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Women & Psychosis: A Guide for Women and Their Families Centre for Addiction
and Mental Health

2. Recovering from psychosis

Women and Psychosis: A Guide for Women and Their Families

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Issues for Today’s Women

In our society, poverty, domestic abuse and childhood sexual abuse are experienced more often by women than men. Other pressures may include cultural expectations to be slim, a “good” mother and a family caretaker, all while holding down a full-time job. In some households, these issues loom very large. Immigrant and refugee women (and men) may also face discrimination, exploitation, isolation and language barriers. We don’t know whether such pressures contribute to the origin of psychosis or to the speed of recovery.

CommonQuestions about Recovering from Psychosis

Since becoming ill, I'm not feeling very good about myself. Is this normal?

The experience of psychosis is a life crisis. It is a trauma that may, in itself, lead to a posttraumatic stress reaction. It is hard, after an episode of psychosis, to know what to expect of the future. So much remains unknown.

In addition, negative stereotypes still exist in many communities about people with mental illness. This stigma has a negative impact on people living with psychosis. If you are not feeling good about yourself, ask yourself whether this is due to stigma, depression, fear about the future or something else. Try to sort out your feelings and discuss them with a trusted family member, friend or therapist.

Talking things over will help you rebuild confidence and decide on the next steps in recovery. Some women find it useful to attend a support group for women who have had similar experiences.

What can I do to recover from my illness?

A woman trying to regain control over her life needs to work closely with her doctor and other health care providers. Together, they can explore the personal risk factors that may have contributed to the illness. It is important to learn as much as possible about what may have caused the episode, so that similar situations can be avoided in the future. Therapists usually recommend plenty of sleep, exercise, a nutritious diet, a social support network, positive family connections, meaningful work and structured days. Often, regular appointments with a mental health worker and low-dose medications are needed to keep psychosis at bay.

Recovery after psychosis does not happen quickly or easily. One of the biggest challenges for you is how to manage your anxiety about an uncertain future. With help from others, you must find a way to keep sight of future possibilities.

Questions about Medications

What drugs are used to treat psychosis?

Antipsychotic medications are the foundation of treatment for psychosis. To prevent relapse, medication is usually continued after the psychosis is over. New antipsychotics are always being developed.

Here are some names of antipsychotics commonly used in Canada:

“Typical” antipsychotics (older drugs)

“Atypical” antipsychotics (newer drugs)

- haloperidol (Haldol)
- trifluoperazine (Stelazine)
- perphenazine (Trilafon)

- olanzapine (Zyprexa)
- risperidone (Risperdal)
- quetiapine (Seroquel)

Other medications may also be prescribed. These can address the psychosis or manage the side-effects of drugs, such as stiff muscles for example. Extra medication may also be prescribed for sleep problems, depression, anxiety, weight gain or mood swings.

Do women respond differently to drugs than men do?

Women usually need lower doses of drugs than men do during acute phases of illness and maintenance phases (when symptoms are under control). However, this may not be true after menopause. Women may at first need lower doses because they are more likely to take medication as instructed. Women and men’s bodies may absorb and metabolize drugs differently. Doses are also affected by diet, weight, heredity, smoking, drinking alcohol, or using street or other prescription drugs. Antipsychotic drugs tend to accumulate in fat cells of the body and, because women on average have more fatty tissue than men have, the drugs last longer in women’s bodies.

Do women experience any side-effects?

With any medication, unwanted side-effects may develop. In most cases, side-effects are not serious, and they often respond to treatment or disappear as therapy continues. You may experience some side-effects before you notice the benefits of your medication. This is a sign that the drug is being absorbed into the body and is beginning to work. Do not stop your medication without checking with your doctor first.

Side-effects can vary with the dose and medication. Some women have almost no side-effects, or very mild ones. Others have side-effects that are more severe and troubling. Each person’s responses are unique. Be aware of the possible side-effects. Be sure to tell your doctor about any side-effects you experience.

Most drugs used in psychiatry decrease metabolism and therefore cause weight gain. This is a serious problem for most women and requires careful attention to diet and exercise. It can contribute to a higher risk of diabetes and cardiovascular disease. It is important to let your doctor know if there is diabetes or cardiovascular disease in your family, and to have regular tests of glucose levels.

Drug Effects on Menstruation

Many drugs used in psychiatry block the transmission of the neurochemical dopamine, increasing the secretion of the hormone, prolactin. This process may interfere with menstrual periods. Tell the doctor if there is a change in your menstrual cycle. If you're period has stopped, don't jump to the conclusion that you're pregnant. If at all possible, the doctor will adjust your medications so that menstruation is not interrupted. Though some antipsychotic drugs lower fertility, if your menstrual periods stop, it may mean that you are pregnant. If this is not something you are ready for, be sure to use contraception. It is important to discuss contraceptive issues with your doctor or mental health worker.

The rise in prolactin can cause other side-effects, too. These include breast tenderness or swelling and, sometimes, milk flow from the breasts. Some women find these side-effects very uncomfortable. Another side-effect can be vaginal dryness. Some women also feel less interested in sex than usual or may be unable to reach orgasm. It is important to discuss sexual side-effects with your health care provider.

Drowsiness and passivity

Medications may also cause drowsiness or feelings of passivity. Feeling passive means that, instead of standing up for yourself, it is easier to just “go along.” In domestic situations, women may find themselves taken advantage of because their medications make them passive. In some work, driving or caretaking situations, the sedative effect can be very dangerous and needs to be discussed with your doctor. There are usually simple ways to deal with this side-effect.

Tardive dyskinesia (TD)

Older drugs used for psychosis sometimes cause involuntary movements (tardive dyskinesia) after many years of taking the drug. The newer drugs are less likely to cause this problem.

Other side-effects

Other side-effects can include constipation, muscle stiffness, restlessness, anxiety, insomnia, drooling or nightmares. Rarely, epileptic-like seizures may occur.

How long will I need to take medication?

This will depend on the person, the situation, the phase of illness, the diagnosis and the stresses you are under. You may need to take medications even after the symptoms have decreased or gone away. If you don’t continue to take medication, you may risk having another psychotic episode. Most people do not like the idea of taking medication regularly. Taking antipsychotic medication is like using sunscreen lotion when out in the sun to protect against skin cancer. Medication helps to protect against stressful life events that can trigger a relapse into psychosis. Discuss all medication concerns with your doctor.

Is it OK to drink alcohol when I’m taking the medication?

The occasional glass of wine or beer should not trouble most people. However, drinking a lot can make you more likely to relapse. Specialized counselling exists for those who have problems with alcohol or other drug use.

What about the effect of taking other drugs?

It is very clear that using street drugs worsens psychotic symptoms. Even if you are free of symptoms, drug use can cause symptoms to return. Drug use can lead to relapse and being hospitalized.

Over-the-counter drugs, prescription drugs, herbal remedies, caffeine and smoking may also interact with your medication. Caffeine raises the blood level of some antipsychotic drugs. Smoking cigarettes may affect how your body metabolizes your medication. Many smokers may need to take larger doses of medicine. You should talk to your doctor or pharmacist about using any of these drugs.

Do birth control pills affect my medication?

Birth control pills, or oral contraceptives, contain female hormones - estradiol and progesterone. These hormones can inhibit liver enzymes that metabolize the prescribed drugs. When this happens, more of the drug goes into your bloodstream. As a result, the blood levels of antipsychotic drugs may rise and unwanted side-effects can occur. It is best to consult your doctor about how birth control pills and antipsychotic drugs might interact.

What other types of birth control could I consider?

Some women prefer barrier methods, such as the male or female condom or a diaphragm. Insisting that all male partners wear condoms during sexual intercourse is probably best. Condoms not only minimize the risk of unwanted pregnancy, but also help stop viruses or other infections from spreading. Since the outbreak of the HIV/AIDS epidemic, it is crucial to be safe against infection. You may find it hard to ensure that a male partner wears a condom at all times. If so, it is best to consult your doctor about what else is available. New products are being developed.

You may want to check the availability of morning-after pills, and to ask your doctor whether they would be a good option for you. You may find it useful to attend sex education classes. There, you can learn about the large choice of contraceptives in everyday use. You can also learn how to say “no” to unwanted sexual advances. It is important to be protected from abuse and harassment.

Can the antipsychotic drugs take away nutrients from my body?

This is a very complex area. Some prescription drugs may affect how the body absorbs and metabolizes vitamins and minerals. More needs to be learned about this topic. It is useful to have your doctor take a blood test to periodically check your levels of folates and vitamin B. You may also wish to speak to a nutritionist or pharmacist.

Questions aboutTreatments other than Medication

Besides drugs, what else is used to recover from a psychotic episode?

Learning about the illness and its treatment is crucial. This will help you to make informed treatment decisions, and to stay as healthy as possible. A rehabilitation program can help you regain confidence and skills. Therapy or counselling can help you cope with illness. Cognitive therapy, which focuses on the links between thoughts, feelings and actions, can teach you how to cope with specific symptoms. You can participate in individual or group counselling. Marital and family counselling is often helpful.

Support for the family is important. Parents, siblings, partners and children are all deeply affected by a relative’s psychosis. They need to learn how to cope practically with their family member’s illness from day to day. They also need the chance to talk about their concerns.

Are herbal remedies effective?

To date, there is not enough evidence to support using herbal medicines to treat psychosis. Some herbal remedies may actually cause psychiatric symptoms. More research is needed in this area. You should inform your doctor if you take any herbal remedies.

Is shock treatment ever used for psychosis?

Shock treatment, or electroconvulsive therapy (ECT), is sometimes advised for people with psychosis. Shock treatments used today usually apply electricity to one side of the brain - not both sides as was done in the past. Current shock treatments cause little memory loss compared to the older forms. The actual amount of memory loss depends on the number of consecutive treatments, the time between treatments, and the person’s unique response.

What is TMS?

A new form of treatment is transmagnetic stimulation (TMS), which applies magnetic waves to the brain. TMS is helpful for specific symptoms such as hallucinations.

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