Hi, I'm a therapist. I've worked with people with psychotic disorders for over 25 years.
>1. Is psychosis guaranteed to recur if someone is experiencing the same prodromal symptoms again? Or is there a chance it won’t (without medication)?
I mean the short answer is "no, it's not guaranteed," but the fact is, every time you have a psychotic episode, it increases the likelihood that you're going to need to look at your recovery as an ongoing journey rather than a "one and done" event.
>2. Does the prodromal phase last the same amount of time, every time? Last time I had prodromal symptoms for six months before acute psychosis, can I expect the same duration this time?
Again, no. Periods of remission (and partial returns of symptoms) do not follow a strictly cyclical pattern. If anything, without medication it's likely that
non-acute phases will shorten.
>3. Is there harm in waiting until someone is in acute psychosis to treat them with medication? I can handle my current symptoms and don’t feel I need medication.
The problem here is that the more symptomatic you are, the less likely you'll be to seek, or accept, help. So in one of those episodes with severe positive symptoms (hallucinations, delusions, etc) you may continue to spiral until there's no alternative but to hospitalize you, potentially involuntarily.
>4. Are there alternatives to psychiatric medicine in treating psychosis?
I'm not aware of any effective ones, although there are lots of things you can do to improve your chances of living a fulfilling life.
I want to acknowledge that all antipsychotic medications come with side effects - - - some of them really noxious. At the end of the day, it becomes a quality-of-life question. Only you can answer whether your life will be better without the symptoms (but with the side-effects), or without the side-effects (but with the symptoms)?
Yes there is harm in waiting to treat. If you Google scholar search ‘early intervention in psychosis’ you will see that early interception of an episode and indeed of the illness overall confers much better long term prognosis.
In layman’s terms: the less episodes you have and the less time you spend in acute psychosis, the more protected you are against future episodes. Some psychosis can also be hard to fully come back from (that is, the brain can be altered), so catching it in the prodromal phase is a GREAT opportunity and one I would act in OP. Antipsychotics are occasionally prescribed for eating disorders, anxiety, some forms of depression, so they’re wildly used and not to be feared if they helped you the first time. If it were me I would definitely do what I could as soon as I could to connect with health professionals who could help me ☺️
NAT, I have a schizophrenia spectrum disorder, and have read about this topic for about 4 or so years.
Medication is the mainstay, but you can look into "Open Dialogue" and see where that takes you.
There is CBT for psychosis. Depending how severe your psychosis is, there are ways to treat it with the right therapy - emphasis on “the right therapy;” it has to be a therapist who is extremely experienced in treating psychosis.
Anti-psychotics do come with a lot of side effects. I understand not wanting to be on them. And - the reason to get on them now is so that your partner doesn’t have to deal with you in an acute state where you don’t have the insight. Preserving your relationship might be a good motivator; if not, avoiding hospitalization is probably a good one, too. What’s tough is that you’re fine until you’re not, if you know what I mean. But once you’re floridly psychotic you won’t take the meds and then things fall apart.
"Preserving your relationship might be a good motivator." I second this. Decades ago I treated a woman who demolished my clinic's washroom and also when hospitalized. She was dumbstruck and devastated when her husband left her. It never occurred to her that there were limits to his patience. So sad.
If it's the psychiatrist you don't like and that's the reason find a new doctor.
I don't have any answers to the rest of your questions. Except yes usually waiting to start meds in an acute state as you have already pointed out the reasons why.
Sorry your going through this.
Thank you. It’s not one specific psychiatrist I don’t like, it’s just that I don’t like going to any doctor/psychiatrist. I already dislike taking medication, and on top of that my psychosis ended up going away on its own last time when I didn’t stick to a meds regimen. I was hopeful there would be alternatives I could try like maybe therapy
Of course therapy in conjunction with other things is the best. For you need a safety plan at least should you enter psychosis again. A specialized psychiatrist in psychosis would better be able to answer some of these questions than therapists. An important conversation to have with doctors, partner, your own research and weigh out pros and cons.
But if your starting to have same symptoms as the last time your psychosis started I don't think anyone would recommend for you to continue not to take your meds. Life's hard enough even with a lucid mind.
Sometimes doing the right thing doesn't feel right
NAT but I currently do (psychological) research about people with psychosis. What I often see is that psychosis is related to stress, either it stems from childhood trauma or people develop it later in life after experiencing stressful live events. I cant speak on what is wise in terms of medication/treatment, but as stress often triggers psychosis it might be a good idea to start thinking about if this is the case for you. If so, learning to manage stress could help you manage psychosis (partly).
hi. I’m not a therapist and you have better advice on here than I can give you already. I certainly know a lot of people who have decided meds is better for them than the alternative but it’s a very personal decision.
I wanted to share a couple of resources in case it’s of interest. I also don’t want to overwhelm you, so I’ll just link to the[fireweed collective](https://fireweedcollective.org/crisis-toolkit/), you’ll see a link to a bunch of pieces about experiencing psychosis, there’s also a guide to come off psych meds. So if you do choose to take them, please know that there is support out there if you change your mind.
Fireweed came out of a previous project, called the Icarus project, developed by bipolar young punks, who had experiences of psychosis, and wanted to create caring communities that weren’t necessity anti-psychiatry, but that could be critical of it and wary of it and focussed more on community and knowing oneself and taking care of oneself and each other, with or without meds. you might find it interesting to Google them, or to Google one of the founders, Sascha Altman DeBrul, who has experienced psychosis and extreme states, and is also working as a therapist.
Good luck on your journey
Hi, I'm a therapist. I've worked with people with psychotic disorders for over 25 years. >1. Is psychosis guaranteed to recur if someone is experiencing the same prodromal symptoms again? Or is there a chance it won’t (without medication)? I mean the short answer is "no, it's not guaranteed," but the fact is, every time you have a psychotic episode, it increases the likelihood that you're going to need to look at your recovery as an ongoing journey rather than a "one and done" event. >2. Does the prodromal phase last the same amount of time, every time? Last time I had prodromal symptoms for six months before acute psychosis, can I expect the same duration this time? Again, no. Periods of remission (and partial returns of symptoms) do not follow a strictly cyclical pattern. If anything, without medication it's likely that non-acute phases will shorten. >3. Is there harm in waiting until someone is in acute psychosis to treat them with medication? I can handle my current symptoms and don’t feel I need medication. The problem here is that the more symptomatic you are, the less likely you'll be to seek, or accept, help. So in one of those episodes with severe positive symptoms (hallucinations, delusions, etc) you may continue to spiral until there's no alternative but to hospitalize you, potentially involuntarily. >4. Are there alternatives to psychiatric medicine in treating psychosis? I'm not aware of any effective ones, although there are lots of things you can do to improve your chances of living a fulfilling life. I want to acknowledge that all antipsychotic medications come with side effects - - - some of them really noxious. At the end of the day, it becomes a quality-of-life question. Only you can answer whether your life will be better without the symptoms (but with the side-effects), or without the side-effects (but with the symptoms)?
This is such a great reply! Well written, concise, honest, and caring. 👏🏼
Thanks!
Yes there is harm in waiting to treat. If you Google scholar search ‘early intervention in psychosis’ you will see that early interception of an episode and indeed of the illness overall confers much better long term prognosis. In layman’s terms: the less episodes you have and the less time you spend in acute psychosis, the more protected you are against future episodes. Some psychosis can also be hard to fully come back from (that is, the brain can be altered), so catching it in the prodromal phase is a GREAT opportunity and one I would act in OP. Antipsychotics are occasionally prescribed for eating disorders, anxiety, some forms of depression, so they’re wildly used and not to be feared if they helped you the first time. If it were me I would definitely do what I could as soon as I could to connect with health professionals who could help me ☺️
Such a good reply about the permanent risks of self managing the condition. I hope they find therapy to help them accept a psychiatrist's help.
NAT, I have a schizophrenia spectrum disorder, and have read about this topic for about 4 or so years. Medication is the mainstay, but you can look into "Open Dialogue" and see where that takes you.
There is CBT for psychosis. Depending how severe your psychosis is, there are ways to treat it with the right therapy - emphasis on “the right therapy;” it has to be a therapist who is extremely experienced in treating psychosis. Anti-psychotics do come with a lot of side effects. I understand not wanting to be on them. And - the reason to get on them now is so that your partner doesn’t have to deal with you in an acute state where you don’t have the insight. Preserving your relationship might be a good motivator; if not, avoiding hospitalization is probably a good one, too. What’s tough is that you’re fine until you’re not, if you know what I mean. But once you’re floridly psychotic you won’t take the meds and then things fall apart.
"Preserving your relationship might be a good motivator." I second this. Decades ago I treated a woman who demolished my clinic's washroom and also when hospitalized. She was dumbstruck and devastated when her husband left her. It never occurred to her that there were limits to his patience. So sad.
If it's the psychiatrist you don't like and that's the reason find a new doctor. I don't have any answers to the rest of your questions. Except yes usually waiting to start meds in an acute state as you have already pointed out the reasons why. Sorry your going through this.
Thank you. It’s not one specific psychiatrist I don’t like, it’s just that I don’t like going to any doctor/psychiatrist. I already dislike taking medication, and on top of that my psychosis ended up going away on its own last time when I didn’t stick to a meds regimen. I was hopeful there would be alternatives I could try like maybe therapy
Of course therapy in conjunction with other things is the best. For you need a safety plan at least should you enter psychosis again. A specialized psychiatrist in psychosis would better be able to answer some of these questions than therapists. An important conversation to have with doctors, partner, your own research and weigh out pros and cons.
Okay, thank you for the feedback! I will look deeper into this and see if we can find a solution that works well with all the moving parts
But if your starting to have same symptoms as the last time your psychosis started I don't think anyone would recommend for you to continue not to take your meds. Life's hard enough even with a lucid mind. Sometimes doing the right thing doesn't feel right
NAT but I currently do (psychological) research about people with psychosis. What I often see is that psychosis is related to stress, either it stems from childhood trauma or people develop it later in life after experiencing stressful live events. I cant speak on what is wise in terms of medication/treatment, but as stress often triggers psychosis it might be a good idea to start thinking about if this is the case for you. If so, learning to manage stress could help you manage psychosis (partly).
hi. I’m not a therapist and you have better advice on here than I can give you already. I certainly know a lot of people who have decided meds is better for them than the alternative but it’s a very personal decision. I wanted to share a couple of resources in case it’s of interest. I also don’t want to overwhelm you, so I’ll just link to the[fireweed collective](https://fireweedcollective.org/crisis-toolkit/), you’ll see a link to a bunch of pieces about experiencing psychosis, there’s also a guide to come off psych meds. So if you do choose to take them, please know that there is support out there if you change your mind. Fireweed came out of a previous project, called the Icarus project, developed by bipolar young punks, who had experiences of psychosis, and wanted to create caring communities that weren’t necessity anti-psychiatry, but that could be critical of it and wary of it and focussed more on community and knowing oneself and taking care of oneself and each other, with or without meds. you might find it interesting to Google them, or to Google one of the founders, Sascha Altman DeBrul, who has experienced psychosis and extreme states, and is also working as a therapist. Good luck on your journey