IN CRISIS OR NEED SUPPORT? Call Here 24/7 anytime! 1-844-437-3247

Thinking about suicide? 9-8-8 is here to help. Call or text 9-8-8 toll-free, anytime. English and French.

You are currently on the:

CMHA National

Visit our provincial websites

Services for First Episode of Psychosis

1st Step is an assessment and treatment program for people who are experiencing a first episode of psychosis — an experience where you might have trouble telling the difference between what is real and what isn’t. Referrals are welcome from anyone, including families, doctors and community partners.

1st Step

1st Step is an assessment and treatment program for people who are experiencing a first episode of psychosis — an experience where you might have trouble telling the difference between…

General Information

  • Frequently Asked Questions About Psychosis

    There are many questions someone living with psychosis might wonder: Will I have to go to hospital? How long do I have to stay on medication? What are the side-effects of medication? What do I tell my friends? At 1st Step, you’re not alone – we’re here to help. Read on to find out the most commonly-asked questions about living with psychosis and their answers.

    Does this illness mean I’m “crazy”?

    The symptoms you are experiencing are part of a biological or physical problem and do not change who you are as a person.

    What are the medication side-effects?

    Generally, doctors try to treat your symptoms with low doses of medication. They will work with you to find medication that is comfortable for you.

    How long do I have to stay on meds? Will I have to take them for the rest of my life?

    This is one of the most asked questions that we hear. We can’t give you a definite answer; everyone is different. This is something to discuss with your physician and treatment team. Some people are recommended to remain on medication for a year after symptoms have cleared up, others may need to stay on longer, and others may need to take lifelong medication.

    When can I go back to work/get a job/return to school?

    Most people are able to return to work or school after experiencing a psychosis. Some people are able to continue at work or school while in treatment; others need to take some time out to recover. It’s a difficult question to answer because everyone is different, and everyone’s experience is unique; however, our team has an occupational therapist that can help you in this area of recovery.

    What do I say if my friends find out I’m taking medication?

    A lot of people have this concern. They’re worried what people will think if they know about their illness. Many people are surprised by the amount of support that they receive from others. One thing that is helpful is to speak with others who have gone through a similar experience. At 1st Step, we run groups to talk about these kinds of issues. It gives you a chance to meet others who are recovering or who have recovered from psychosis, and to find out how they are managing and what solutions and strategies they have come up with.

    Will I get addicted to the medications?

    Medications prescribed for psychosis, depression, and bipolar illness are not addictive; however, we do not recommend that you stop taking them suddenly, as sometimes people will experience some physical discomfort. What we do recommend is that you work with your physician and follow their recommendations when you and your treatment team have agreed to discontinue a medication. Generally, medication dosage is slowly decreased over weeks, sometimes months, and you will be taught what signs of a return of symptoms to watch for.

    Can I still drink/use marijuana and other street drugs with the medications?

    We will recommend that you do not drink alcohol with medication. Alcohol can have a harmful interaction with some medication. It also tends to increase side effects so that if your medication makes you feel drowsy, having a drink will make you even more tired. You certainly don’t want to drive a car or use machinery if you are taking medication and using any alcohol!

    Some street drugs, like amphetamines (e.g. crystal meth), can cause psychosis. Others, like marijuana, may bring on psychotic symptoms in people who are at risk for a psychotic illness (e.g. family history). At the same time, we realize that young people do use alcohol and street drugs, and we think it is important that you be honest about your use. That way, we can work together to find the best possible treatment.

    Will I be forced to go to hospital?

    Our goal at 1st Step is to work with you in the community. Hospital is reserved for those who are finding that their symptoms are just too overwhelming to manage on their own, and need some extra support and a reduction in life’s daily stressors. In Ontario, the Mental Health Act allows a physician by law to require a person to go to hospital if their illness is so severe that they are not able to care for themselves, are at risk of harming themselves, or at risk of harming others. If this should happen, you would have a right to appeal this decision.

  • General Resources
  • Information About Antipsychotic Medication

    The use of medication is an important part of treatment for psychosis along with individual and group counselling, peer support, family therapy, school and vocational support. This combination helps people manage symptoms and improve quality of life.

    Taking care of your physical health is important while taking antipsychotic medication.  There is an increased risk of diabetes, weight gain, sugar and lipid abnormalities, sexual side effects. Maintaining regular appointments with your doctor and nurse can help you to have good physical health.

    Antipsychotic medications are the main class of drugs used to treat people with psychosis and schizophrenia. They are also used to stabilize moods in bipolar disorder, reduce anxiety in anxiety disorders.


    • to relieve symptoms of psychosis such as delusions (false beliefs) and hallucinations (seeing or hearing something that is not there)
    • Calm and clear mental confusion
    • reduce the stress and anxiety these symptoms cause
    • prevent further episodes of psychosis
    • Reduce and control psychotic symptoms while keeping side effects at a minimum

    How Antipsychotic Medications Work

    Psychosis is thought to be caused by a dysregulation of the brain chemical called dopamine. The antipsychotic medication helps modify this dopamine effect which makes the symptoms of psychosis (hallucinations and delusions) less commanding and preoccupying. It does not always make the symptoms go away completely. People may still hear voices and have delusions but they are more able to recognize what isn’t real and focus on other things like work, school, hobbies, and family.

    Types of Antipsychotic Medications

    Most people are taking the second generation (also called atypical) antipsychotic medication. They can also treat mood and anxiety disorders and have milder movement related side effects. People may need to try different antipsychotics before finding the one that works best for them. This medication is available in tablets and long acting injections.

    Some people may need to use a combination of medications to treat other symptoms of mental health problems or to offset side effects.

    Typical Antipsychotics Include

    • Risperidone (Risperdal)
    • Quetiapine (Seroquel)
    • Olanzapine (Zyprexa)
    • Ziprasidone (Zeldox)
    • Paliperidone (Invega)
    • Aripiprazole (Abilify)
    • Clozapine (Clozaril)
    • Risperdal Consta ( every 2 week injection)
    • Invega Sustenna (monthly injection)
    • Invega Trinza ( every three month injection)
    • Abilify Maintena (monthly injection)

    Side Effects

    Antipsychotic medication can cause side effects and these may go away as your body adjusts to the medication. The following are common side effects that people may or may not experience:

    • Sedation (sleepiness, low energy)
    • Weight gain
    • Decreased sex drive and function, discharge from breasts
    • menstrual cycle irregularities
    • Dizziness
    • Movement effects ( tremor, muscle stiffness)
    • Restlessness
    • Repetitive involuntary movements (rare)

    Some people accept the side effects as a tradeoff for relief of psychotic symptoms, others find the side effects distressing.

    Do not stop taking the medication until you check with your Psychiatrist or nurse.

    Your side effects will be monitored closely and there are a variety of ways to help manage them. Your psychiatrist may:

    • Adjust the medication dose
    • Prescribe another medication to help control the side effect
    • Change the medication

    Dosage and Duration

    Initially a low dose of antipsychotic will be started, which may be gradually increased over time. It may take several weeks for the medication to have its full effect. If the

    antipsychotic medication does not produce satisfactory results another antipsychotic can be tried.

    It is recommended that you take your medications everyday as prescribed even after your symptoms of psychosis are gone. Recommended that you take medication for 2 years.

    If you miss a dose take it as soon as you remember; unless it is close to the next scheduled time that you would normally take the medication.

    There are other medications that may also be used to help with other symptoms such as sleeping difficulties, depression, anxiety and mood swings.

    If you have questions about your medications or their side effects please contact your clinician, nurse and speak with your psychiatrist.

  • Information About Your Medication

    The use of medication is an important part of the treatment for psychosis, along with education about the illness for you and your family, group and individual counseling, monitoring of symptoms, family support and cognitive behavioural therapy.


    • to relieve the symptoms of psychosis
    • to reduce the stress and anxiety these symptoms cause
    • to prevent further episodes of illness


    There are many different medications available to treat the symptoms of psychosis. These medications are called antipsychotics, also referred to as neuroleptics. These medications are divided into two categories: typical antispychotics and the newer atypical antipsychotics.

    • Typical Antispychotics: haloperidol (Haldol), trifluoperazine (Stelazine), perphenazine (Trilafon) and others
    • Atypical Antispychotics: risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), Clozapine (clozaril)

    These medications are equally effective in the treatment of an early episode of psychosis. The atypical antipsychotics are usually tried first, because they also treat mood and cognitive impairments, and differ in terms of the side effects profile.

    Side effects

    • tiredness
    • sedation
    • weight gain
    • sexual dysfunction
    • dizziness
    • dry mouth
    • menses changes
    • blurred vision
    • nausea
    • urinary retention
    • increased appetite
    • constipation

    Some other side effects include restlessness, stiffness, tremors and involuntary movements. Please let your clinician know when you experience any side effects. You may experience side effects before you notice the benefit of the medication. This is a sign that the medication is being absorbed into the body and starting to work. Do not stop taking the medication until you check with your psychiatrist or nurse.

    Most side effects experienced will diminish over time. Your side effects will be monitored closely and there are a variety of ways to help manage them.

    Dosage and duration

    Initially, a low dose of antipsychotic will be started and may be gradually increased over time. It may take several weeks for the medication to have its full effect. If the antipsychotic medication does not produce satisfactory results, another antipsychotic can be tried.

    It is recommended that you take your medications every day as prescribed, even after your symptoms of psychosis are gone. If you miss a dose, take it as soon as you remember, unless it is close to the next scheduled dose of medication. There are other medications that may also be used to help with other symptoms such as sleeping difficulties, depression, anxiety and mood swings.

  • Managing Your Recovery

    There are many tools and skills to learn for managing your recovery from psychosis and preventing relapse. With a positive attitude and the right support, recovery is possible. Read on to learn about maintaining your recovery.

    What can I do to prevent relapse?

    Learn how to reduce and manage stress through identifying coping tools for dealing with stressful life events:

    • Celebrate your achievements.
    • Set achievable goals, including specific strategies for coping with change, staying social and having a trusted support network.
    • Maintain regular medical check-ups.
    • Participate in positive social, recreational and work activities.
    • Seek the help of a therapist, and/or participate in group therapy or a self-help group.
    • Continue to take prescribed anti-psychotic medication.
    • Talk to your psychiatrist or GP if you have any concerns regarding the side effects of medication or are considering reducing your medication. Ensure that your concerns are heard and enlist the help of a trusted friend, your clinician, a peer support coach or a family member if necessary.
    • Seek and develop relationships with family and friends where you feel comfortable, happy and secure.
    • Avoid using illicit drugs, especially cannabis and amphetamines which can trigger further episodes.
    • Know your early warning signs of relapse and create a relapse prevention plan that you share with your helping professionals, family members, and good friends.

    Tips for limiting alcohol

    Strategies to reduce how much you drink:

    • Dink light beer. Drink slowly.
    • If you’re going to a party, bring your drinks with you so that you control what you drink.
    • Mix your own drinks with a small amount of alcohol, or even no alcohol — no one will know.
    • Be ready with your reason for not getting drunk at the party (e.g. “I have to get up early tomorrow,” “I’m not in the mood,” “I’m cutting back,” “my liver is mad at me”).
    • Use humour — it is very unlikely that others will mind if you’re not drinking; they probably will not even notice.
    • Do something that you’re passionate about to fill up your free time when you would otherwise be drinking. Join a group, class, or club.

    If you drink to relax in social situations, try working with your clinician on other strategies to deal with social anxiety. Many people feel awkward or uncomfortable in a large group, especially with new people.

    Information about your medication

    The use of medication is an important part of the treatment for psychosis, along with education about the illness for you and your family, group and individual counseling, monitoring of symptoms, family support and cognitive behavioural therapy.

  • Recovery Stories

    Share your story

    Are you or your family member currently involved with the 1st Step program? Have you graduated from 1st Step? We would love to hear from you. By sharing your own recovery story or just a few words of advice, you can help other people who are just starting along the path to improved health.

    Please call Garry at (519) 576-2333, ext. 4530 and we’ll work out the details. Thank you!

    Recovery stories

  • Showcase (Artwork and Poetry)

    In the 1st Step Showcase, you’ll find artwork and poetry from past 1st Step participants.



    The Gentle Whisper

    By Happy Face

    With half a brain and a full mind
    I still thought of you
    While sinking in a textured sea
    You were true
    Like dust burning soft holes through my eyes
    Abracadabra poof
    A forced-laugh face, relaxed my attitude
    Myself, I prefer a jolted replay
    In it lies the truth
    I never thought I could believe in a systematic scream inside mood
    Me.  I talk about him too much
    To the doctors of sales spoof
    Slowly in partial fragments become unglued
    Consider it with your last food
    Prisons always sell doom
    I have control, I’m in my room
    I don’t re-toil over my work, why pause and loom?

    Extreme Self Esteem

    By Happy Face

    yeah it’s me
    living awkwardly, almost worldly with aqua coloured wordies
    yeah it’s me
    worries, high stories, and no Maury to talk me to glory
    how am I supposed to live penthouse
    when I’m sleeping in the lobby
    how am I supposed to get rent out
    when even I’m tired of being sorry
    sirens see that and don’t want to party
    it seems their misrepresentation needs work, they’re not me
    feeling blue isn’t worth talking

  • What is Psychosis?

    The word “psychosis” is used to describe a medical condition that affects the mind, in which there has been some loss of contact with reality. The experience of psychosis varies greatly from person to person, so that individuals experiencing psychosis may have very different symptoms; however, the common thread is that it affects an individual’s thoughts, feelings, and behaviours.

    Psychosis is a common medical condition that affects about 3% of the population. Psychosis tends to emerge during adolescence and young adulthood, affecting males and females equally. A first episode of psychosis is often frightening, confusing, and distressing for the individual, and upsetting for their family and friends; however, the good news is that it can be treated effectively.

    What causes psychosis?

    At this time, there are many theories about what causes psychosis, but no definite answers. Psychosis occurs in a variety of mental and physical disorders; therefore, it likely has multiple causes. Biology, stress, and drug use are three of the most common theories.


    Neurotransmitters: There is strong evidence that some psychoses involve a dysfunction in neurotransmitters in the brain. Neurotransmitters are the “chemical messengers” of the brain. They transmit impulses throughout the brain and the central nervous system. Of particular importance is the neurotransmitter dopamine. Most antipsychotic drugs that control the positive symptoms of psychosis also block the transmission of dopamine.

    Genetics: Individuals whose close relatives experience psychosis are themselves at increased risk. For example, the risk of developing psychosis associated with Schizophrenia in the general population is approximately 1%, yet the children and siblings of those with Schizophrenia have respective lifetime risks of 13% and 9%.

    Brain Changes: Changes have been found in the brains of some individuals with Schizophrenia, which appear to have been present since birth or early childhood. Possible causes of the changes include: genetic transmission, abnormal neurodevelopment, and pregnancy or birth complications (e.g. exposure of mother to a virus during the second trimester of pregnancy).


    For some people, psychosis appears to occur primarily in response to stress. In most cases, it is believed that a vulnerability to psychosis combined with stress will lead to psychosis symptoms.

    Vulnerability to psychosis is acquired through a genetic predisposition, or as a result of an environmental insult to the brain (brain damage). Vulnerability can be measured by a family history of psychotic disorders, birth complications (e.g. oxygen deprivation of the baby), or brain injuries.

    Stresses can be such things as significant life events (e.g. death of a loved one, moving to a new city, etc.), abuse of alcohol and drugs, or stressful living conditions (e.g. high levels of family conflict or financial problems).

    The degree of vulnerability varies from person to person. Likewise, the amount of stress that may trigger psychosis likely differs for each individual. For example, a person with a low vulnerability might withstand a large amount of stress without experiencing psychosis, whereas a person with a high vulnerability might only withstand a minimal amount of stress without experiencing psychosis.


    Psychosis can be induced by drugs or can be drug-assisted. For example, it appears that amphetamines can cause a psychotic episode, while other drugs, including marijuana, can increase a person’s natural vulnerability to psychosis resulting in a psychotic episode.

    Is a psychotic person dangerous?

    Although some individuals with psychosis may experience mood swings and increased feelings of agitation, they are more likely to present emotional dampening and social withdrawal. While strong delusions and hallucinations may cause a person to react unpredictably or even aggressively, individuals with psychosis are rarely violent, and in fact, they are at much greater risk of causing harm to themselves than to others.

    Read more about what causes psychosis.

    Common symptoms of psychosis

    The most common symptoms of psychosis include disorganized or confused thinking, speaking, and behaviour; changes in mood; delusions; and hallucinations.

    Disorganized or confused thinking, speaking, and behavior

    Thoughts become confused and seem to either speed up or slow down. Examples of disorganized behaviour include:

    • Difficulties performing activities of daily living (e.g. cooking, maintaining hygiene)
    • Marked unkemptness, or unusual or inappropriate dress
    • Inappropriate sexual behavior
    • Unpredictable and unprovoked agitation
    • Inappropriate affect (e.g. laughing while describing a personal tragedy)
    • Catatonic behavior

    The individual experiencing psychosis may have difficulties concentrating, following instructions or conversations, and remembering things.

    Changes in mood

    An empty feeling marked by a lack of emotions and difficulty expressing feelings. Individuals with psychosis may feel strange and cut off from the rest of the world.


    Strongly held beliefs which are unusual and unjustified. They are generally organized around one or more of the following themes:

    • Persecutory (most common): Belief that one is being followed, tormented, or subjected to ridicule
    • Referential (also common): Belief that certain gestures, comments, songs, or other environmental cues are specifically directed toward oneself
    • Grandiose: Belief that one has special abilities or “powers”
    • Religious: Delusions have religious themes (e.g. receiving orders from God)
    • Somatic: Belief that something unusual is occurring in or on one’s body, despite medical evidence to the contrary
    • Loss of Control over Mind or Body: Belief that one’s thoughts or body are being controlled by forces or by other individuals. Belief that thoughts are broadcast so others can hear them. A belief that thoughts are being taken out of one’s head or are somehow inserted into one’s brain
    • Delusions are considered “bizarre” if they are clearly implausible and are not derived from ordinary life experiences. For example, believing that one’s internal organs have been replaced by someone else’s without surgery would be considered a bizarre delusion, while the belief that one is being followed by the police would be considered non-bizarre.


    Seeing, hearing, feeling, smelling or tasting things that do not actually exist.

    • Auditory hallucinations are the most common. They are usually experienced as voices that are perceived as distinct from the individual’s own thoughts.
    • Visual hallucinations are often of a disturbing and intrusive type.

    Phases of psychosis

    There are three phases involved in psychosis: the prodromal phase, the acute phase, and the recovery phase.

    Prodromal phase

    Often not clear until after positive symptoms emerge:

    • Something isn’t quite right
    • Not definite
    • Negative symptoms emerge (e.g. loss of motivation, decreased range of facial expression)
    • Become more isolated
    • Drop out of activities
    • Less concern with personal appearance
    • Unusual preoccupations such as religion, politics, or science fiction

    Acute phase

    Characterized by the experience of intense symptoms (e.g. hallucinations, delusions, thought disorder). Symptoms become obvious to others. These types of symptoms are often referred to as positive symptoms.

    • Usually in this phase that treatment begins
    • Early intervention leads to quicker recovery, better outcomes

    Recovery phase

    Gradual return to normal functioning:

    • Often difficult to come to terms with what has happened
    • Sometimes a grief reaction follows, due to the losses that occur as a result of the illness
    • Confidence and self esteem may be affected
    • Sometimes there is a loss of faith in one’s own judgment and perceptions

Family/Caregiver Information

  • How To Approach Someone You Feel Needs Help

    Supporting a family member or loved one experiencing their first episode of psychosis can be overwhelming as families navigate the mental health services in their community, provide support to their loved one experiencing symptoms of psychosis and take in the many emotions that come about in this experience.

    • Individuals experiencing a psychotic episode will often not reach out for help. If you are concerned about someone, you may have to approach them first.
    • Approach the individual you are concerned about in a caring and non-judgmental manner.
    • Specifically state why you are concerned.
    • It is often best to state your concerns in behavioral terms. For example, “I have been concerned because you don’t seem to be spending any time with your friends anymore.”
    • Do not speculate on what their diagnosis might be. For example, do not state, “I am concerned that you might be getting psychotic.”
    • Arrange to talk to the individual in a private setting.
    • If the individual is unwilling to talk with you, let them know that you will be available if they would like to talk with you in the future.
    • Ask if their family has expressed concern. Ask if they think it is okay for you to talk to the family.

    It can be very distressing to realize that someone you love is experiencing psychosis. You may feel shocked, confused, bewildered, guilty or helpless. It may be hard to take the first step towards getting help: you may be unsure of what the problem is, or the person experiencing a psychotic episode may not realize they are unwell or want to admit to needing help. They may also need help finding out what is happening to them and what kind of treatment they require. The first step is often to visit their family physician; their doctor can then refer them to more specialized professionals, such as psychiatrists, mental health centers or early psychosis intervention programs.

    If a loved one has experienced any of these symptoms, consider a referral to an early intervention service in your area:

    • a significant change in normal personality, which lasts weeks or months;
    • faster, slower or disorganized speech that is difficult to follow;
    • suspicious, guarded or fearful behavior;
    • a severe change in sleep pattern;
    • an inability to function at their normal level (e.g. can’t perform at school or work, neglects hygiene or personal affairs);
    • a preoccupation with unusual ideas (e.g. thinks they hear God’s voice, believes coded messages are being left for them in the media)

    If you are in Ontario, you can find a list of early psychosis intervention programs at Call one in your area that seems appropriate for the person you want to help. You will speak with an intake worker who will ask you some questions, assess the situation and talk to you about what’s next. This will help you determine whether the program is appropriate for your loved one and what other services may be necessary.

    Some programs may need the person to seek help for themselves before they can provide services to them. If the person you are worried about is unwilling to seek help, the intake worker will be able to suggest some strategies for you to try, or give you information about other service options that may work to engage your loved one to seek help. You may also want to call a family support program for additional suggestions.

    If you are worried about your loved one’s safety, check in on them regularly. Always take talk of suicide or self-harm seriously. If your loved one is suicidal, stay calm and offer them your support. Be there to listen to their concerns, show them that you love them, and help them reduce any stressors that may be adding to their depression. Try to stay positive and give them hope. Assure them that help is available and that things can get better, and that having the courage to seek help is a sign of strength rather than a sign of weakness or failure. If your loved one’s suicidal thoughts persist, talk to a mental health professional.

    In an emergency situation, ensure that your loved one gets help immediately. If necessary, go with them to the appropriate service. Use emergency resources such as your local hospital emergency room or mobile crisis program.

    You may find it difficult to cope with a friend or family member who is experiencing psychotic symptoms. It is important to be yourself and to understand that psychosis is stressful for everyone whose lives it touches. If you are finding your feelings particularly overwhelming, it may be helpful to talk with a friend or counselor who can help you understand and accept what has happened to your loved one.

  • Preparing For A Loved One’s Psychiatric Assessment

    Some helpful hints for preparing for and attending a loved one’s psychiatric assessment:

    • Write down exactly what has been happening and what you have observed. Include what actions you may have taken up to now. Bring this with you.
    • Write down questions you may have (you’ll probably find that you have more during the interview). Be persistent in asking your questions.
    • Take paper and pen with you to write down what is said so you don’t have to rely on your memory afterwards.
    • Be realistic in your expectations. This is an initial meeting and more meetings may be scheduled. Change happens slowly.
    • Be sure to get a sense of when you will hear back about test results, follow-up appointments, etc.

    Keep a list of who you see, when, why, what they say and what happens. It will give you the confidence to be sure that you have your thoughts in order when dealing with people who may not have the whole picture.

    What will happen during an assessment for the individual concerned?

    Whether you see your family doctor, a mental health clinic or a psychiatrist, it is likely that a range of information will be gathered. All mental health clinicians as well as physicians are guided by the rules of confidentiality. That means that whatever you discuss will remain confidential within the treatment team unless you agree to share the information with others such as a family member.

    A full history might include:

    • Physical illnesses
    • Developmental information
    • School history
    • Problems related to social environment or family environment
    • Occupational history
    • Housing problems
    • Economic problems
    • Legal problems
    • Addiction problems
    • Is there a family history of mental illness? How was it treated?

    The interviewer will ask more specifically about the presenting problem:

    • When did it start?
    • What was going on in the person’s life at the time?
    • How did it affect daily functioning (e.g. school/work, social life, family life)?
    • They will likely want to zero in on specific symptoms and ask about the presence of others not mentioned.
    • Your loved one may not be able to tolerate a full interview. Information can also be gathered more slowly over time.
    • A physician might then make a formulation of what appears to be happening and suggest treatment. It may also be suggested that the person have a complete physical examination.
  • Recognizing And Managing Symptoms At Home

    Whether hallucinations, delusions, or signs of thought disorder, an individual experiencing an episode of psychosis may show different commonly-recognized symptoms. Read on for tips on how to recognize and manage your loved one’s symptoms.

    Hallucinations (sensory experiences not shared by others)

    Possible signs:

    • Pacing
    • Restlessness
    • Increased social withdrawal
    • Increased preoccupations
    • Irritability
    • Talking to oneself

    Coping strategies:

    Work with the person to develop a strategy of what is helpful for them. Identify and reduce what is causing them stress. See the doctor or mental health worker if necessary. Some tips to provide distraction are:

    • Provide an activity (e.g. a walk, card or board games, simple chores)
    • Encourage the person to have conversations with others
    • Relaxation (e.g. stress management tape)
    • Exercise
    • Work
    • Provide competing stimuli (e.g. portable stereo, TV, radio, movie)

    What doesn’t work:

    • Attempts to reason or debate with the voices

    Delusions (fixed, false beliefs)

    Possible signs:

    • Fearfulness
    • Suspiciousness
    • Preoccupation
    • Refusal to maintain routine/activities
    • Irritability

    Coping strategies:

    • Avoid debate, reasoning
    • Acknowledge person’s distress
    • Avoid collusion
    • Avoid interpreting meaning of the delusion
    • Speak about how the person is feeling. For example: If anxious, talk about how to manage that anxiety; if they are losing sleep, discuss how to manage that.
    • Try: “I can see that those thoughts are making you feel very anxious (worried, upset, irritable, etc). Let’s work together to help you feel more relaxed.”

    Delusions are part of the illness. Try to avoid emotional responses. Try to empathize with the fear, anxiety and distress.

    Thought disorder (thoughts seem confused, disorganized, sped up or slowed down)

    Possible signs:

    • Incoherence
    • Illogical thoughts
    • Inappropriate emotional responses (e.g. laughs at very sad news)
    • Pacing
    • Restlessness
    • Irritability
    • Preoccupation

    What helps:

    • Structured routine
    • Limits to behaviour
    • Simple words, short sentences
    • Ask the person to repeat the instructions you gave them
    • Lower the stimulation around them (e.g. turn off radio or TV when speaking with them)
    • Do not provide too many choices, as this may seem confusing right now
Skip to content