Editing Psychosis (section)

== Treatment ==
The treatment of psychosis depends on the specific diagnosis (such as schizophrenia, bipolar disorder or substance intoxication). The first-line treatment for many psychotic disorders is antipsychotic medication,
<ref name="fn_72">{{cite web |url=https://www.nice.org.uk/guidance/cg178 |title=Schizophrenia: Full national clinical guideline on core interventions in primary and secondary care |date= 12 February 2014 |author=National Collaborating Centre for Mental Health |access-date= 21 September 2022 |archive-date= 1 September 2022 |archive-url= https://web.archive.org/web/20220901012650/https://www.nice.org.uk/guidance/cg178 |url-status=live }}</ref> which can reduce the positive symptoms of psychosis in about 7 to 14 days. For youth or adolescents, treatment options include medications, psychological interventions, and social interventions.<ref name=":3" />

=== Medication ===
The choice of which [[antipsychotic]] to use is based on benefits, risks, and costs.<ref name="Lancet09" /> It is debatable whether, as a class, [[typical antipsychotic|typical]] or [[atypical antipsychotic]]s are better.<ref>{{cite journal | vauthors = Kane JM, Correll CU | title = Pharmacologic treatment of schizophrenia | journal = Dialogues in Clinical Neuroscience | volume = 12 | issue = 3 | pages = 345–357 | year = 2010 | pmid = 20954430 | pmc = 3085113 | doi = 10.31887/DCNS.2010.12.3/jkane }}</ref><ref>{{cite journal | vauthors = Hartling L, Abou-Setta AM, Dursun S, Mousavi SS, Pasichnyk D, Newton AS | title = Antipsychotics in adults with schizophrenia: comparative effectiveness of first-generation versus second-generation medications: a systematic review and meta-analysis | journal = Annals of Internal Medicine | volume = 157 | issue = 7 | pages = 498–511 | date = October 2012 | pmid = 22893011 | doi = 10.7326/0003-4819-157-7-201210020-00525 | doi-access = free }}</ref> Tentative evidence supports that [[amisulpride]], [[olanzapine]], [[risperidone]] and [[clozapine]] may be more effective for positive symptoms but result in more side effects.<ref name="barry 2012" /> Typical antipsychotics have equal drop-out and symptom relapse rates to atypicals when used at low to moderate dosages.<ref name="AFP07">{{cite journal | vauthors = Schultz SH, North SW, Shields CG | title = Schizophrenia: a review | journal = American Family Physician | volume = 75 | issue = 12 | pages = 1821–1829 | date = June 2007 | pmid = 17619525 }}</ref> There is a good response in 40–50%, a partial response in 30–40%, and treatment resistance (failure of symptoms to respond satisfactorily after six weeks to two or three different antipsychotics) in 20% of people.<ref name="AFP10">{{cite journal | vauthors = Smith T, Weston C, Lieberman J | title = Schizophrenia (maintenance treatment) | journal = American Family Physician | volume = 82 | issue = 4 | pages = 338–339 | date = August 2010 | pmid = 20704164 }}</ref> Clozapine is an effective treatment for those who respond poorly to other drugs ("treatment-resistant" or "refractory" schizophrenia),<ref>{{cite journal | vauthors = Taylor DM, Duncan-McConnell D | title = Refractory schizophrenia and atypical antipsychotics | journal = Journal of Psychopharmacology | volume = 14 | issue = 4 | pages = 409–418 | year = 2000 | pmid = 11198061 | doi = 10.1177/026988110001400411 | s2cid = 27270415 }}</ref> but it has the potentially serious side effect of [[agranulocytosis]] (lowered [[white blood cell]] count) in less than 4% of people.<ref name="Lancet09" /><ref name="BMJ07">{{cite journal | vauthors = Picchioni MM, Murray RM | title = Schizophrenia | journal = BMJ | volume = 335 | issue = 7610 | pages = 91–95 | date = July 2007 | pmid = 17626963 | pmc = 1914490 | doi = 10.1136/bmj.39227.616447.BE }}</ref><ref>{{cite journal | vauthors = Essali A, Al-Haj Haasan N, Li C, Rathbone J | title = Clozapine versus typical neuroleptic medication for schizophrenia | journal = The Cochrane Database of Systematic Reviews | issue = 1 | pages = CD000059 | date = January 2009 | volume = 2009 | pmid = 19160174 | pmc = 7065592 | doi = 10.1002/14651858.CD000059.pub2 }}</ref>

Most people on antipsychotics get side effects. People on typical antipsychotics tend to have a higher rate of [[extrapyramidal side effects]] while some atypicals are associated with considerable weight gain, diabetes and risk of [[metabolic syndrome]]; this is most pronounced with olanzapine, while risperidone and [[quetiapine]] are also associated with weight gain.<ref name="barry 2012">{{cite journal | vauthors = Barry SJ, Gaughan TM, Hunter R | title = Schizophrenia | journal = BMJ Clinical Evidence | volume = 2012 | date = June 2012 | pmid = 23870705 | pmc = 3385413 | url = http://www.clinicalevidence.bmj.com/x/systematic-review/1007/archive/06/2012.html | url-status = dead | archive-url = https://archive.today/20140911114812/http://www.clinicalevidence.bmj.com/x/systematic-review/1007/archive/06/2012.html | archive-date = 2014-09-11 }}</ref> Risperidone has a similar rate of extrapyramidal symptoms to haloperidol.<ref name="barry 2012" />

=== Psychotherapy ===
Psychological treatments such as [[acceptance and commitment therapy]] (ACT) are possibly useful in the treatment of psychosis, helping people to focus more on what they can do in terms of valued life directions despite challenging symptomology.<ref>{{cite journal | vauthors = Ost LG | title = The efficacy of Acceptance and Commitment Therapy: an updated systematic review and meta-analysis | journal = Behaviour Research and Therapy | volume = 61 | pages = 105–121 | date = October 2014 | pmid = 25193001 | doi = 10.1016/j.brat.2014.07.018 }}</ref> [[Metacognitive training]] (MCT) is associated with reduced [[delusion]]s, [[hallucination]]s and [[negative symptoms]] as well as improved [[self-esteem]] and functioning in individuals with schizophrenia spectrum disorders.<ref>{{cite journal | vauthors = Penney D, Sauvé G, Mendelson D, Thibaudeau É, Moritz S, Lepage M | title = Immediate and Sustained Outcomes and Moderators Associated With Metacognitive Training for Psychosis: A Systematic Review and Meta-analysis | journal = JAMA Psychiatry | date = March 2022 | volume = 79 | issue = 5 | pages = 417–429 | pmid = 35320347 | pmc = 8943641 | doi = 10.1001/jamapsychiatry.2022.0277 }}</ref>

There are many psychosocial interventions that seek to treat the symptoms of psychosis:  [[need adapted treatment]], [[Open Dialogue]], psychoanalysis/psychodynamic psychotherapy, [[major role therapy]], [[Soteria (psychiatric treatment)|soteria]], psychosocial outpatient and inpatient treatment, [[milieu therapy]], and  cognitive behavioral therapy ([[Cognitive behavioral therapy|CBT]]). In relation to the success of CBT for psychosis, a randomized controlled trial for a Web-based CBTp (Cognitive Behavioral Therapy for Psychosis) skills program named Coping With Voices (CWV) suggest that the program has promise for increasing access to CBTp. It also associated benefits in the management of distressing psychotic symptoms and improved social functioning. When CBT and the other psychosocial interventions<ref>Gottlieb, J. D., Gidugu, V., Maru, M., Tepper, M. C., Davis, M. J., Greenwold, J., Barron, R. A., Chiko, B. P., & Mueser, K. T. (2017). Randomized controlled trial of an internet cognitive behavioral skills-based program for auditory hallucinations in persons with psychosis. ''Psychiatric Rehabilitation Journal, 40''(3), 283–292. <nowiki>https://doi.org/10.1037/prj0000258</nowiki></ref> these are used without antipsychotic medications, they may be somewhat effective for some people, especially for CBT, need-adapted treatment, and soteria.<ref name="Schizophrenia Research 2019 p.">{{cite journal | vauthors = Cooper RE, Laxhman N, Crellin N, Moncrieff J, Priebe S | title = Psychosocial interventions for people with schizophrenia or psychosis on minimal or no antipsychotic medication: A systematic review | journal = Schizophrenia Research | volume = 225 | pages = 15–30 | date = November 2020 | pmid = 31126806 | doi = 10.1016/j.schres.2019.05.020 | url = https://www.sciencedirect.com/science/article/abs/pii/S0920996419301823 | access-date = 2020-05-28 | url-status = live | s2cid = 159040608 | archive-url = https://web.archive.org/web/20200625185822/https://www.sciencedirect.com/science/article/abs/pii/S0920996419301823 | archive-date = 2020-06-25 }}</ref>

=== Early intervention ===
{{Main|Early intervention in psychosis}}

[[Early intervention in psychosis]] is based on the observation that identifying and treating someone in the early stages of a psychosis can improve their longer term outcome.<ref>{{cite journal | vauthors = Birchwood M, Todd P, Jackson C | title = Early intervention in psychosis. The critical period hypothesis | journal = The British Journal of Psychiatry. Supplement | volume = 172 | issue = 33 | pages = 53–59 | year = 1998 | pmid = 9764127 | doi = 10.1192/S0007125000297663 | s2cid = 32411917 }}</ref> This approach advocates the use of an intensive multi-disciplinary approach during what is known as the [[critical period]], where intervention is the most effective, and prevents the long-term morbidity associated with chronic psychotic illness.

=== Systematic reform ===
Addressing systematic reform is essential to creating effective prevention as well as supporting treatments and recovery for those with psychosis.

Waghorn et al.<ref name=":4">{{Cite journal| vauthors = Waghorn G, Still M, Chant D, Whiteford H |date=2004|title=Specialised Supported Education for Australians with Psychotic Disorders |journal=Australian Journal of Social Issues|language=en|volume=39|issue=4|pages=443–458|doi=10.1002/j.1839-4655.2004.tb01193.x |doi-access=free}}</ref> suggest that education interventions can be a building block to support those with psychosis to successfully participate in society. In their study they analyse the relationship between successful education attainment and psychosis. Findings suggest proportionately more school aged persons with psychosis discontinued their education, compared to those without psychosis.<ref name=":4" />

Waghorn et al.<ref name=":4" /> finds that specialised supported education for those with psychotic disorders can help lead to successful education attainment. Additionally, future employment outcomes are relative to such education attainment. Established approaches to supported education in the US include three basic models, self-contained classrooms, onsite support model and the mobile support model. Each model includes the participation of mental health service staff or educational facility staff in the student's education arrangements.<ref name=":4" />

Potential benefits of specialised supported education found from this study include coordination with other service providers (e.g. income support, housing, etc.) to prevent disrupting education, providing specialised career counselling, development of coping skills in the academic environment.<ref name=":4" /> These examples provide beneficial ways for people with psychosis to finish studies successfully as well as counter future experiences of psychosis.<ref name=":4" />