Psychosis is a condition that affects the mind, causing some loss of contact with reality. The main symptoms are delusions and hallucinations. Delusions are false beliefs, not based in reality, that the person refuses to give up, even when presented with factual evidence that contradicts the belief. Hallucinations involve seeing or hearing things that don’t exist. Other symptoms of psychosis can include confused thinking and speech, decreased emotions, and decreased motivation.
Psychosis is associated with several mental health conditions, but the main ones are schizophrenia, bipolar disorder, and major depressive disorder with psychotic features. Substance abuse can also cause psychosis due to intoxication or withdrawal effects. Around 100,000 Americans experience first-episode psychosis each year. Most often, the initial psychotic episode occurs in the late teenage years to mid 20s.
People experiencing acute psychosis often present to emergency departments when their symptoms become dangerous or intolerable. Delusions may lead a person to harm themselves or others, while hallucinations can be very disturbing. Medications like antipsychotics can rapidly reduce psychosis symptoms, but accessing these medications often requires going to the ER.
How does the ER treat psychosis?
The emergency room provides first-line treatment to stabilize someone in a psychotic state. The goals are to:
– Ensure the person’s safety and the safety of others
– Reduce acute symptoms like delusions, hallucinations, and confused thinking
– Determine if an underlying medical condition is causing or contributing to psychosis
– Start ongoing treatment to prevent future relapses
To accomplish these goals, the ER takes several steps:
Medical evaluation
The doctor will do a medical exam and order urine and blood tests. They check vital signs and look for signs of drug use. These evaluations determine if infections, brain injuries, thyroid problems, or substance use are fueling the psychosis. Underlying medical causes need to be treated.
Medications
Powerful antipsychotic medications rapidly resolve acute psychotic symptoms. The doctor will prescribe these, often starting with pills but sometimes using fast-acting injections. Possible medications include haloperidol, ziprasidone, aripiprazole, and olanzapine. Benzodiazepines like lorazepam relieve agitation and help the person calm down.
Observation
The ER staff will closely monitor the individual for several hours to days. They ensure medications are working and watch for side effects. Observation continues until psychosis resolves and the person is no longer a risk to themselves or others.
Mental health assessment
Psychiatric specialists will do a full exam and history. They diagnose specific conditions like schizophrenia that are causing psychosis. These experts initiate long-term treatment recommendations to prevent future psychotic relapses when the person leaves the ER.
Involuntary hospitalization
If medications and observation don’t stabilize acute psychosis, the person may require psychiatric hospitalization. Laws allow for involuntary holds when someone’s mental state makes them dangerous. Hospitalization continues until psychosis resolves, which typically takes 1-3 weeks.
Medications for Psychosis in the ER
The ER has access to powerful antipsychotic medications that can rapidly reduce psychosis symptoms like delusions, hallucinations, and confused thinking. Here are some of the medications commonly used:
| Medication | Form | Usual Dose | Time to Work |
|---|---|---|---|
| Haloperidol | Injection or pills | 2-10 mg | 30-60 minutes |
| Ziprasidone | Injection | 10-40 mg | 30-60 minutes |
| Aripiprazole | Injection | 5.25-15 mg | 1-3 hours |
| Olanzapine | Injection or pills | 5-20 mg | 15-45 minutes |
| Lorazepam | Injection or pills | 1-4 mg | 15-30 minutes |
These rapid-acting medications provide fast relief while also allowing time to do a full psychiatric assessment and planning for ongoing treatment after leaving the ER.
When to Go to the ER for Psychosis
The emergency room should be utilized when:
– Psychotic symptoms like delusions or hallucinations come on suddenly or severely worsen
– Confused thinking makes it hard to function or care for yourself
– You have thoughts of harming yourself or others
– Medications prescribed for psychosis are no longer controlling symptoms
– You need immediate access to psychiatric specialists and medications
Don’t wait until symptoms become intolerable or dangerous. Early intervention in the ER can rapidly stabilize psychosis and prevent worsening.
What to Expect in the ER
Visiting the ER for psychosis can be stressful, especially when thinking is unclear. Knowing what to expect can provide comfort. In the ER, you can anticipate:
– Waiting initially in a waiting room, followed by a private room
– Being asked questions about symptoms, history, and medications
– Potentially being interviewed by psychiatric specialists
– Medical tests like bloodwork, urinalysis, and vitals checks
– Administration of antipsychotic medications, likely starting with a pill form
– Monitoring and observation for several hours or days
– Adjustments of medications until symptoms improve
– Discharge planning when psychosis has stabilized, with prescriptions and mental health follow-up
The ER staff recognizes psychosis is frightening and will work to make you feel safe. Having a trusted family member or friend present can also provide support.
Outlook After Leaving the ER
The emergency room treats the acute crisis of psychosis, but ongoing treatment is needed after leaving the ER. Recommendations may include:
– Take antipsychotic and other psychiatric medications daily as prescribed
– See a psychiatrist and therapist regularly for therapy and medication management
– Participate in psychosocial rehab to rebuild skills weakened by psychosis
– Utilize case managers and peer support specialists for assistance
– Avoid illicit drugs and limit alcohol, as these worsen psychosis
– Learn to recognize early warning signs of psychosis relapse
– Develop a crisis plan for dealing with future psychotic episodes
While relapses may happen, with proper treatment most people can manage psychotic disorders and avoid needing the ER again. Early intervention at the next psychotic relapse is essential.
Advantages of Going to the ER
The ER has unique advantages for treating acute psychosis:
– It offers immediate access to psychiatric care, medications, and safety monitoring, 24/7
– Powerful injectable antipsychotics and benzodiazepines work quickly
– Medical tests can detect underlying causes fueling psychosis
– Involuntary hospitalization is possible if needed for safety
– No appointments or insurance approvals required – you just walk in
– After stabilization, connections are made to ongoing outpatient care
For a psychotic crisis requiring rapid symptom relief and expert care, the ER can be life-saving. The quick results help restart your life after an episode.
Risks of Avoiding the ER
Some people may hesitate to go to the ER during psychosis because of stigma around mental illness or bad hospital experiences. However, avoiding the ER carries risks:
– Psychotic symptoms can worsen unchecked, becoming severe and harder to treat
– Dangerous behavior like suicide or violence become more likely
– Medications prescribed as outpatient may be inadequate or poorly adhered to
– Lack of supervision means increased vulnerability when thinking is impaired
– Minimal access to psychiatric specialists delays diagnosis and treatment planning
– Illicit drug use becomes more likely in an effort to manage symptoms
Overall, avoiding the ER can delay recovery, while worsening symptoms and risky behaviors put your safety in jeopardy. Don’t let stigma prevent getting urgent help.
Financial Help Accessing the ER
For those without insurance, the ER can be costly. However, resources exist:
– Medicaid covers emergency room visits for those who qualify based on low income
– Hospitals have charity care and financial assistance programs for uninsured patients
– Community health clinics provide free or low-cost care and may help access the ER
– Prescriptions can be filled affordably at some pharmacies and with drug company coupons
– Mental health case managers assist obtaining medications and applying for benefits
Finances shouldn’t get in the way of emergency psychiatric care. Reach out in your community for help accessing affordable services.
Supporting Others Experiencing Psychosis
When someone you care about develops psychosis, you can help by:
– Learning about psychotic disorders to better understand their experience
– Providing reassurance and emotional support without judgment
– Monitoring symptoms and encouraging early ER intervention when needed
– Offering transport to the ER when unstable or dangerous
– Participating in discharge planning and care coordination
– Promoting adherence to medications and ongoing treatment
– Helping to avoid substance use and manage stress
– Being patient – recovery from psychotic episodes takes time
With compassionate support, an episode of psychosis can be overcome. Your company through the difficult ER experience can make a big difference.
Conclusion
A psychotic crisis constitutes a psychiatric emergency requiring rapid intervention. The ER offers round-the-clock access to safety monitoring, powerful antipsychotic medications, medical evaluation, involuntary hospitalization when needed, and linkage to ongoing care. This quick relief of symptoms helps prevent worsening while starting you on the path to long-term recovery. Don’t hesitate to utilize the ER for expert care when psychosis becomes severe. With treatment, most people with psychotic disorders can expect an improved quality of life and productive future.