Four years ago, I experienced a severe psychosis as part of a manic episode of my bipolar disorder. I was agitated, talking very fast, unable to sit still and had racing thoughts and delusions. I believed I was in danger from other people. I was then admitted through accident and emergency at the hospital; the psychosis and mania had become so bad, I could not be treated at home.
I wanted to explore the options available and give some advice to those with a loved one who is going through psychosis.
The NHS describes psychosis as, ‘a mental health problem that causes people to perceive or interpret things differently from those around them, which may include hallucinations and/or delusions about the world.’ The hallucinations could be when a person sees, hears, or tastes things that are not there. For example, they can hear voices, which feel very real to the person experiencing them. Delusions are beliefs not held by others; a conspiracy to harm the person is a common delusion.
So what can you do?
1. Remain calm: don’t panic When your loved one is in a state of psychosis, it can be very frightening. They may say or do things which are alarming. If they have an illness such as a schizophrenia or bipolar disorder, the environment around them can feel heightened, so make sure you aren’t expressing negative emotions or body language, and don’t get angry with them. This is especially important if they are in a manic episode or having hallucinations, because they may also become, in rare circumstances, irritable and/or aggressive. You should ask a loved one what you can do to keep them safe and whether they feel safe at home or want to go into hospital. My parents asked me this but in psychosis, because you don’t have insight, you may not be aware you are going to be hospitalised. It’s a fine line as being admitted via A&E is scary for the person with psychosis – I had to be given medication to calm me. So remember to be as calm as possible and not to be frightened by the person’s experiences. As Dr Jason Taylor, psychiatrist at the Priory Hospital Chelmsford, advises the following: ‘Listen to them calmly and try to understand what they are experiencing. ‘It may be best not to challenge bizarre or odd beliefs, as this might impede their trust in you. ‘Relatively few people with psychosis are aggressive, but can be if they are agitated, say from hearing voices. ‘It’s important to check if they are wanting to harm themselves too and to keep any implements away. ‘It is helpful to understand if they have taken any drugs that may have caused the psychosis. ‘It is also helpful to talk about the nature of their experiences without challenging them.’ It is important to get medical help as quickly as possible if someone is also expressing suicidal thoughts.
2. Seek medical help
Psychosis can sometimes be induced by drugs such as skunk cannabis or from a long-term mental health illness. It’s important if the person is under a psychiatry team to contact their team and to find the number of the local Crisis team, who will come out to you in an emergency. In an emergency, if out of hours, an ambulance may have to be called or the person may need to attend A&E. This is not ideal but could be the only option. Dr Taylor says: ‘Advise them to seek professional help through contacting their GP, local MIND or local mental health services; some will accept self-referral to a crisis team. ‘In emergencies, going to A&E is an option if the friend or loved one is willing. ‘You may also want to consider requesting a Mental Health Act assessment at home should the situation warrant this’. Once they have recovered, don’t be overbearing. Between episodes, support the person to go to medical appointments, know the person’s warning signs and work with their therapist, but only if your loved one wants you to be involved. If they do, create a safety plan when they are well to help minimise another serious episode and ask the person what they want in it. For example, they may want you as next of kin to act on their behalf or they may want a partner to phone their doctor.
Dr Taylor adds: ‘Be aware of the importance of encouraging them to take medication regularly and lead a healthy lifestyle. ‘Also support them if they need this. For example, accompany them to meetings with any allocated mental health professional to discuss any concerns, say, around symptoms, and medication side effects.
3. But what if it’s a drug-induced psychosis?
Dr Taylor says: ‘Increasingly this is a problem with stronger forms of cannabis such as skunk and synthetic cannabinoids such as spice. ‘Cocaine and amphetamines, as well as hallucinogens such as LSD, can also cause psychosis. ‘Some drug-induced psychoses will settle over 48 hours if the person avoids using again. ‘If the person is distressed by psychotic symptoms, such as paranoia, or is presenting risks, then seek professional help. Antipsychotic medication is usually helpful in relieving symptoms.’
When someone you love goes through psychosis, it can be terrifying but there are a range of options to help. If they are under a psychiatry or crisis team already, it’s important to inform them about the episode. If it is the first time they have had a mental health issue, they may need to see an early intervention team or, in an emergency, A&E will assist.
When you are admitted to hospital with psychosis, as I was, loved ones play a key part. You may feel angry or heightened with your family if you don’t have insight and if you are sectioned under the Mental Health Act, as next of kin, often families have to be informed and agree to this.
I found that once I got better, I was so grateful for family support in hospital. They advocated for me, visited every day, took me out for a few hours at a time allowed by my doctor, listened to my fears, my anger, my upset. They brought me food, teddies and colouring books. They worked with my doctor to ensure I got the correct treatment and followed the advice of my medical team. Remember that this isn’t your loved one’s fault and, with treatment, they can recover.
For more information, see: Gov.uk, Mind and Rethink.
Read more: http://metro.co.uk/2018/03/20/how-to-support-a-friend-or-family-member-through-psychosis-7380925/?ito=cbshare
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