Psychosis can sap your energy, confidence and motivation — you can feel less capable of keeping up your physical health or lose the desire to try. Another major influence on your physical health is the side-effects of antipsychotic medication.

Newer antipsychotic medications have fewer side-effects, but weight gain is still common. People being treated for psychosis are much more likely than the general population to be overweight, have high blood pressure and develop diabetes.

It means you have some combination of:. There is support to help you get healthy and stay healthy. I was sick of being unfit and unwell and sitting on the couch. There are many government and community-run support providers available in Australia. These include:. These types of programs often employ peer support workers — people with a lived experience of mental health issues who have undertaken training in mental health. Organisations that can connect you with community support services include:.

Some people react fearfully or judgmentally when they learn a person has a psychotic illness. For that reason, some people choose carefully who they tell about their mental health issues. How do you cope? Knowledge is power. There are a lot of people out there going through something very similar, and places exist for you to meet them, tell your story and hear theirs.

The SANE Forums provide a safe, anonymous, respectful place for people to share their experiences and make connections. A relapse is when, after you recover from an episode of psychosis, your symptoms return and you experience another episode.

A relapse prevention plan is a powerful tool for staying well and avoiding a worsening of your mental health issue. Making a plan involves:. Having a relapse prevention plan can make you and the people who care for you feel more secure, even if you never have to use it. You can read more about relapse prevention plans at Orygen and Here to Help. Because of the way psychosis affects thinking, feeling and behaviour, if your symptoms worsen at some time in the future, you may not be able to make good decisions about your care.

If you make an advance care directive, keep a copy somewhere obvious and make sure the people close to you know about it, including any health professionals you are working with. Ask them to carry with them a simple summary of what to do and where to call for help if needed — in their phones, for example. Having an advance care directive makes it much easier on you and the people who care for you if you ever need serious help.

For more information, see Advance Care Planning Australia. Seeing someone you care for experience the symptoms of psychosis can be confusing, frightening, hurtful, frustrating and terribly upsetting. Often, the person hears voices. There may be one or many voices, and they will sound exactly like real voices. It can lead to the individual harming themselves or, less often, others.

Treatment can manage or prevent psychosis, but it can return if the person stops taking their medication. There may also be a risk of suicide. During a psychotic episode, a person may experience delusions. Paranoid delusions can cause a person to be suspicious of individuals or organizations, believing them to be plotting to cause the person harm. Delusions of grandeur involve a strong belief that the person has a special power or authority. For instance, they may believe that they are a political leader.

Anyone who is experiencing psychosis should receive urgent medical attention. Treatment can provide both short- and long-term help. Early treatment can improve long-term outcomes, but it can take time for healthcare professionals to provide an accurate diagnosis. Psychiatrists recommend considering the possibility of a psychotic disorder in a young person if they show signs of:. There is no biological test for psychosis, but laboratory tests can rule out other medical problems that might explain the symptoms.

To diagnose psychosis, a doctor will carry out a clinical examination and ask various questions. They may also do tests to rule out other factors, including :. A lack of sleep may also trigger psychosis. Antipsychotic drugs are the main form of treatment for people with a psychotic illness.

Antipsychotics can reduce psychosis symptoms in people with psychiatric disorders, such as schizophrenia. However, they do not treat or cure the underlying condition. A person can only use these drugs under supervision from a doctor, as they can have adverse effects. The doctor will also treat any underlying conditions responsible for the psychosis.

Where possible, family support can also help. The person may need to stay in the hospital. Sometimes, a doctor will prescribe rapid tranquilization. They give the person a fast acting medication that relaxes them to ensure that they do not harm themselves or others.

The person does not stay in the hospital but uses antipsychotic drugs to help prevent further episodes.