Which kinds of health care professionals offer treatment for psychosis in Singapore?

Doctor's Answer

When someone enters a state of mind that does not connect with reality, he may develop psychosis. Two core features of psychosis are hallucinations and delusions.

Hallucinations occur when the senses perceive something that is not real and can come in many forms, including

  • auditory (hearing voices that are not there),
  • visual (seeing things that are not there), and
  • tactile (pertaining to touch) hallucinations.

Delusions, on the other hand, are false beliefs.

Psychosis can be a symptom of other conditions

Some conditions, medical and psychological, that list psychosis as a primary symptom include:

  • schizophrenia,
  • epilepsy,
  • bipolar disorder,
  • psychotic depression,
  • postpartum psychosis and
  • drug-induced psychosis.

Treatment for psychosis

Recent advances in therapies mean that psychosis is now more treatable than ever before.

Treatment usually involves medicine, education about the illness, counselling, family support and practical support. Avoiding drugs, reducing stress and learning ways to cope with challenging situations can help prevent a relapse of psychosis. With the right support and treatment, it is possible to manage the symptoms and/or make a recovery. In many cases, the symptoms may not vanish entirely and a person may still experience residual symptoms from time to time.

Psychosis is usually diagnosed as part of another mental illness, like schizophrenia, schizoaffective disorder or bipolar affective disorder. Over time, the diagnosis might change or stay the same. Treatments for psychosis include antipsychotic medication, specialist psychological therapies and community support programs to help with social connection, physical health, accommodation and work or school. Treatment for psychotic illness can last 2–5 years, or even longer. During that time, the treatment regimen may change to improve the results and reduce side-effects.

Treatment may require a team of mental health professionals including a psychiatrist, mental health nurses, occupational therapists or psychologists.

Early intervention

Research has suggested the best outcomes for treatment occur when psychosis is detected and treated early, before the illness has a chance to develop.

Medicine

A person with psychosis may be prescribed antipsychotic medicines. Treatments work by altering chemicals in the brain, including dopamine. Antipsychotics usually take several weeks to reduce symptoms, such as hallucinations or paranoia. But they may immediately produce a calming effect and help with sleep. Antipsychotic medicines may cause side effects, so it is important to find the right medicine for each person. Some people may also be offered other drugs (for example, antidepressants or mood stabilisers) if there are mood-based symptoms, as well as additional medication to help reduce the side effects caused by the antipsychotics.

Psychologist and counsellors can help an individual understand his experiences and develop coping strategies to deal with them. He may be offered 'cognitive behavioural therapy for psychosis' (sometimes called CBTp). This is a type of cognitive behavioural therapy (CBT) specifically for people experiencing psychosis. Other forms of psychological therapy include supportive psychotherapy, family therapy and self-help groups.

Community support programs

Mental health services can also provide practical support for people with psychosis. Stable accommodation, financial security, social support and having a meaningful role in society are essential components of recovery. People suffering from long-term psychosis may require rehabilitation and assistance to find suitable work. Social workers, occupational therapist, physiotherapists, community psychiatric nurses are all important members of the team.

People with schizophrenia do best if they have:

  • medication and psychological treatment together – not just one or the other
  • medications to manage depression or anxiety, if needed
  • education about their illness (individual psychoeducation)
  • a supportive partner, family member or friends involved in their care
  • access to 24-hour crisis support
  • a mental health professional who takes care of planning and coordinating their individual care (case management)
  • support to find and keep a job or continue education
  • somewhere safe and affordable to live
  • support to maintain a healthy lifestyle

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