From the Guidelines
An episode of psychosis is a complex condition that requires a comprehensive treatment plan, including antipsychotic medication and psychosocial interventions, to reduce morbidity, mortality, and improve quality of life, as recommended by the American Psychiatric Association 1.
Definition and Causes
An episode of psychosis refers to a temporary mental state where a person loses touch with reality, experiencing symptoms such as hallucinations, delusions, disorganized thinking, and abnormal behavior. Psychotic episodes can occur in various conditions, including schizophrenia, bipolar disorder, severe depression, substance-induced psychosis, or brief psychotic disorder.
Treatment Approach
The treatment approach for an episode of psychosis typically involves antipsychotic medications, such as those recommended by the APA 1, including:
- Antipsychotic medication, with monitoring for effectiveness and side effects
- Clozapine for treatment-resistant schizophrenia or substantial risk of suicide attempts or aggressive behavior
- Long-acting injectable antipsychotic medication for patients with a history of poor or uncertain adherence
Psychosocial Interventions
In addition to pharmacotherapy, psychosocial interventions play a crucial role in managing an episode of psychosis, including:
- Coordinated specialty care programs for first-episode psychosis
- Cognitive-behavioral therapy for psychosis (CBTp)
- Psychoeducation
- Supported employment services
- Assertive community treatment for patients with a history of poor engagement with services
Importance of Early Intervention
Early intervention is crucial for better outcomes, as prolonged untreated psychosis can lead to more difficult recovery 1. Identifying the specific cause of psychosis, such as neurotransmitter imbalances, genetic factors, stress, trauma, or substance use, helps determine the most appropriate treatment approach. Hospitalization may be necessary if there's a risk of harm to self or others.
From the Research
Episode of Psychosis
- The episode of psychosis being referred to is likely the first episode, as it is a critical period for intervention and treatment 2.
- During this period, patients may experience significant functional impairment, which can impact their future prognosis and treatment outcomes 2.
- The first episode of psychosis is often characterized by key diagnostic issues, and clinicians must select the most effective treatment option to contain the illness 2.
Treatment Options
- Treatment options for psychosis include the use of first-generation or second-generation antipsychotic medication 2.
- Both medication types are associated with certain side effects, such as tardive dyskinesia and weight gain, respectively 2.
- The choice of treatment may depend on the patient's specific needs and circumstances, such as the presence of comorbidities like substance abuse 2.
Acute Psychotic Agitation
- Acute psychotic agitation is a medical emergency that requires urgent assessment and management 3.
- Treatment options for acute psychotic agitation include oral or intramuscular administration of antipsychotic medication, such as risperidone or haloperidol, often in combination with a benzodiazepine like lorazepam 4.
- The goal of treatment is to rapidly control agitation and psychosis, while minimizing the risk of adverse effects 4.
Comparison of Antipsychotic Medications
- Studies have compared the efficacy and safety of different antipsychotic medications, including olanzapine, quetiapine, and risperidone, in the treatment of early psychosis 5.
- These medications have been shown to be effective in reducing symptoms of psychosis, although they may have different side effect profiles 5.
- The choice of medication may depend on the patient's individual needs and circumstances, as well as the specific characteristics of the medication [(6,5)].