Managing Symptoms at Home - Early Psychosis Intervention

Below are some tips for how to cope with various symptoms your family member may be experiencing. Other information can be found in the Dealing With Psychosis Toolkit. The DWP Toolkit is a comprehensive approach where the person, with a support person, learns to understand and cope with living with a psychotic disorder.

Ask if your loved one has completed a "Relapse Prevention Plan" and if so, if you could have a copy.

Provide comfort and reassurance when symptoms are distressing. Although you may not know what it is like, it is clear that the experience is unpleasant. Together try to identify any current stressors that may have increased symptoms (e.g., a recent argument, personal problem, or worry about an upcoming event. The DWP Toolkit provides help with problem-solving and dealing with stress.)

Encourage the person to not use any street drugs or alcohol as these may make their symptoms worse or lead to a relapse. There are some great internet resources your family member can use to help them stop or reduce their drug use.

Hallucinations (sensory experiences not shared by others)

Some examples are:

When your family member is feeling relatively well, discuss with them what they find helpful and how you can work together to reduce the impact of the symptoms.

Hearing voices
Tactile sensations – e.g., bugs crawling under skin

Possible Signs:

Talking to oneself
Looking as if he or she is hearing something
Increased social withdrawal
Increased preoccupations

Managing Strategies:

Try to empathize with the fear, anxiety, and distress.

Encourage your young person to take their medication. Lower stimulation in person's environment, for example, fewer people, turn off the TV, gaming systems etc.

Ask what has helped in the past.

If the hallucinations continue and are worrisome, call the EPI team or physician involved in their care.

Encourage your young person to use strategies they have learned through therapy or from the DWP Toolkit. Suggest that your young person engages in an activity that will distract them from the symptom such as:

watching TV or listening to music
talking with a family member or friend
exercise like cycling, swimming
using a relaxation technique (see section on stress management)

What doesn't work:

Attempts to reason or debate with the voices

Delusions (fixed false beliefs)

Some examples are:

Belief that someone is watching them
Fear that they will be harmed by someone
Belief that they are being sent messages e.g., through TV or radio
Belief that they are special or have special powers

Possible Signs:

Suspiciousness
Preoccupation with exotic ideas or philosophies
Fearfulness
Refusal to maintain routine/activities
Pacing or restlessness

Management Strategies:

Identify the underlying feelings such as fear or anxiety and address that with the person. Say: "If this is making you feel really anxious, what can we do to help that?"

Consider using stress management techniques or introducing distractions such as activities, chores, or music. You might want to try talking about something else if possible.

Again, call your family physician or EPI team involved if the symptom persists, worsens, alarm you or you are concerned about your family member harming themselves or another person.

What doesn't work:

Trying to reason or debate about the delusions

Cognitive Problems

Some examples are:

Concentration
Learning
Memory
Abstract thinking
Speed of processing information

Management Strategies

Have a structured routine
Using simple words and short sentences
Asking your family member to repeat the instructions you gave them
Remove any distractions when speaking them e.g., turn off radio or TV
Offer only a couple of choices as it can hard for them if there are too many choices
Further suggestions are available in the DWP toolkit in the resources section of this website

Supporting Taking Medication

The DWP Toolkit provides further information about medications and how to get the most out of them.

Many people have difficulties in taking any medication as it is prescribed. Some may not take it as directed, while others may take for a while and stop, and others may simply refuse to take the medication at all.

There are a number of possible reasons why a person may not take medication as directed. These include:

Unpleasant side effects
Not believing that they have an illness
Taking the pills reminds a person that they have a psychiatric disorder
The medication routine may be too complicated and confusing
The person may forget
The medication may not be effectively controlling the symptoms
The person may feel well again and not understand why they need to continue to take the medication
Some people enjoy their symptoms and miss them when they are gone

What Helps:

Being educated about psychosis and how treatments work is an important part of a young person's care. Understanding the purpose of the medication and how it should be taken, what to look for in terms of changes and managing side-effects will help a young person to be in control of their illness.

Encouraging your young person to talk about the medication, what they understand about how it works, what it does and what happens if they don't take it as directed, how they feel about taking medication, what makes it difficult for them and what would help make it easier. This helps them to be in control.

Complaints about side effects should be taken seriously. These are real and uncomfortable and there are remedies. Encourage your young person to talk with their doctor about what they are experiencing and to look at options for reducing or eliminating troublesome side-effects.

To help with forgetfulness, try blister packs from the pharmacy, dosettes (the containers with the days of the week on them), and/or a simplified regime such as once a day at a set time.

Often associating taking the pills with an activity such as brushing teeth or eating a meal is helpful. Have them keep the pills in a very visible but safe place, e.g. beside the toothpaste or on the kitchen table.

It may take some time before your family member decides there are benefits to staying on their medication. You can help by monitoring their wellness and letting the EPI team know if there is an increase in symptoms or a relapse.

Injectable medications are available for some prescriptions. They are usually given once every 2 weeks or once a month. This is an option for some people who have difficulty taking the medication as prescribed, e.g. not having to remember to take the pills).

Having a Good Relationship With Your Family Member

Being able to communicate with our family members is something that we may take for granted. However, in times of stress and challenge, good communication can be difficult. Psychosis can also sometimes require specific ways to communicate. To improve and support meaningful communications, consider the following suggestions:

Patterns of communication

People who have psychosis are particularly sensitive to criticisms, so it's important be non-judgmental in your communications.
Notice and compliment the positives rather than focusing on problem behaviours: These could include helpful actions, positive qualities or positive changes. Ignore troublesome behaviours that are not harmful.
Allow more time for your family member to respond. Psychosis can affect thought processes. It may be a bit longer for your family member to process what you have said and respond back.
Focus on the feelings rather than the content. When someone gets angry, and or upset, they may say things or lash out
When your son/daughter seems angry, upset, or sad, focus on his/her feelings and figure out what happened to create this "feeling state". For example, "You seem to be angry with me, but I know it must hurt a lot when you are reminded that your friends are graduating from college and you aren't with them… that must really hurt…" Focus less on the "content" of what your son/daughter said and more on the "feeling" behind the comment.
Have mutual "time-outs". All family members get on each other's nerves at times. Psychosis can introduce lots of stressors for families and frustrations that lead to arguments and potentially heated battles. When you and your family member begin to yell at each other, communicate the need to stop the behaviour: "I'm yelling at you, and you are yelling at me… this isn't helping because we are both out of control… we both need to calm down… I'm going to the kitchen to sit and calm myself, and I want you to go to the living room to calm yourself… in 15 minutes, let's get back together and talk about what just happened."
Don't expect immediate changes in undesirable behaviours but make an attempt to notice even small changes. We all get stuck in the way we do things, so give it time.
Physical abuse or threats of violence (punching a wall, breaking/throwing items) should never be tolerated. If your family member is showing aggression, give a firm command such as "Please stop". Give them space. If practical, move to quieter, more open surroundings. Leave the situation and call the police if you fear for your safety or that of others.
All healthy relationships require limits and clear boundaries but for people experiencing psychosis, clear limits are especially important. It can be difficult for them to distinguish reality from non-reality and to know where the boundaries of one's self or others are, so it is crucial that families set limits about what is acceptable in the home for the well-being of everyone in the family.