Now and then the symptoms will be quite obvious and leave no doubt as to what’s happening. Other times, however, it will be unclear that the person really is psychotic.
The person conduction the assessment has to ask questions in order to get an impression of the patient’s normal state. Even though it’s the ill person who is interviewed, it’s equally important that others contribute as much information as possible, especially family members or others who live with this person. Make a list of unusual behaviour, school reports, work plans, feedback from teachers, co-workers or friends, etc., and give it to the therapists. Sometimes the therapists might disagree with the diagnosis and that you end up receiving conflicting explanations. This may be because the person is having different and changing experiences, which may change the diagnosis.
Ask questions if you are unsure about what is happening.
Why is hospitalisation sometimes necessary?
When someone has a psychotic disorder, admission to hospital may be crucial for several reasons. Here there is help for performing physical tests and with starting treatment. Medication can be carefully monitored to establish the most effective dose and to avoid unwanted side effects.
Everyone (including the patient and family) may need a break from the situation, depending on the duration of the illness and other circumstances.
Now and then people who develop a psychotic disorder put themselves and others in danger, so that others need to take control. Beyond this, perhaps the most important effect of hospitalisation is to establish a long-term treatment relationship with a psychotherapist or arrange for cognitive therapy and outpatient follow-up. This treatment should ordinarily go over some months, or even years.
Psychiatric wards have developed specific methods, called environmental therapy, for the treatment of mental disorders.*
When someone agrees to be admitted to hospital, this is called “voluntary commitment”.
A patient admitted on a voluntary basis has the right to leave the hospital at any time.
When someone is admitted to hospital against his will, this is called “involuntary commitment”.
Under certain conditions, the correct treatment alternative will be hospitalisation, even if the person in question disagrees. Involuntary commitment normally occurs when the family is no longer able to care for the patient and when the patient does not realise that he or she needs help and can benefit from treatment. Sometimes there may also be a risk of suicide or of harming one’s reputation and, for example, making irrevocable financial transactions in a manic phase. introduction
“Involuntary commitment normally occurs when the family is no longer able to care for the patient and when the patient does not realise that he or she needs help and can benefit from treatment. Sometimes there may also be a risk of suicide or of harming one’s reputation and, for example, making irrevocable financial transactions in a manic phase.”
Involuntary commitment may take place only when a doctor has determined that the patient meets the following criteria:
- The patient has a psychosis
- The illness requires immediate treatment and care attainable through admission to hospital
- The patient is a danger to himself or others and needs protection
- The patient has refused, or is not in a condition to give consent to, necessary treatment and care for his disorder, i.e. the possibility of recovery or substantial improvement is gone
- The patient is suffering an overload
In connection with commitment, a psychiatrist is to examine the patient to determine if he or she needs to remain there. In Norway the patient can appeal to the Control Commission against being committed.
How long does the recovery process take?
This is a question that is very hard to answer. People recover at different rates and get better to different degrees. In other words: some get over it quickly, while for others it takes longer. For some there are good days and bad days, others level out. Treatment and circumstances – medication, rehabilitation, a place to live, etc., play a role, of course. Although there are general tendencies, in any event it is best to talk with professionals familiar with the matter.
Remember that a psychotic episode is an important event is a person’s life. So it isn’t strange that it normally takes a long time – weeks, months and sometimes longer to get better. The experience is also traumatic for family members and friends. Everyone needs time to recover and if necessary to adapt to their living situation.
Some have problems accepting mental illness – either in themselves or in someone they know. The block it out, denying that any illness exists. Others handle it better. They do something difficult, yet important – accept the experience as a part of life and go on from there. A lot of support from professionals, family and friends makes this easier.
Understandably, still others will develop a fear regarding psychoses. They become fearful of experiencing another episode. They may have nightmares. Nor is it unusual to be depressed after an episode. The therapists always need to be informed if the person becomes depressed or talks about suicide.
For first-episode psychosis, approximately 70–80% of patients should be out of the psychosis after a year, most after three months. Almost all are quickly rid of their “positive” symptoms (delusions, hallucinations); what remains longer are the so-called negative symptom (loss of energy, social isolation, etc.). But the outcome always depends on whether the patient and family members are active participants in treatment. If a person takes an active part in treatment and sticks with it to the end, the chances are that everything will be all right.