Young asian girl worried sitting on couch

Psychosis

May 15, 2023

Lucy Robinson

About the Author: Lucy is a low-intensity cognitive behavioural practitioner who treats and assesses adults who experience common mental health difficulties within the NHS.

What is psychosis?
Causes of psychosis in children and young adults.
Symptoms of psychosis.
Treating psychosis
What types of professionals are involved?
The journey of treating psychosis
How to support someone with psychosis
How can I support my child with psychosis?
Useful resources

What is Psychosis?

‍Psychosis is when a person becomes disconnected from reality. This may result in them experiencing sensory input that is not there. For example, seeing things and/or hearing voices as well as thinking and believing things that do not appear to be logical. It can be incredibly scary and cause a lot of distress for the person experiencing these symptoms as well as the people around them.

Psychosis can be a symptom of schizophrenia or bipolar disorder but someone can also experience a psychotic episode on its own.

The prevalence of psychosis within young people is different in different reports. It has been generally accepted, though, that psychosis will first occur in the ages of 16-30 with it being rare that a child has a psychotic episode before the age of 15.

However, the prevalence of psychotic symptoms in young people is more common with 17% of young people reporting psychotic symptoms.

Causes of Psychosis in children and young adults

While the exact cause of psychosis is unknown, some factors have been found to contribute to psychosis as outlined below.

Health Conditions

As mentioned above psychosis can be a symptom that is caused by a psychotic disorder. This can include schizophrenia and bipolar but other ones are schizotypal (personality) disorder and delusional disorder. Depression can also cause psychosis.

There are also health conditions that can trigger psychosis. These include Addison’s disease and meningitis as well as deficiencies in vitamin B1 and B12.

Genetics

Having a family member such as a sibling and/or parent diagnosed with psychosis increases your likelihood of developing it. Researchers are currently uncertain as to why this is but it seems that a combination of genes may be responsible for making people more vulnerable to psychosis. It appears to be one of many factors that can cause psychosis.

Brain abnormalities

There are some differences in the structure of the brains of people who experience psychosis but this is not seen within everyone. Targeting neurotransmitters in the brain, though, such as dopamine with medication has been found to alleviate symptoms. This suggests a role of these transmitters within psychosis.

Triggers

There are also environmental factors that increase the likelihood of psychosis symptoms such as:

Substance abuse (specifically cannabis usage) and withdrawal
Medicine usage (rare)
Physical, emotional or sexual abuse
Stressful life events (e.g. money, work pressure)
Obstetric complications
Maternal malnutrition

Symptoms of Psychosis

There are two types of symptoms that psychosis can be divided into. The first type is positive symptoms and the second is negative symptoms.

Positive Symptoms

Delusions- false beliefs not grounded in reality
Hallucinations- seeing or hearing things that are not there
Abnormal cognitive behaviour- communication is impacted negatively, such as answers to questions that may seem unrelated
Abnormal motor behaviour- such as excessive movement and/or abnormal posture and resistance to instructions

Negative Symptoms

Reduced motivation
Social withdrawal
Reduced self-care
Lack of emotions
Loss of ability to experience pleasure
Thoughts of self-harm and suicide

“Sarah is 17 years old. Her parents have recently divorced which has caused a lot of stress for Sarah and she has been using cannabis to cope. Sarah has started to hear voices as well as believing that her neighbours are spies who are trying to physically harm her and her sister. She has withdrawn from social activities as a result and is spending her time watching her neighbours instead of playing football which she says she no longer enjoys. Sarah’s parents have begun to become concerned about Sarah’s fixation on her neighbours as well as the fact that she is reporting hearing people’s voices in the house. Sarah’s parents believe it might be helpful for Sarah to speak to a mental health expert.”

Treating Psychosis

The treatment and management of psychosis involves a comprehensive treatment plan that aims to help people achieve goals for their recovery. The doctor or psychiatrist will take the time to come up with a plan that is right for each person but this will depend on whether this is the first episode of psychosis or not.

The first episode of psychosis

Anti-psychotic medication with family therapy and individual CBT.

Subsequent episodes

Anti-psychotic medication with family therapy and individual CBT and/or art therapy.

Medication is usually the first treatment that is given for psychosis, alongside psychological intervention. In the first episode of psychosis, the family may choose not to use medication and just have the psychological intervention though, the interventions are more successful when medication is taken alongside.

When choosing medication parents/carers and the young person need to discuss the benefits and possible side effects of each drug with a professional, so that they can come to an informed decision.

Cognitive behavioural therapy (CBT) is a type of talk therapy that focuses on how we think and act and how this affects how we feel. Research shows that CBT is effective in helping people with psychosis.

The idea behind CBT for psychosis is to help the young person monitor and manage the thoughts, actions and feelings that might make the depressive symptoms worse.

During the sessions, the young person will learn about psychosis and how it works. The young person will learn to make changes to the way they think about certain situations, as well as learn to problem-solve.

Eventually, the young person will develop their personal toolbox for coping with psychosis in a healthier way.

Family therapy is a type of therapy that focuses on the family as a whole, as a way to support the young person in coping with psychosis. This can help reduce symptoms of psychosis.

The family will learn how to resolve conflict and improve communication and emotional bonds. By working together, they will learn to take helpful actions that will help to support the young person when they are having difficulties.

Eventually, the family will build a strong support network that will be responsible for spotting warning signs and encouraging the person to get the most out of their treatment.

Art therapy

‍Art therapy is a type of therapy that uses creativity to help the person with psychosis express their emotions such as fear and confusion. This can be especially helpful for the person who finds it difficult to voice how they feel. Research suggests that art therapy is enjoyed by people with psychosis and builds their confidence in themselves and hope.

Art therapy might involve different forms of art such as painting, sculpting, and the use of music.

A crisis plan is also important to have as sometimes people with psychosis can feel like they are not able to cope and can have thoughts about self-harm or suicide. The doctor, psychiatrist or mental health expert might propose certain actions that can be taken in these situations. This might include encouraging the person to contact crisis services. A list of these can be accessed on the NHS website. Crisis teams are made up of mental health professionals who are there to offer urgent help on a 24-hour basis.

What types of professionals are involved?

‍There are different professionals that may or may not be involved throughout the treatment process of psychosis in young people. These might include family therapists and doctors/psychiatrists, mental health nurses, support workers and social workers. These terms might be confusing, but the main difference is in the training that each of these professionals has received.

Cognitive Behavioural Therapists

These are therapists who have been trained in Cognitive Behavioural Therapy using this model to form an idea of a patient’s mental health difficulties and to treat them. When working with psychosis the therapists would have been trained in how to help the child/young person manage their symptoms to improve wellbeing.

Doctors

These are professionals who are trained in medicine. This will likely be the family GP, who might find it necessary to prescribe certain medications that might help the person cope.

Psychiatrist‍

These are professionals who are also trained in medicine. However, they also specialised in the field of psychiatry. Psychiatrists will prescribe certain medications that will help with the episode of psychosis.

Mental health nurses‍

Nurses trained in mental health might also be involved. If the young person is in a hospital setting or is seen by a crisis team due to self-harm or suicide, a mental health nurse might help to give treatment by administering medication.

Support workers

Workers trained in helping vulnerable people to live better lives might also be involved with the young person. This might be within a community setting or a crisis. Their role is to provide emotional and practical support (e.g. helping parents to cope, helping with paperwork, and making child-care arrangements).

Social workers

Workers trained in protecting vulnerable individuals might also be involved. This might be within a community or a crisis. Social workers will problem-solve and organise the right support for the young person to ensure their protection.

The journey of treating Psychosis

Assessment

This is an important phase, where the therapist will first assess the young person. They will ask many questions, including certain questions about the symptoms of psychosis and the possibility of self-harm or suicide. This will help to create a full picture of what is going on and to know what type of treatment will be most helpful. From there, the therapist might decide on a treatment plan that includes medication, psychological therapy and a crisis plan for the person.

Therapy sessions

These sessions will take place on a more long-term basis. An important aspect of the therapy session is the relationship the therapist will build with the young person and the family. This will create a safe space to encourage them to explore their difficulties. The sessions will equip the young person and the family to understand and manage the psychosis.

Homework

This can be an important part of treatment. The therapist might get the young person and family members to practice certain tasks at home. Homework tasks will help the young person and the family to develop a sense of achievement and mastery in coping with psychosis.

Crisis

The psychiatrist or therapist may have made agreements with the person on what to do if they experience sudden desires to self-harm or commit suicide, due to intense depressive episodes. For this reason, it may happen that other mental health staff will need to see them at their home or at the hospital to provide support.

Progress and setbacks

When having treatment for psychosis, there will be progress and setbacks. Even with successful therapy, the person might still experience some extremes in their mood. It is important not to feel discouraged when this happens, as this is normal when dealing with psychosis.

These situations provide opportunities to discover new ways to move forward together with the mental health experts involved in the treatment.

Ending therapy

This will eventually prepare the young person and the family for the end of therapy. The end of therapy will take place once the young person and the family have made a lot of progress and have reached their treatment goals. The young person and the family will leave therapy with many skills that they can use without the help of the therapist.

Follow up

The therapist might schedule follow-up meetings to check how the young person copes. If they are doing well, there will be no need for more support. But if they continue to have challenges, this will be an opportunity to have extra support.

How to support someone with Psychosis

It can be challenging when you have a loved one who has been diagnosed with psychosis. It can be scary and confusing for everyone involved. Fortunately, there are some things that you can do to help. These are discussed below.

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Understand psychosis

It is a good idea to read as much information about psychosis as you can. Understanding this disorder and how it works will help you to recognise the signs that your loved one needs help and how to help manage their symptoms.

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Help them to feel supported

A loved one with psychosis can feel isolated sometimes because they can feel disconnected from reality and suspicious of others intentions. Your attitude towards them can make a big difference in how they respond to you.

Show acceptance: They might be struggling with very negative thoughts or they might feel embarrassed. For this reason, it is important to show acceptance and remind them that they are loved and valued no matter what.

Be feelings driven: A difficult aspect of psychosis is that they may strongly believe in theories that you do not such as that there are voices in the house. It is more helpful to work with their feelings comparing to validating or denying these beliefs. For example, asking questions such as how do you feel about hearing these voices or how can we help your feeling of fear?

Be patient and calm: People with psychosis can be very scared and therefore might be irritable and even aggressive. Do not feel discouraged if this happens and try to focus on where this is stemming from, thinking about how you would act if you are feeling scared or anxious. If you can manage the underlying feeling the person is experiencing the other behaviours may reduce.

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Help them to find the right support

Encourage them to find support through a GP, psychiatrist or therapist. If this involves your child who is under the age of consent, you can contact these services. You might:

Help them to book an appointment with a GP, psychiatrist or therapist
Offer support when they attend appointments (e.g. waiting in the waiting room or attending some sessions if you need to)
Help them search for support groups or self-help resources
Encourage them to keep attending sessions and to not give up
Learn about their medication
Give them reminders to take their medication

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Know when to get urgent support

When your loved one is experiencing a psychotic episode, it is good to keep an eye out for signs of self-harm or suicide. If you suspect that your loved one is at risk of hurting themselves, you should get immediate support. You should contact a GP or the NHS urgent helpline. If you are concerned that your loved one is at immediate risk always call 999.

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Plan support in advance

Have a conversation with your loved one and plan out what you and others can do during the episode. You might want to consider the following:

Make sure you have a list of emergency contact services
Taking hold of bank cards, vehicles or any other important assets
Be ready to prepare meals that are easy to eat, especially when they are unwell
Think about helping them with their usual tasks that they won’t be able to get done
Talk with your loved one and their healthcare provider on what to do if they refuse to take their medication

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Help them to reduce stress

Reducing sources of stress will always be helpful for anyone experiencing mental health difficulties. For example, you might:

Try to keep a positive atmosphere at home
Encourage them to do activities that relieve stress and/or that they find to be helpful (e.g. light exercise, deep breathing)
Keep the environment quiet with few stimulations

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Look after yourself too

You need to look after yourself. Whether you are a parent, family member or a friend, you will be in a better position to give help, as long as you are taking care of your own well-being too. To do this you might:

Get other family members involved in supporting your loved one
Schedule some time off for yourself
See a professional that can support your mental health

How can I support my child with psychosis?

To support your child with psychosis, it’s vital to seek advice from a medical professional to ensure the right diagnosis and treatment.

The following is a list of things parents/guardians can consider to do on their behalf in supporting your child:

Having patience
Stay on board with the treatment plan and medication schedule – inform others around them e.g. teachers and school nurse about medication needed to be taken at school
Communicate with teachers about your child’s psychosis so they can adjust on their side to support the child during difficult times, e.g. less homework/extra breaks
Reassure your child that treatment takes time and eventually will make life better
Family therapy – communicate and educate all members of the family on how to deal with any such disruptive situations that may appear due to having a child with psychosis
Monitor side effects of medication – follow up with health care provider if any unusual side effects appear and negatively affect symptoms

If you see no improvement in your child and/or are concerned about your child, it is always best to seek professional help or visit the GP.

Useful Resources

Royal College of Psychiatrists

To read information about helping a young person with psychosis on the Royal College of Psychiatrists.

MIND

To read information about helping someone with psychosis on the MIND website.

For urgent support

To get urgent help, you or your loved one should contact the NHS urgent helpline or the Samaritans.