Essential Information for Patient and Family

• Agitation and strange behaviour are symptoms of a mental illness.
• Symptoms may come and go over time. Anticipate and prepare for relapses.
• Medication is a central component of treatment; it will both reduce current difficulties and prevent relapse.
• Family support is essential for compliance with treatment and effective rehabilitation.
• Community organizations can provide valuable support to patient and family.
  

Specific Counselling to Patient and Family

• Discuss treatment plan with family members and obtain their support for it.
• Explain that drugs will prevent relapse and inform patients of side-effects.
• Encourage patient to respect community standards and expectations (dress, appearance, behaviour)
• Assess and secure the safety of the patient and those caring for him/her.
• Unreasonably high demands may be harmful, but patients should be allowed to function at the highest reasonable level in work or other daily activities.
• Minimize stress and stimulation:
  • Avoid confrontation or criticism unless necessary to prevent harmful or disruptive behaviour.
  • Do not argue with psychotic thinking.
  • Structured problem solving with patient and family and social skills training with patient can be of considerable benefit.

Medication

• Antipsychotic medication will reduce agitation, hallucinations, and delusions(e.g.risperidone 1-6mg per day). Dose should be the lowest which relieves these symptoms.
• Inform the patient that continued medication will reduce the risk of relapse. In general, antipsychotic medication should be continued for at least twelve months following a first episode of illness and longer after a subsequent episode.
• If the patient fails to take medication as requested, injectable long-acting antipsychotic medication may ensure continuity of treatment and reduce risk of relapse.
• Inform patient of potential side-effects. Common motor side-effects include:
  • acute dystonias or spasms that can be managed with injectable benzodiazepines or antiparkinsonian drugs
  • akathisia (severe motor restlessness) that can be managed with dosage reduction or beta blockers
  • Parkinsonian symptoms (tremor, akinesia) that can be managed with oral antiparkinsonian drugs (e.g. benztropine 0.5-2mg a day)

Specialist Consultation

• If facilities exist, consider shared care with speciailst for all cases of psychotic disorder.
• Depression or mania occurring with psychotic symptoms may need other treatment. If possible, consider consultation to clarify diagnosis and begin best treatment.
• Consultation with appropriate community services may reduce family burden and improve rehabilitation.
• Agitation which is dangerous to the patient, the family, or the community will require close supervision or hospitalization.
• In case of severe motor side effects and comorbid substance use consider specialist consultation.

What a doctor might say to a person with a chronic psychotic disorder