This information is adapted from the ROYAL COLLEGE OF PSYCHIATRISTS, who produce a helpful series of leaflets that are accessible online: Royal College of Psychiatrists.

For the carer

About psychosis

Psychosis is a word used to describe symptoms or experiences that happen together. Each person will have different symptoms, the common feature is that they are not experiencing reality like most people.

Some people only have a single episode and make a full recovery; for others, it is a longer process. As 1 in 10 people with psychosis commit suicide, it is important to recognise the symptoms of Depression. An earlier onset of psychosis (i.e. in adoelscence) may be associated with more severe forms of psychosis, so this is not a diagnosis to apply a wait and see approach with for too long, regardless of the direct risks to the young person or to others if he or she is Paranoid

A person with psychosis may:

• hear, smell, feel or see things which other people do not (Hallucinations)
• have strange thoughts or beliefs which may make the person feel they are being controlled, persecuted or harassed (Delusions)
• have muddled or blocked thinking (Thought disorder)
• at times seem unusually excited or withdrawn and avoid contact with people
• not realise that there is anything wrong with themselves (Lack of insight).

Early changes in the person’s behaviour

As a carer, you may notice that the person:

• has problems understanding reality and thinking clearly
• talks to themself and/or appears to be listening to something else
• has problems communicating effectively• loses interest in their personal appearance and

life in general

• is restless, irritable or tense and anxious
• avoids other people
• is aggressive or violent (in a minority of cases)
• be very high (Mania) or very low (Depression), or swing from one state to the other (manic

depression).

Making a diagnosis

There is no single specific test for psychosis as the symptoms are common to a number of disorders, including schizophrenia, manic-depression/bipolar disorder and psychotic depression.
A diagnosis is made by talking to the person and a close relative or friend to get an understanding of the person’s history, as well as considering all other possible causes for the symptoms. Diagnosis is made by a Psychiatrist, who will usually be accessibkle via the young person's GP, if they have one (see How to speak to a DOCTOR if you need help with this.)

Treatments

• There is a NICE Guideline - Schizophrenia (over 18yrs) although this is not specifically focussed on the needs of younger people.
• Medication (Pharmacological treatment) should be started as soon as possible if there is a psychosis, to help the most disturbing symptoms and this can make it possible for other kinds of help to work.
• Once acute symptoms are under control, Relapse prevention is an important intervention.
• Other treatments used together with Pharmacological treatments, or on their own, include:
• Talking therapies (psychotherapy), such Cognitive Behavioural Therapy (CBT).
• FamilyWork is usually an important part of the care package, especially for young people, and with a focus on:
• reducing Expressed Emotion
• supporting Relapse prevention

As the carer, you may feel:

• guilty
• worried that you are losing the person you knew
• wonder if anyone else in the family will be affected
• exhausted by caring and ensuring that the person is safe
• scared about admitting there is a problem
• worried about the long-term outcome for the person
• worried about coping and getting help
• worried about the long-term financial responsibilities of caring
• worried about people’s negative attitudes towards mental illness and the stigma associated with it.

Tips for carers

You need to try to get into a partnership with your doctor and members of the mental health team

• Good communication between a doctor, members of the mental health team, a person with psychosis and their carer is important, but takes time and effort.
• Forming a positive, long-term relationship with all the staff and doctors involved in the care of the patient is especially important if the condition is long-term.
• If the person has the symptoms for the first time, it is important to see the GP as soon as possible. The GP, or a member of the Community Mental Health Team (CMHT), or Child and Adolescent Mental Health Service (CAMHS) will make the initial assessment before referring the person to a specialist.

If the person refuses to see a doctor...

• The carer or another trusted person should try to persuade them to accept professional help.
• The person may not need to go into hospital, as assessment and treatment can now be done at home by the CMHT or CAMHS.
• Where there are very real risks that cannot be contained in the community, it may be necessary to Use the Mental Health Act.

Questions to ask the doctor

1. What does the diagnosis mean?
2. Can you explain it in a way that I will understand?
3. Are there any treatments?
4. Where can I get information about medication and possible side-effects?
5. How long will it take for the medication to work?
6. Are there other things we can do to help ourselves?
7. What can we expect in the near future and over time?
8. Will the person be able to continue in work or in education?
9. Is it safe for the person to drive?
10. Will the person I care for get better?
11. How often should I come and see you?
12. Can you give me an out-of-hours emergency telephone number?
13. Do you have any written material on this disorder, if not who does?
14. Is there anything that we can change at home to make things easier, or safer?
15. Are there any organisations or community services that can help?
16. Which health service worker is my main contact for guidance and advice?

For the professional

As a professional working with people with psychosis and their carers, we hope that the following is a helpful guide to good practice.

When doing an assessment, do you?

• Try to see the patient and the carer separately, as well as together
• Try to see them at home first
• Do you allow yourself enough time to?
• Listen, and, listen again
• Obtain a life history
• Leave time for questions and discussion
• Explain how you/the doctors arrived at the diagnosis
• Talk about the prognosis - or find an opportunity for the young person to speak to an expert about this
• In the management of the illness, do you?
• Discuss possible treatments
• Talk about the possible side-effects of drugs
• Talk about the importance of the patient maintaining positive social roles, work or education goals, if possible (see Taking Responsibility for integration and Dis-integratedInterventions)
• Spend time asking about the carer’s health: physical and emotional
• Make it clear that someone will always be available.
• Give an out-of-hours telephone number.
• Make sure that there is a named professional

person whom the family can contact at any time.

• When you write your letter to the GP, consider sending a copy to the patient and carer.
• Try to talk to the GP on the telephone as well as writing.
• Make sure the patient and the carer have adequate information about their care and treatment.

Further help

Royal College of Psychiatrists

17 Belgrave Square, London SW1X 8PG.
Tel: 020 7235 2351 ext 259.
Produces information for the general public on common mental health problems and treatments.
Royal College of Psychiatrists

MIND

Granta House, 15-19 Broadway, London E15 4BQ.
Mindinfoline: 0845 766 0163.
Publishes a wide range of literature on all aspects of mental health.
MIND

Rethink

30 Tabernacle Street, London EC2A 4DD.
National Advice Service: 020 8974 6814.
Voluntary organisation that helps people with severe mental illness, their families and carers.
Rethink

MDF The Bi-polar Organisation

Castle Works, 21 St George’s Road, London SE1 6ES.
Tel: 08456 340540.
National user-led organisation providing support and information.
MDF-Bipolar

The Princess Royal Trust for Carers

Further information for carers is available from
The Princess Royal Trust for Carers,
142 Minories, London EC3N 1LB.
Tel: 020 7480 7788;
Carers Trust