“What are hallucinations?” I need to know | 3

Her daughter was struggling, but she gathered the insight and will to tell her mother she wanted to learn about the voices and get help. When they began researching treatment, they realized “What are hallucinations?” was the easy part. And on they went.

But for an effective early intervention, signs and symptoms have to be observed, noted, and reported. That means family and friends are major players.

When I began working with clients with psychosis spectrum disorders, gratitude came quickly and hit hard.

I’d been trying to manage my own emotional and mental illnesses for decades. However, it was nothing compared to what those with, say, schizophrenia were going through.

It always weighed heavily on my heart.

Intro

It’s time to wrap up our three-part hallucinations series. We discussed general information in part one and causes: risk factors and triggers in part two. Now it’s on to treatment.

Real quick: let’s take a look at a couple of things from parts one and two before we get rolling.

Here’s our working definition of hallucination…

An individual is experiencing a hallucination when they perceive sensory input as real – but there isn’t an external stimulus.

As you likely know, there are specific types of hallucinations, auditory (largely voices) being the most common.

Important: As you’ll see, our treatment review is all about schizophrenia. Why?

Within a psychiatric/psychological context, hallucinations driven by the emotional and mental illnesses (e.g. schizophrenia) are the only ones studied and treated. Hallucinations generated by illness, medication, or substance use are an entirely different animal.

I’m thinking the majority of folks reading the series are interested in the psychiatric/psychological angle.

How is schizophrenia treated?

Early intervention, assessment, diagnosis, psychotherapy, psychosocial therapy, medication, follow up

The information shared on Chipur is only as good as its source. That’s why all that follows comes from Schizophrenia & Psychosis Action Alliance: Shattering barriers to treatment, survival and recovery.

Early intervention

Early intervention is huge for those who have schizophrenia. Keep in mind, studies have shown that people experiencing first-time psychosis often have symptoms for more than a year before receiving treatment. That’s too long.

But for an effective early intervention, signs and symptoms have to be observed, noted, and reported. That means family and friends are major players.

By the way, according to research, people with schizophrenia who get early and intensive treatment have the best long-term results. And those who have a strong support system do better than those without the encouragement of family and friends.

Here are some signs and symptoms to look for…

Extreme expressions of emotion, unpredictable mood swings, engaging in risky activities (shoplifting, sex, gambling, erratic driving, etc.), extreme social withdrawal, misuse of prescription or illicit drugs, not making sense or not understanding others, distracted – seemingly responding to internal stimuli, significant weight loss or gain, unkempt appearance, untreated sores, tattered clothing, unpleasant body odor, obvious signs of disconnection from reality.

It’s a troubling list, isn’t it. And it’s understandable that a knee-jerk reaction would be to sidestep involvement. But the longer it’s put off, the harder it is on the individual – and those they may come in contact with.

Save lives: if the individual is talking or behaving in a threatening manner toward self or others, don’t hesitate –  dial 988 (if necessary, 911) in the U.S  Psychology Today has an excellent list of worldwide suicide hotlines snd prevention resources.

Psychotherapy

If you aren’t familiar with the psychosis spectrum disorders, you may wonder why I’d include psychotherapy as a treatment. After all, it’s a meds only thing right?

Be it managing thoughts and behaviors, learning more about the illness, or how to differentiate what’s real and what isn’t, therapy sessions can be of great assistance – just like any emotional or mental illness.

Every few minutes the voices say something derogatory to me, which discourages me a little bit. But I have to be strong enough to say to them, ‘Hey, would you quit stalking me? Don’t talk to me – leave me alone!’ I have to say these types of things all day long. It’s like a fight.

Composer, producer, vocalist, musician Brian Wilson

Commonly used therapies for the psychosis spectrum disorders include cognitive behavioral therapy (CBT) and cognitive enhancement therapy (CET) aka cognitive remediation.

It’s important to mention that those closest to the “patient” often pursue therapy/counseling for themselves.

Psychosocial therapy

With hard work and the right therapist, psychotherapy can bring improvement for someone with schizophrenia. But there’s more work to be done – like learning how to become part of the community. That’s where psychosocial therapy comes in.

Let’s take a look at some of the components…

• Social skills training: the emphasis is on improving communication and social interactions.
• Rehabilitation: schizophrenia typically develops during critical career-building years. Rehabilitation may include job counseling, problem-solving support, and education in money management.
• Family education: knowledge of psychosis spectrum disorders can help individuals who love someone with these illnesses.
• Self-help groups: community care and outreach programs to continue working on social skills.
• Coordinated specialty care (CSC): designed for folks experiencing a psychosis spectrum disorder episode for the first time. It’s a team approach that combines medication and psychological therapies and includes social and employment services. The aim is to change the direction and prognosis for the disease by catching it in its earliest stages. Again, research shows that people with schizophrenia who get early and intensive treatment have the best long-term results.
• Assertive community treatment (ACT): highly personalized services to help people with schizophrenia meet life’s daily challenges like taking medication. ACT professionals also help handle problems proactively and work to prevent crises.
• Social recovery therapy: the focus is on helping the patient set and achieve goals and building a sense of optimism and positive beliefs about themselves and others.

Now, that’s an awful lot, but missing one piece could be disastrous.

Residential treatment programs

As you may imagine, a residential treatment program may become a necessity. And in most cases, family members are involved in the decision-making.

Needless to say, that’s a load. Though I’ve not included them here, Schizophrenia & Psychosis Action Alliance provides a super list of helpful questions for families to ask when exploring options.

Medication

Antipsychotics: first and second-generation

I know I’m painting with a broad brush, but if there’s a psychosis spectrum disorder case that doesn’t call for medication, I haven’t seen or heard of it. That’s one of the reasons working with folks with schizophrenia, etc. weighed heavily on my heart. It’s one tough row to hoe.

The primary medications for the treatment of psychosis are the first and second-generation antipsychotics

Second-generation antipsychotics

Also known as atypical antipsychotics, the second generation antipsychotics began to hit the market in the mid-1970s – the bulk coming along during the 1990s. Their primary action is blocking receptors in dopamine pathways.

Though they’re reported to have a less intense side effect profile than their first-generation relatives, weight gain and increases in blood sugar and cholesterol levels can be an issue.

Included are……

• aripiprazole (Abilify)
• asenapine (Saphris)
• brexpiprazole (Rexulti)
• cariprazine (Vraylar)
• clozapine (Clozaril)
• llperidone (Fanapt)
• lumateperone (Caplyta)
• lurasidone (Latuda)
• olanzapine (Zyprexa)
• paliperidone (Invega)
• quetiapine (Seroquel)
• risperidone (Risperdal)
• ziprasidone (Geodon)

Keep in mind that atypical antipsychotics are often prescribed as an augmenting agent for a number of disorders – and off-label as part of a first line meds combo.

First-generation antipsychotics

The first-generation antipsychotics, aka typical antipsychotics, were developed in the 1950s. The first was chlorpromazine (Thorazine).

Since they’re believed to have a greater impact on receptors in dopamine pathways, they may cause significant movement disorders like intense muscle stiffness or tardive dyskinesia.

Drugs in this group include…

• chlorpromazine (Thorazine)
• fluohenazine (Proxlixin)
• haloperidol (Haldol)
• loxapine (Loxitane)
• perphenazine (Trilafon)
• pimozide (Orap)
• thioridazine (Mellaril)
• thiothixene (Navane)
• trifluoperazine (Stelazine)

Taking medication for psychosis spectrum disorders can be challenging. Those using them need and deserve support.

That’ll do it

That’s that for our hallucinations series. If you or someone you care about are dealing with them, I hope you found the information helpful.

As we wrap it up, there’s every reason in the world to be hopeful about the future of psychotic spectrum disorders treatment. To catch a glimpse, head over to the Schizophrenia & Psychosis Action Alliance website (link below) and tap on Research (and Support).

Again, be sure to check out general hallucination information in part one and causes: risk factors and triggers in part two.

A big thank you to Schizophrenia & Psychosis Action Alliance for the info – and their compassion and hard work. Pay them a visit and see what’s going on.

If you’re up for even more emotional and mental illness info and inspiration reading, peruse the titles on the articles page or by category below.

After a decades-long battle with panic, generalized anxiety, fluctuating moods, and alcohol dependence; Bill finally found his life’s passion and work – lending a hand to those in the same boat. At age 49 he hit grad school and earned his counseling credentials. And he continues his service through Chipur and other projects.