If your family member is experiencing psychosis, he or she may be having a difficult time distinguishing reality from internal experience.  Terms often used to describe psychosis include hallucinations, delusions, and confused thinking.

We think of psychosis as being on a continuum. A large proportion of the population will have psychotic-like experiences. For example, people commonly report hearing their cell phone ring even though no call has come through. This is an example of an auditory hallucination but most of the time we are able to just dismiss these experiences. The further up the continuum one goes, the harder it is to dismiss these experiences and the more distressing and captivating these experiences become.

Ultimately psychosis is an umbrella term used to define a number of different symptoms. Under this umbrella are different diagnoses including schizophrenia, schizoaffective disorder, and delusional disorder, but please talk to your doctor or therapist to learn more about this. It can be caused by medical conditions, drugs, sleep deprivation, but is often the sign of a mental illness.

Early signs and symptoms are often subtle and can be difficult to distinguish from typical adolescent behavior, though you may notice gradual changes in your loved ones’ thoughts, behaviors, and overall functioning. While many of these signs may not represent early psychosis, it is important to get an assessment from a doctor if you start to notice any of these changes. Recognizing these signs and responding early can make a big difference.

• A drop in grades, job performance, or other activities
• Uneasiness around others
• A decline in self-care or personal hygiene
• Withdrawing from family and friends
• A noticeable change in mood (apathy, anxiety, sadness)
• Becoming suspicious of others

Knowing the early signs of relapse can be helpful. If you witness some of these changes, it may be a good time to schedule an appointment with your psychiatrist at the INSPIRE clinic:

• The person may feel like they are being watched or spied upon, or feel that information in their environment relates to them in ways that does not make sense
• The person may not make sense when speaking, have difficulty following a conversation or remembering things
• The person may become very convinced of a false belief and not be able to function because of it
• The person may become more withdrawn or have more intense moods (be unusually excited, angry, anxious, or tearful)

• Educate yourself and get involved- families play an integral part on the road to recovery (you might want to start here: NAMI:  Information on Psychosis)
• Help your loved one find a peer support group to allow for connection (take a look at INSPIRE clinic resources guide for local groups)
• Encourage your loved one to consider individual or group psychotherapy through INSPIRE clinic or the community that emphasizes distress management, resiliency, recovery, and coping skills
• Support your loved one in working with your INSPIRE clinic treatment team to find the effective dose of medication with the fewest side effects
• Help your loved one get connected with supported education and employment services so that they can continue to reach their goals

It is common to feel helpless and overwhelmed if a loved one is experiencing psychosis. It is also easy to overlook your own needs and the impact that psychosis is having on you. Therefore, the most important recommendation is to take care of yourself.

We use the analogy of the oxygen mask on an airplane where the safety instructions always recommend that you put on your oxygen mask before helping others to do so. This means that if you aren’t taking care of yourself you can’t take care of others, so it is important to consider what you need to do in order to stay physically and mentally healthy. This may include making sure you have someone to talk to (therapist, support group etc), exercising, spending time with family and friends, and continuing to do hobbies you enjoy. And make sure you do it!

Antipsychotics are the most common medication used to treat psychosis. Most medications within this class are potentially useful at controlling symptoms, which means making distressing symptoms less frequent, intense, or troubling.

We have handouts in the INSPIRE Clinic that explain common side effects and population wide responses, but it important to note that individuals respond differently to medications. It is therefore important to work closely with your INSPIRE Clinic providers to find the right medication at the lowest effective dose.

Taking a comprehensive and integrative approach to treatment is something that the INSPIRE Clinic strives for. In addition to medication management, this includes cognitive behavioral therapy, social work support, vocational/educational supports, and clinical trials. All of the treatment that INSPIRE Clinic provides is supported by research, so we are confident that it can be helpful.

At this time, there are more suggested treatments than there is data to back it up, but we are always open and encouraging of families to bring in information on alternative approaches, and we can discuss them critically together.

Yes! Psychosis often comes in episodes of heightened symptoms that can last a few days to months. In between these episodes, symptoms can be very manageable. Many people achieve recovery through a combination of effective illness self-management and treatment and go on to live the life they want!

If you have concerns about your loved one…

• Reflect what you see: Example: “We’ve noticed that you’ve spent the past couple of weeks in your room and when we have seen you you’ve looked really sad and scared”
• Open up about your concerns: Example: I’m worried that you’re not feeling well and that this is getting in the way of you enjoying your summer
• Ask questions: Example: “Am I right that you have been feeling sad lately? Is there anything I can do to help you feel better? What do you think about making an appointment to see the doctor?” Tip: After you speak, give the person plenty of time to digest the information and respond.
• Respond:  Example: Agreeing to leave him or her alone for 24 hours but checking in again after that time.
   

If your loved one is experiencing hallucinations or delusions…..

• Listen to what they're saying. Look for elements of reality. Ask yourself what they are feeling, or how you would feel in the situation.
• Ask clarifying questions only. Comment about the feeling, without stating any judgments about the content.
• Begin to identify "common ground"- reality you can agree on, or a way of addressing the feelings the person is having.  Agreeing to disagree is okay!
• Remember that they may perceive this as reality. Directly confronting delusions usually causes people to become defensive and less prepared to consider alternatives.
   

If your loved one becomes aggressive….

Individuals with psychosis are more often withdrawn and historically are more likely to be victims of violence than perpetrators, however, aggression can occur and you should know what to do if it does

• Develop a plan with your treatment team early on
• Keep the environment as low-key as possible and to speak to the person with a kind, matter-of-fact voice.
• Give clear direction such as “stop please”
• If he or she does not stop, leave the room or house quickly and give them space until he or she has calmed down
• Take threats seriously and get help early on by calling other family, friends, or emergency personnel
• If you feel that your loved one is in imminent danger of harming themselves or someone else you should call 911. Ask for a crisis intervention trained officer and clearly state what you are observing and your concerns. If appropriate also clearly state that your loved one does not have access to weapons.
  
  

If your loved one is inactive or appears unmotivated…

• Offer or suggest a simple activity (going for a walk, gardening, listen to music), don’t insist that they do to much
• Try to have a daily routine so that things are predictable and try not to give too many instructions at one time
• Try to make allowances for him or her is they may need to do things like eating at unusual times (leaving healthy snacks in the fridge)
• Offer praise for the effort and process, not necessarily the outcome of activities
• Find out about medication side effects as they can interfere with motivation
   

If your loved one is having problems with thinking, concentration, or memory:

• Keep instructions simple and short. Instructions may need to be repeated. Be patient.
• Put things in writing whenever possible.
• Memory aids can be useful, including calendars, diaries, pill containers, watches that beep, sticky notes with reminders
• Give praise for actions that are initiated and followed-through
• Offer guiding questions such as,"What's the first step?"; or "How would you begin?"
   

Resources

Early Psychosis Intervention's Coping Booklet

How Should I behave around the Person who is Ill? from Yale School of Medicine

Tips for Communication and Family Living from the Early Assessment & Support Alliance