The first step in treating psychotic symptoms is to pin down their cause. If the psychosis is due to substance intoxication or substance withdrawal, the psychotic symptoms treatment recommendation will necessarily be very different that if the diagnosis is Schizophrenia or Mood Disorder.
Anti psychotic medications are effective in managing symptoms across the variety of different diagnoses, but their dosage and duration vary widely depending on the particular condition being treated. Psychic symptoms caused by substance intoxication are usually transient and self limited, and disappear spontaneously.
The best treatment is usually as simple reassurance, talking the person down, providing realty cues and corrections, and ensuring a structured, safe, and quite environment. Occasionally, an anti psychotic or a sedative medicine is helpful, especially if the person is severely agitated or sleepless. On rare occasions, a brief hospitalization or prolonged emergency room stay may be necessary.
Things get much more complicated if the psychotic symptoms triggered by substance intoxication don’t disappear as expected within days or weeks of stopping the drug. In these instances, it is impossible to know for sure what is happening.
Did the cocaine cause an usually prolonged cocaine psychosis, or did it merely trigger a psychosis in someone who was already vulnerable and might have had the problem anyway, or was the cocaine taken secondarily after the person was well on the way to becoming psychotic? If psychotic symptoms persist beyond a few days, anti psychotics should be started and the person needs careful observation in a structured environment to avoid the risk of suicide, violence, or accidents.
Usually these episodes respond well to medication and the patient can be gradually tapered off the antipsychotic medicine and advised strongly to stay forever away from mind altering drugs because they have proven to be so destructive .
If psychotic symptoms occur during substance withdrawal, this will usually indicate that the person had been dependent on alcohol or on a sedative hypnotic medication, or both. The withdrawal syndrome can constitute a medical emergency with appreciable risks of delirium tremens, seizure and death. Active detoxification, establishing electrolytic balance with intravenous fluids, and vitamin replacement are crucial. Symptomatic treatment may also be necessary with antipsychotic medication directed toward the psychotic symptoms and agitation.
Brief psychotic episodes are usually treated with a short course of antipsychotic medication, removal from the stressful situation, the provision of a structured and safe environment, and finally psychotherapy to identify the stressors, teach new coping skills for dealing with them, and to help you deal with the painful fact that you had a psychotic episode.
Delusional Disorder is usually treated with antipsychotic medications. Psychotherapy can also be helpful to sharpen reality testing and call into question the certainty with which the patient holds the delusional belief.