Psychosis: Crisis Intervention Techniques
Source: CIT Conference Notes 2021
Psychosis is a symptom, not a diagnosis. The three most common diagnoses are: anxiety, depression and substance use. Psychosis is what people commonly call “crazy”. Neighbors and strangers call in more frequently than family members.
Medical conditions that show the symptom of psychosis (such as seeing shadows and hearing negative voices) are: Schizophrenia, Bi-Polar, Depression, and Drug use (like methamphetamine).
Other symptoms include: disorganized speech, flat affect, catatonia, work salad, laughing and/or talking to self, long pauses (while listening to inner voices), no eye contact, etc.
Stigma leads to denial and rejection of treatment and/or meds. Meds can have side effects, such as too much dopamine can cause psychosis, while too little dopamine can cause catatonia. Dopamine is controlled by ant-psychotic medications which can affect other parts of the brain. Family involvement in and support of treatment is helpful.
Hallucinations are very real and very scary to the person having them.
They can affect all five senses. Command hallucinations can lead to dangerous behaviors, so it’s okay to get right to the point:
Are you hearing voices?
Are the voices telling you to harm yourself or others?
Do you plan to obey the voices?
To determine if the hallucinations are due to substance withdrawal, ask: When is the last time you used or drank?
It is important to determine if the threat is imminent, if the person has an action plan, and is the person planning to act. Let the person talk (in order to gather information). Is the person escalating?
Do’s and Don’ts
Limit unnecessary bystanders as too many people can cause agitation and/or distraction.
Maintain your connection with the person while debriefing, by talking to the person, not your partner. (Your partner will pick up the important details).
Validate the person’s feelings rather than the hallucinations.
Don’t make false promises.
Don’t use force as long as it is safe.