Building a House: Treating Psychosis With Anti-Psychotics

"I do use them, if the patient is agreeable. I use them as sparingly as possible, because the side effects of antipsychotics are extremely uncomfortable, and the long-term effects are likely deleterious. (The data on long-term effects is confounded by the long-term effects of staying psychotic for decades, and results are contradictory, but that is for another post.) But often, in the earliest stages of our work together, a small dose of an antipsychotic can make our therapy work much easier."

"I think of the early stages of treatment with someone experiencing psychosis as akin to building a house. If we build the house on bare dirt without pouring a concrete foundation, the house might look fine for a while. But because the dirt under the house will shift with time, the house will crack and eventually collapse. The anti-psychotics act like a concrete foundation."

Antipsychotics are used when patients agree, applied as sparingly as possible due to uncomfortable side effects and likely harmful long-term effects, though data are mixed. Small doses early in treatment often facilitate psychotherapy by providing emotional stability and improved reality testing. The medication functions as a temporary foundation enabling therapeutic work and life rebuilding such as returning to work, school, or relationships. Building recovery without medication is possible but tends to be slower, more arduous, and sometimes less successful. Antipsychotic medication alone does not cure psychosis; sustained recovery requires therapy and reestablishing meaningful life activities.

Read at Psychology Today