Treatment for Psychosis Post Emotional Trauma
For psychosis following emotional trauma, a comprehensive approach including psychological first aid, antipsychotic medication, and trauma-focused therapy is recommended, with atypical antipsychotics as first-line pharmacological treatment due to better tolerability.
Initial Assessment and Management
- Perform a thorough assessment to rule out secondary causes of psychosis before initiating psychiatric treatment 1, 2
- Evaluate for risk of self-harm or aggression to determine appropriate treatment setting 2
- Assess level of community support and the family's ability to manage the crisis 2
- Treatment should be provided in outpatient services or home settings when possible and safe 1, 2
- Consider inpatient care when there are significant safety concerns or when the degree of crisis is too great for the family to manage 1, 2
Psychological First Aid (PFA)
- PFA should be implemented as an initial early intervention following traumatic exposure 1
- PFA shows positive effects for reducing anxiety and facilitating adaptive functioning in the immediate and intermediate term 1
- Key components of effective PFA include:
Pharmacological Management
- Atypical antipsychotics are preferred as first-line treatment due to better tolerability and improved adherence 2, 3
- Recommended initial target doses include:
- Implement treatment for 4-6 weeks using adequate dosages before determining efficacy 2
- Avoid excessive initial dosing as it leads to unnecessary side effects without hastening recovery 1, 2
- Monitor closely for extrapyramidal side effects, which should be avoided to encourage future medication adherence 1, 2
- Short-term use of benzodiazepines as adjuncts to antipsychotics may help stabilize the acute clinical situation 2
Trauma-Focused Psychological Interventions
- Trauma-focused treatments have shown promising effects for reducing positive psychotic symptoms 4
- Cognitive Recovery Intervention (CRI) has demonstrated effectiveness in reducing trauma symptoms following a first episode of psychosis, especially for those with high pre-treatment levels of trauma 5
- Trauma-focused psychological interventions appear safe to use in people with psychosis and are effective in reducing post-traumatic stress symptoms 6
- Integrative approaches that address both post-traumatic stress symptoms and trauma-related psychosis include:
Family Involvement and Support
- Include families in the assessment process and treatment planning 1, 2
- Provide emotional support and practical advice to families who are usually in crisis at the point of treatment initiation 1
- Develop supportive crisis plans to facilitate recovery and treatment acceptance 1
- Progressively inform and educate families about the nature of the problem, treatments, and expected outcomes 2
Follow-up Care and Relapse Prevention
- Ensure continuity of care with treating clinicians remaining constant for at least the first 18 months of treatment 2, 3
- Maintain antipsychotic medication during the recuperative phase (4-12 weeks after acute phase control) as additional improvement may occur over 6-12 months 2
- Consider gradual dose reduction to decrease side effects, especially if high doses were needed for acute control 2
- Thoroughly discuss early warning signs of relapse with both patient and family to enable prompt intervention 3
Common Pitfalls to Avoid
- Don't delay treatment until a crisis develops, such as self-harm, violence, or aggression 1
- Avoid switching medications too early (before 4-6 weeks) or too late (continuing ineffective treatment) 2
- Don't neglect monitoring for side effects, which are a common reason for medication non-compliance 2
- Avoid abrupt discontinuation of antipsychotics after acute symptom resolution, as maintenance therapy prevents relapse 2
- Be aware that experiences of both psychotic symptoms and psychiatric treatment can be traumatic and may become barriers to engaging in mental health services 8