“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. On they went.

---

But for early intervention to occur, 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, say, an 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?

The information shared here 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 early intervention to occur, signs and symptoms have to be observed, noted, and reported. That means family and friends are major players.

Here are some things to look for…

Extreme expressions of emotion, dramatic mood swings, engaging in risky activities (shoplifting, sex, gambling, erratic driving, etc.), extremes 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 an unpleasant list, isn’t it. And it’s understandable that one may want to avoid getting involved. But the longer it’s put off, the harder it is on the individual – and those with whom they may come in contact.

If the individual is talking or behaving in a threatening manner toward self or others, don’t hesitate to 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, meds are the only option.

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.

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

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 and schizophrenia can help individuals who love someone with these illnesses. Research shows that people with schizophrenia who have a strong support system do better than those without the encouragement of friends and family.
• Self-help groups: community care and outreach programs to continue working on social skills.
• Coordinated specialty care (CSC): designed for folks experiencing an episode of psychosis spectrum disorders 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. 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: puts the focus on helping the patient set and achieve goals and building a sense of optimism and positive beliefs about themselves and others.

That’s an awful lot, and one missing piece could mean disaster.

Medication

I know I’m painting with a broad brush, but if there’s a psychosis spectrum disorder that doesn’t require medication, I haven’t seen or heard about 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 schizophrenia 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 the dopamine pathways.

Though they 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)

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 the 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.

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.

That’ll do it

That’s going to do it 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 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 assistance – and their hard work. Head on over 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.