Medication for psychosis

Psychosis is a complex condition. The exact cause of the condition is unknown, but it is probably due to a combination of different factors. However, studies show that psychosis is often associated with an imbalance in the neurotransmitters in the brain, especially the neurotransmitter called dopamine. In some areas, there is too much dopamine, in other areas there is too little.

Too much dopamine in the areas of the brain responsible for thinking and perception is thought to contribute to symptoms of psychosis. For example, you may experience different types of hallucinations and delusions. Medications for psychosis work primarily by stabilising dopamine levels in the brain, but they also affect other neurotransmitters.

Once you start feeling the effects of the medication, you will experience clearer thinking and fewer hallucinations. For example, you may find that the voices you hear become weaker or disappear completely. You may also find that things you thought were 100 per cent true now feel less black and white. For example, if you were previously convinced that your neighbour was a malicious person, you are now not so sure. Instead, you are able to find other explanations for things you used to be absolutely convinced about.

There are several types of medication for psychosis. Some of them are:

• Olanzapine
• Quetiapine
• Clozapine
• Zuclopenthixol

In addition to their antipsychotic effect, these types of medication also have a positive effect on anxiety and sleep problems. The most common side effects of this type of medication are increased appetite, dizziness, tiredness and changes in the body’s sugar and fat metabolism.

Clozapine

Clozapine is a special medication used to treat psychosis. It seems to have a stronger effect than any other medications for psychosis. However, it is never the first choice due to rare but serious side effects affecting the bone marrow and heart muscle. Read more in Treatment with Clozapine.

Other types of medication for psychosis:

• Haloperidol
• Risperidone
• Paliperidone
• Amisulpride
• Perphenazine
• Lurasidon
• Aripiprazol
• Brexpiprazo
• Cariprazin

These types of medication have an antipsychotic effect and do not usually increase appetite or cause sleepiness. The most common side effects of this type of medication are muscle stiffness, involuntary movements and tremors.

In patients who suffer such side effects, the medication Orphenadrine can be used. It reduces the discomfort. In addition, sexual side effects have been observed, including menstrual disturbances and breast tenderness in women and erectile dysfunction in men.

The most common side effect of Aripiprazole, Brexpiprazole and Cariprazine is a feeling of inner restlessness and agitation. However, in most people, these side effects are only seen at the beginning of treatment.

All medications are available as tablets. Many are also available as melt tablets that dissolve quickly in the mouth. Below you can see ways in which the various products can also be taken.

Lurasidone

Must be taken with food to be properly absorbed by the body.

Olanzapine, Haloperidol and Aripiprazole

Can be administered as a fast-acting injection.

Haloperidol, Perphenazine, Risperidone, Olanzapine, Paliperidone, Aripiprazole

Available as slow-release medication. This is a long-acting injection that is administered every 14 days or once a month.

Your therapist will first choose medications that are known to have the fewest side effects. It varies from person to person which medication works best and also causes the fewest side effects.

It is therefore impossible to know in advance which medication will work best for you. It may therefore be necessary to change your medication to achieve the best effect and the fewest possible side effects.

As a general rule, you will be treated with one type of antipsychotic medication at a time. An exception may be if, at times, you need extra medication in addition to your basic treatment. After consultation with your doctor, you can get a prescription for a low-dose antipsychotic medication (PN medication). You can take it as needed, two to four times a day.

Medications for psychosis, like all medications, can have side effects. However, not everyone experiences side effects from the treatment.

When side effects occur, they vary in severity and often depend on the dose taken. For some people, it may therefore be a good idea to lower the dose rather than change their medication.

When you start taking the medication, it may take several months before you feel the full effect. However, any side effects may be noticeable as soon as you start taking the medication.  However, they often subside over time.

Typical side effects

• Tremors or muscle stiffness
• Inner turmoil or restlessness
• Increased appetite and weight gain
• Effect on blood cholesterol
• Effect on white blood cells
• Effect on heart rhythm
• Increased saliva production or dry mouth
• Sexual disorders, for example reduced libido, erectile dysfunction and/or problems with ejaculation
• Hormonal disturbances, for example changes in menstrual cycle
• Allergic reactions.

For as long as you are being treated for psychosis, the doctor who is in charge of your treatment will renew your prescriptions and ensure that the right treatment guidelines are followed. Among other things, the doctor will:

• Ask about the effects and side effects of the medication
• Order and interpret blood test results
• Order and interpret electrocardiograms (ECG).

If you are being treated with several types of medication at the same time, your doctor will ensure that the medications work well together.

The treatment of psychosis is divided into different phases. An acute condition is treated as described under the ‘acute phase’ and the ‘stabilisation phase’, while a long-term condition is treated as described under the ‘stabilisation phase’ and ‘maintenance phase’.

Acute phase

In the acute phase, you experience a number of psychotic symptoms such as auditory hallucinations, paranoia and irregular thoughts. You are less able to cope with everyday living, and it can be more difficult for you to take care of yourself and carry out ordinary tasks. You may feel anxious and restless and find it difficult to stay calm. Your treatment focuses on the acute symptoms of psychosis, and you are often offered medication with a sedative effect.

However, in the acute phase, antipsychotic medication that does not primarily have a sedative effect has been seen to work quickly and effectively. For example, a fast-acting injection.

Stabilisation phase

During the stabilisation phase, psychotic symptoms persist. But you feel calmer, and the treatment is starting to work. You get to drink, eat and sleep, and you are better able to communicate with other people.

It is often at this stage that patients are discharged for follow-up by the regional psychiatric services, their family doctor and/or the municipal services. The stabilisation phase is a vulnerable phase in which it is important to continue treatment.

The phase is forward-looking and focused on your continued medical treatment. There will often be a switch to less sedative medication and an adjustment of the dose, depending on the effect and side effects.

During this phase, many are offered slow-release medication. This is medication for psychosis that is administered as an injection once every 14 days or once a month.

Maintenance phase

During the maintenance phase, you become familiar with your disease and become better at taking care of yourself. You are often treated at an outpatient clinic, where you talk to your therapist about the early warning signs of psychosis in order to avoid a relapse. Some still experience symptoms of psychosis, which they learn to live with. You are taught about your illness and the symptoms of psychosis.

Your medical treatment is monitored regularly, and your treatment will be adjusted to the lowest effective dose. It may be necessary to change your medication, for example due to side effects.

• Is this your first psychotic episode? 1-2 years of treatment.
• Have you had psychotic episodes before? 2-5 years of treatment.
• Have you had multiple psychotic episodes in the past? At least 5 years of treatment.

If you are admitted to a hospital, your medication will be administered and dispensed by the staff at the ward.

Well in advance of your discharge, a plan will be made for your future medication. The staff will ensure that you can obtain your antipsychotic medication free of charge at a clinic or pharmacy. This means that you do not have to pay for the medication yourself.

If you have been given medication as an injection (slow-release medication) while in hospital, a plan will be made for where you can get the injections after you are discharged. This could be in an outpatient psychiatric clinic, at your family doctor or at a health centre in your municipality.

If you start taking medication while you are receiving psychiatric treatment as an outpatient, you will be given prescriptions at the clinic, which you can take to a pharmacy. The staff at the ward where you are being treated are responsible for dispensing antipsychotic medication, writing prescriptions and communicating with your family doctor via the Shared Medication Record (Fælles Medicinkort (FMK)).

If you are taking several different medications at the same time, or if you find it difficult to remember to take your medications, it may be helpful to use pill dose boxes or dose-packed medications from your pharmacy.