Psychosis is a mental health condition characterized by the presence of delusions, hallucinations, disorganized behavior, and poor self-care. It can significantly impact an individual's social and occupational functioning. In this article, we will delve into the diagnosis, treatment, and management of psychosis at different levels of care, from primary to tertiary settings.
The diagnosis of psychosis involves identifying the core symptoms such as suspiciousness, fear without obvious explanation (delusions), and experiencing talking, smiling, or laughing to oneself (hallucinations). Other manifestations include disorganized behavior and poor self-care. When these symptoms are present, it is crucial to seek professional help for an accurate diagnosis and appropriate management.
Primary Care Level:
At the primary care level, wellness centers play a vital role in identifying and referring individuals with psychosis to primary health centers (PHC). If there is an immediate threat to self or others, referral to a taluk or district center is recommended. Regular follow-up and rehabilitation are crucial during this stage. Challenges in treatment continuation should be monitored and managed effectively. In cases of unsatisfactory outcomes, collaboration with higher centers and social welfare departments can help optimize treatment and provide disability certification and welfare benefits if needed.
Treatment for psychosis often involves medication and psychoeducation. Risperidone, an antipsychotic medication, is commonly prescribed, starting with a low dose and gradually increasing as needed. Trihexyphenidyl may be added to manage specific symptoms. Psychoeducation plays a crucial role in helping individuals understand the medical model of psychosis, address misconceptions, and build hope. It is also important to inform patients about possible adverse effects of medications.
Follow-Up and Referral:
Regular follow-up is essential to assess changes in symptoms and manage any adverse effects of the medication. Adjustments in medication dosage may be required based on the individual's response. Referral to a taluk or district level center may be necessary in cases of diagnostic confusion, poor response to medication, comorbid conditions, or significant adverse effects. Collaboration between primary care and secondary care centers ensures continuity of care for individuals with psychosis.
Secondary Care (Taluk/District Hospitals):
At the secondary care level, referral from primary care may occur due to diagnostic confusion, poor response to medication, intolerance to medication, poor treatment adherence, comorbid conditions, or challenging situations. It is essential to clarify the diagnosis and rule out organic causes through neuroimaging if necessary. Different treatment approaches are followed based on positive and negative symptoms, with a focus on managing associated conditions such as depression, anxiety, and extrapyramidal symptoms.
Tertiary Care Centers:
Tertiary care centers provide specialized interventions for individuals with psychosis. Psychoeducation, family therapy, cognitive remediation, cognitive-behavioral therapy, social skills training, vocational rehabilitation, and supported education are some of the interventions available. Specific interventions may be required for substance use disorders, pregnancy and puerperium services, and addressing sexual and endocrine problems.
Psychosis is a complex mental health condition that requires comprehensive diagnosis, treatment, and ongoing management. Collaboration between different levels of care, from primary to tertiary, ensures that individuals with psychosis receive appropriate interventions and support. By understanding the symptoms, diagnosis, and treatment options for psychosis, we can work together to improve the lives of those affected by this challenging condition.