Psychosis

What is psychosis?

Psychosis is a mental disorder where a person loses the capacity to tell what’s real from what isn’t. They may believe or sense things that aren’t real, and become confused or slow in their thinking.

Psychosis often occurs as a part of other mental illnesses. It is treatable.

Symptoms

Someone experiencing psychosis loses the ability to tell what is real from what is not.

Psychotic symptoms vary from person to person and even between one episode and another, so for the best diagnosis, talk to your doctor.

The four main types of psychotic symptom are delusions, hallucinations, disordered thinking and disordered behaviour.

Delusions

Delusions are false or irrational beliefs. We all experience momentary, harmless delusions from time to time — that the traffic lights are against us when we’re running late, or that our lucky lotto numbers will win this week. That kind of delusion is normal and not harmful.

For someone living with psychosis, delusions are more persistent and much more intense. Psychotic delusions:

• don’t respond to evidence: delusional beliefs feel absolutely real to the person having them — even if you prove with perfect logic that the delusion is impossible, it won’t change their mind. A person with psychosis cannot spot their own delusions
• aren’t shared by other people from the same cultural background: believing your lotto ticket is lucky is a delusion commonly held by people in our society, so it’s not considered part of an illness. But if you believed your lotto ticket had supernatural powers, or that the numbers contained some message specially sent to you, that would be more concerning, as it’s not a commonly held belief in your culture.

Kinds of delusion

There are many different kinds of delusion, but most fall under the following categories:

Delusions of persecution

The most common delusions experienced by people with psychosis are paranoid delusions — believing that you’re being watched, followed or persecuted by forces that mean you harm.

Delusions of reference

It’s also common to believe you’re receiving special messages or codes — like in TV shows, songs or advertising.

Delusions of grandeur

People with psychosis sometimes believe they have special abilities, are unusually important, or are powerful figures, like Jesus or the US President.

Delusions of control

People with psychosis may believe that their thoughts are being controlled or influenced by outside forces — aliens, some real or invented group, an individual or something more vague.

Somatic (body) delusions

A person with psychosis may believe something has happened to their body: something is wrong with it, some part of it is missing or dead, or that they are infested with disease or parasites.

How delusions affect you

Having delusions can be confusing and very frightening. The world stops making sense, or suddenly makes a different, weird kind of sense that no one else sees.

For some people, delusions can be very isolating. It can be hard to make connections and feel close to people around you when you believe things they don’t. Keeping up with work or study can be harder, too. At their worst, delusions can make everyday life much harder to cope with.

Hallucinations

Hallucinations are when you see, hear, feel, smell or taste something that is not actually there.

It’s normal for human senses to be deceived, like seeing faces in things or being tricked by optical illusions.

But the hallucinations involved in psychosis are different. Neurological tests have shown that the voices, visions, smells and other sensations experienced by people with psychosis are indistinguishable from real sensory input.

Psychotic hallucinations aren’t imaginary and they aren’t real: they’re the product of a mind that isn’t working properly.

Kinds of hallucination

One of the most common hallucinations associated with psychosis is hearing voices that no one else can hear.

Although some people hear them only occasionally, others hear them every day, and they can be very distressing. Sometimes the voices are abusive, threatening, or tell the person what to do. People sometimes shout back at their voices, or have conversations with them.

Some people may also experience hallucinations of taste, touch, smell or sight.
“I don’t hear them during the day, but every night when I go to bed they persecute and denigrate me and now I wake up to them as well which is a real pain in the arse.” – Sandy

How hallucinations affect you

Hallucinations, like delusions, seem very real to the person who has them — so it’s no surprise these symptoms can make someone confused and distressed. Some people describe the experience of psychosis as having a dream or a nightmare while you’re awake.

Hallucinations and delusions can reinforce each other — having a taste hallucination, for instance, can convince someone that their food is poisoned, building on a delusion that others want to harm them.

Disordered thinking

Disordered thinking is when everyday thoughts become confused and don’t join up properly. Words and ideas lose their meanings or take on meanings that make no sense. This is usually recognisable to others through changes in your speech, which can include:

• speaking very quickly or slowly
• changing topics frequently
• speaking in muddled-up sentences
• using the wrong words to describe things
• making up words.

Disordered behaviour

Psychosis can disrupt the way a person behaves. They might become easily agitated or act in a childlike way. They might mutter, talk or swear inappropriately, or act in some other socially inappropriate way. They might find it difficult to manage the normal tasks of day-to-day life, like looking after their personal hygiene or home environment.

This behaviour isn’t a choice or laziness, but a real physical symptom of psychosis.

In rare cases, people experiencing psychosis might become catatonic — much less responsive to the world around them. This can include not responding when they’re spoken to or asked to do something, having a rigid or unusual posture or a complete lack of speech or movement.

Causes

Psychosis doesn’t have a simple cause, like a virus or bacteria. The influences and factors that can contribute to an episode of psychosis are complex and not fully understood, but research is advancing fast, and the picture is becoming a little clearer.

How common is psychosis?

The best estimate is that, in any given 12-month period, just under one in every 200 adult Australians will experience a psychotic illness. The figures are slightly higher for men and slightly lower for women.

Psychosis often appears first in late adolescence and early adulthood, when young people are at important stages in their development — getting an education, starting work or exploring relationships. This especially the case for men.

Your chances of having a first episode of psychosis decrease as you age: for every year after you turn 40, your likelihood of experiencing your first episode declines steadily.

Genetics: inheriting a likelihood

Your genes can influence how susceptible you are to psychosis during your life. They don’t cause psychosis or guarantee that you’ll experience it — many people with a genetic susceptibility never have an episode. They just make it more possible.

Some of the genes that influence your susceptibility to psychosis have been identified, but the picture isn’t complete yet.

Like other genetic features, susceptibility to psychosis it can be inherited. If one or both of your parents, your grandparents or siblings has experienced a psychotic illness, your likelihood of experiencing a psychotic illness is raised.

But it’s worth knowing what that really means. Most people with a family history of psychosis will not have an episode themselves. Your chances are raised, but it isn’t inevitable.

Environment: a world of influences

So why do some people with genetically raised chances of psychosis have an episode, while others don’t?

Everything that happens to you from the moment you’re conceived affects the person you will become, including your health.

There are a number of environmental factors that could increase the likelihood of psychosis: your mother’s health during pregnancy, complications with your birth, child abuse, some kinds of head injury and infection, drug abuse, living in urban areas and experiencing high stress and social disadvantage.

Research is continuing on the factors that influence a person’s susceptibility to psychosis. We’re understanding more all the time, but there’s some way to go.

For now, it’s important to know that a complex mix of influences can raise your chances of experiencing psychosis, but no one thing alone causes it.

How a psychotic episode works?

In most cases, psychosis is experienced as an ‘episode’: a period of acute symptoms during which a person will need expert help.

But those intense symptoms don’t usually appear out of nowhere. In fact, there are typically three stages to psychosis: prodrome, acute and recovery.

Stage 1: prodrome

Psychosis frequently begins with general, hard-to-pin-down changes to a person’s thinking and behaviour, like:

• trouble with attention and concentration
• trouble screening out distractions
• irritability, depression, anxiety or suspiciousness
• trouble keeping track of thoughts and conversations
• insomnia
• feeling disconnected from other people, wanting to be alone
• decreased performance at work or school.

These signs are common features of many mental illnesses, and some of them are normal parts of human experience, especially during adolescence when many first episodes of psychosis occur. They don’t necessarily mean a person is developing psychosis, but they can indicate that something might not be right.

During prodrome, which can last for months or longer, signs like these can come and go, but they tend to worsen over time.

These changes are much stronger indicators of psychosis:

• preoccupation with a particular person or subject (particularly religion or spirituality)
• speech or writing that is very fast, muddled, irrational or hard to understand
• talking much less
• loss of concentration, memory and/or attention
• increased sensitivity to light, noise and/or other sensory inputs
• withdrawing from relationships, social life and/or hobbies
• increased anger, aggression or suspiciousness
• decreased or disturbed sleep
• inactivity and/or hyperactivity
• behaving in a way that’s reckless, strange or out of character
• laughing or crying inappropriately, or being unable to laugh or cry
• inattention to personal hygiene
• depression and anxiety
• being unable to feel or express happiness.

Prodrome is the best possible time to seek help — the sooner someone with these symptoms can be assessed, the sooner effective treatment can begin and the better the outlook for recovery.

If you think you or someone you know might be experiencing these changes in their thinking or behaviour now, don’t wait for an episode. See a doctor immediately.

Stage 2: acute

This is the episode itself, when intense symptoms of delusions, hallucinations, disordered thinking and behaviour occur. A person experiencing a psychotic episode cannot make rational decisions about their health and needs to receive professional help as soon as possible.

Stage 3: recovery

With proper, evidence-based treatment, most people experiencing a psychotic episode will begin to recover after a few weeks or months. The recovery is generally gradual, and symptoms from the acute stage can persist for some time.

There are many ways to measure recovery: reduction of symptoms, ability to cope with everyday life, return to school or work. Whatever the measure, people who receive timely treatment for their first episode of psychosis can recover well.

The possibility of relapse

A relapse is when, some time after recovering from an episode of psychosis, symptoms return and the person has another episode.

Relapse rates for psychosis are high: 55-70% of people who have a first episode of psychosis will have a second episode within two years.

There are a few things that are known to reduce your risk of relapse, or lessen its impact if it happens:

• taking medication for as long as your health professionals advise
• staying away from drugs and alcohol
• positive support from carers, family and friends
• learning as much as you can about psychosis and your own early warning signs
• developing a relapse plan (see below) and getting help as soon as you or the people around you notice any symptoms, no matter how minor.

Seeking help

Symptoms you experience during the early stages of psychosis can seem vague or not worth a trip to the doctor, but this is the best possible time to ask for help.

The best place to start in getting a diagnosis, especially early on when symptoms are less severe, is your GP. Your doctor can make an initial assessment, monitor your symptoms over time and, if you need it, refer you to the right kind of health professional — usually a psychiatrist — for specialist treatment.

If your health is deteriorating in the direction of a psychotic episode, getting diagnosed early gives you the best possible chance of minimising its effects and avoiding relapse.

If you have any doubts at all about your mental health or the mental health of someone you care about, see a doctor immediately. If there’s nothing wrong, there’s no harm done. If there is an illness developing, you’re in the best position to treat it.

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.

Conditions associated with psychosis

Psychosis is more often experienced as one part of an illness, rather than as an illness on its own, so when you seek help you may be diagnosed with one of these disorders:

Schizophrenia

If you’ve experienced at least one month of psychotic symptoms, plus at least six months of a suite of other symptoms including low motivation, reduced speech, diminished emotional expression, social withdrawal and more, you might receive a diagnosis of schizophrenia.

Schizophreniform disorder

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

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.

Schizoaffective disorder

This is a less common diagnosis which has symptoms similar to both bipolar disorder and schizophrenia.

These 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. Because of this, it’s sometimes difficult to diagnose schizoaffective disorder accurately.

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. Not everyone who takes drugs develops psychosis, but it’s difficult to know who’s vulnerable and who isn’t.

Postpartum psychosis

In rare cases, women may experience psychosis in the days or weeks following childbirth. For more, see postpartum psychosis.

Brief reactive psychosis

This is usually a short-term reaction to severe stress. It lasts for less than a month.

Borderline personality disorder (BPD)

People living with borderline personality disorder 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 with BPD to experience psychosis.

Major depressive disorder

Psychosis is not a common feature of depression, but may be present in some severe cases.

Organic psychosis

In rare cases, psychosis may result from a brain injury or other neurological disorder.

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.

So it’s very likely that your diagnosis will change over time. That’s normal. 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.

Treatment

The main treatment for psychosis is antipsychotic medication, although there are some new and innovative psychological and neurological therapies emerging too.

Treatment should start as soon as possible, and may continue for as long as two to five years.

Antipsychotic medication

Antipsychotic medications work by altering your brain chemistry to reduce psychotic symptoms such as hallucinations, delusions and disordered thinking, and to prevent them from returning.

Several different options are available, and it’s not unusual to need to change medication. Antipsychotic medications can cause side-effects that will need to be managed — experiences can vary a lot from one person to another.

Other medication you might need to take

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

Psychological therapies are becoming an increasingly useful part of treatment for psychotic illness. Here are some of the most common therapies available.

Cognitive behavioural therapy for psychosis (CBTp)

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.

For example, if you’re hearing voices, it can be your beliefs about those voices that determine how distressing they are and how you react. 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

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.

Supporting and educating families makes it easier for them to cope with their loved one’s illness, helps improve family life and may reduce the person with schizophrenia’s chances of having another psychotic episode or being re-admitted to hospital.

Open dialogue

Open Dialogue emphasises conversation between the person who is unwell and their support network, which might include friends, 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

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.

Other psychological therapies

Given the wide ranging symptoms and impacts of psychotic illness, 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.

Neurostimulation therapies

Electroconvulsive therapy (ECT) can provide short-term improvements for psychosis, especially when it is resistant to medication.

Another, newer therapy is repetitive transcranial magnetic stimulation (rTMS). During rTMS treatments, the patient is exposed to a very specific electromagnetic field for periods of 20-40 minutes at a time. The field can be used to stimulate or reduce activity in brain cells.

rTMS is often used to treat severe depression, but there’s growing evidence that it can help reduce auditory hallucinations in psychosis, including hearing voices.

Finding mental health services

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. Ask your GP.

Early intervention programs for young people

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. Specialist Child and Adolescent Mental Health Services (CAMHS) are also available across Australia — talk to your GP about finding a service near you.

Your public hospital

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 Department of Health can help you identify your local community mental health services, or you can use the National Health Services Directory.

Treatment in a private hospital

With private health insurance, it’s also possible to get treatment in a private hospital. To ensure your money is well spent, research the different types of cover available and the treatment programs offered by hospitals in your area.

Private therapists

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 psychotic illnesses.

Other services

Many community organisations. offer peer mentor programs, outreach through case workers, support groups and recreational programs. Talk to your doctor about options or call the SANE Help Centre on 1800 18 72 63.

Involuntary treatment

In Australia, there are circumstances where you can be legally hospitalised for a mental illness without your consent. You can also be legally compelled to receive treatment — medication and/or therapy — without your consent.

Involuntary treatment is a possibility. Understanding it helps you know your rights if it happens to you or someone you know.

Managing life with psychosis

Living with a complex illness adds a layer of challenges to your life. Those challenges vary from person to person. Luckily, a lot of people have lived with psychotic illness before you, so there’s a huge amount of valuable experience and research to help guide you towards staying well and making your life what you want it to be.

The best ways to get well, stay well and flourish are to get a diagnosis and effective treatment.

Sticking with treatment

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 illness is taking.

While this can be leave you feeling insecure, it’s important that you stick with your treatment, even if you’re frustrated. Nothing helps with schizophrenia more than uninterrupted, long-term treatment.

Also, people who start taking their medication and feel their symptoms reduce sometimes believe they’re well enough to stop treatment. But your illness is still there, and stopping medication too soon can make symptoms return. It’s called the ‘wellness trap’. To avoid it, stick with treatment.

Functional recovery

Psychotic illness can interrupt your work or study life, your relationships and your ability to engage with life in general. If you experience psychosis for the first time when you’re young, it can stop you getting started with those things.

So an important part of managing life with psychosis is help 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 back 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.

Looking after your physical health

Psychotic illnesses can take a toll on your physical health as well as your mental health. Psychosis can sap your energy, confidence and motivation — you either 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 one is still very likely: weight gain.

People being treated for psychotic illnesses are much more likely than the general population to be overweight, have high blood pressure and develop diabetes.

They’re also more likely to smoke, drink too much and use recreational drugs, which can have a negative effect on your mental and physical health.

If you’re struggling with these problems, you may hear your doctor use the term metabolic syndrome. It means you have some combination of:

• weight gain around the abdomen
• high blood pressure
• low levels of the good cholesterol
• high blood glucose levels.

Metabolic syndrome is common in anyone with a sedentary lifestyle and unhealthy diet, but it’s especially common in people with psychosis.

There is support to help you get healthy and stay healthy.

Self-care for family, friends & carers

Seeing someone you care for experience the symptoms of psychosis can be confusing, frightening, hurtful, frustrating and terribly upsetting. The health system can be hard to understand and navigate. Recovery can be slow and uneven. The possibility of relapse can linger.

For all these reasons and more, the people around a person experiencing psychosis — their family, friends, supporters and carers — need their own support.

Caring for yourself

Carers tend to put the needs of the person they’re caring for first. But carers have needs too, and they need to be met, not just because it makes them better carers, but because everyone deserves care.

Physical health

Care, worry and effort can leave anyone physically run down and stressed, so the physical wellbeing of carers is a high priority. The basics of good physical health include:

• Sleep: 7-9 hours of sleep per night during regular hours is hugely beneficial to your health.
• Exercise: you don’t need to run marathons, but anything that raises your heart rate for 20 minutes per day helps. A long walk is a good example.
• Diet: regular, balanced, nutritious meals play a big role in feeding your mind and body.
• Alcohol: keep your alcohol consumption moderate at most, especially if you’re taking medication or might need to drive.
• Smoking and other drugs: the best thing for your health is to quit smoking and avoid illicit drug use altogether.

That’s all easy to say, but knowing those things are helpful doesn’t make them easy to achieve. Be kind to yourself. If you’re struggling to make good health habits happen every day, it’s okay. Good health is no good to you if getting there makes you feel worse.

That’s all easy to say, but knowing those things are helpful doesn’t make them easy to achieve. Be kind to yourself. If you’re struggling to make good health habits happen every day, it’s okay. Good health is no good to you if getting there makes you feel worse.

Your boundaries

One of the most important things to do when supporting someone you care about is to recognise your own boundaries. Decide for yourself how much time and energy you can give, what you’re willing to do and what you’re not willing to do.

It’s okay to say no. In fact, sometimes it’s vital to say no, so that you can continue to provide support in the months and years to come.

Ask yourself:

• How much can I afford to give?
• How am I going to continue looking after myself?

Support for carers

There are many other people out there who share your experience, and many services designed to help carers of people with mental illness. Here are a few places to find support:

• SANE’s carers’ forum, Help Centre 1800 18 72 63
• Mental Health Carers Australia (formerly ARAFMI) 1300 554 660
• Carers Australia 1800 242 636
• Carer Gateway (Commonwealth government)
• NDIS families & carers page 1800 800 110
• Young Carers Network

Caring for someone with psychosis

Research has shown that involving family members in treatment for people with psychosis can help to reduce the likelihood of future episodes.

It helps to learn as much as you can about psychosis. When you’re well informed you have a better handle on what is happening and you can be more confident understanding and making decisions about treatment.

Stories from others caring for people with psychotic illnesses are also a reminder that recovery is possible.

Early on

You may be the first to notice that something isn’t right with your loved one. Because of the way psychosis affects thinking, they may be unaware that they’re unwell or unwilling to seek treatment.

Getting treatment early is one of the best things a person can do for their recovery, but while they are capable of making their own choices only the individual who is unwell can make the decision to seek help.

Be patient and avoid confrontation

As a family member, friend or partner, your role is to offer support in a non-judgmental way. Although you can make suggestions around help seeking, you can’t make a person seek professional support if they’re not ready. You may need to be patient in waiting for the person to take the appropriate steps of their own accord.

Identify services and encourage help-seeking

As with any mental illness, the first stop is usually a doctor. A GP can conduct an initial assessment and refer the person to specialists as appropriate.

Once clinical support is in place, you may also be able to assist your loved one in finding further community support, such as peer support programs or a caseworker.

Sometimes fear of treatment arises from not knowing what is available. The thought of involuntary treatment in the hospital system can be scary, but Australia’s public health system aims to treat people in the community wherever possible. If risk is high or the person would prefer to be treated as an inpatient, then hospital is a possibility.

If you’re both comfortable with the idea and the mental health professional agrees, you can accompany your loved one on their first appointment. You might be able to help explain some of what’s been happening, or just be there as a support during the appointment.

During an episode

Seeing someone you care about experience psychosis can be incredibly distressing. It’s frightening for everyone involved and it can be difficult to know how to respond.

Prioritise safety

Your first concern is for the person’s safety and the safety of the people around them. If you think there’s a risk of physical harm, contact emergency services on 000.

You can also call a crisis assessment or acute care team. The name varies by state, but the service is the same: a small team of mental health professionals will come to you and assess your unwell loved one to decide what urgent treatment they might need.

You can find out more about mental health acute care or crisis assessment teams and the numbers to call to request one at Mindhealthconnect.

Stay calm

Psychosis can be incredibly stressful for both the person experiencing it and those around them. Sharing in your loved one’s distress can cause the situation to escalate more quickly, so try your best to stay calm.

Show compassion

Remember that the person is likely to be feeling scared and confused. Where you can, keep them company and reassure them that they’re not alone. Showing that you care and don’t judge them can mean more than you imagine.

Tips for specific symptoms

Delusions and hallucinations

Your loved one’s delusions and hallucinations are as real for them as what you are seeing and hearing right now is for you. So focus on feelings rather than facts:

• Don’t try to disprove the delusion. Delusional thinking doesn’t respond to reason, so trying to talk them out of it can lead to arguments and distrust.
• The delusion isn’t real, but the underlying emotion is. Validating that emotion (‘I can see you’re really frightened’) can help the person feel less alone.

Disordered thinking

Psychosis can seriously affect a person’s ability to put thoughts and words together, so:

• communicate in clear and simple language
• repeat things if necessary
• be patient and allow the person plenty of time to respond.

Working with the treating team

Once your loved one has taken steps to seek help, it can be helpful to ask for their consent to contact their treating professionals and support workers. Connecting with the treatment team means that you can notify them of any concerns you have and can ask for their advice on how to help your loved one at home.

Ask the treating team when it’s appropriate to contact them and how they would prefer to be contacted.

Having good communication with the treatment team also means you are in a better position to speak up for your loved one if they have concerns about their treatment.

Helping with medication

It’s very common for people with psychotic illnesses to stop taking their medication. There are many reasons why this happens: because the side-effects are bad, because symptoms have reduced, because of distrust in the mental health system, or just the difficulty of remembering to take a tablet each day.

If you suspect your loved one is not taking their medication or sticking with treatment, the first thing to do is talk to them about it. Some reasons can be addressed easily: if they’re just struggling to remember, they could switch to monthly injections. If they’re experiencing side effects, they may be able to reduce the dosage or try a different type of medication.

It’s vital that any changes to medication happen in consultation with the person’s treating health professional. Before considering any change to medication, contact the treating team.

Planning for the future

After an episode of psychosis, it can help to have a conversation with your loved one about how you could manage a similar situation together in the future, and what will happen if they aren’t able to make their own decisions. See the sections of the guide on relapse prevention plans and advance care directives.