Psychotic Disorders Treatment
- What are psychotic disorders and what are the symptoms of psychotic disorders?
- Why consider residential treatment for psychotic disorders?
- What benefits does a therapeutic community provide in the treatment of psychotic disorders?
- How does an integrated treatment team approach work in treating psychotic disorders?
- How does psychiatric treatment in an open setting work?
- How does our comprehensive treatment prepare patients to return to a world beyond Riggs?
- Additional resources on psychotic disorders.
Psychotic disorders are characterized by disruptions in social, emotional and/or cognitive functions. Disturbances tend to cluster in one or more of the following domains: delusions, hallucinations, disorganized thinking or speaking, disorganized or abnormal motor behavior, or negative symptoms, such as decreased emotional expression or interest in pleasurable activities.
Why consider residential treatment for psychotic disorders?
Immersion into our treatment program helps patients with psychotic disorders to:
- develop an awareness of the context of their troubles
- come to grips with the emotional impact of having this kind of disorder, including the potential benefits—and risks—of a medication regimen
- understand how their behavior affects others
- improve their ability to understand the meaning of their symptoms and behavior
- communicate in words instead of behavior
- develop better emotional regulation and ability to tolerate previously overwhelming feelings
- learn adaptive functioning
- make better life choices with the benefit of increased understanding of themselves and their motivations
- discover a life worth living
Successful treatment of people with psychotic disorders recognizes the complexity of the etiology of psychotic symptoms. Over a hundred genetic loci have been identified that may play a role, but it is clear that genes alone are not the answer, and that genes and environment interact in powerful ways (so called epigenetics) in this and other disorders. Studies link psychotic disorders to trauma, including histories of bullying and social isolation. Data suggests that early intervention that includes dialogue with patients and family members can help to keep these types of disorders from becoming chronic. Early, intensive intervention holds the best prognosis.
People struggling with psychotic symptoms often feel isolated and marginalized. At the Austen Riggs Center, we recognize both the importance of being part of a community and the challenges this may pose for people with psychotic spectrum disorders. Community and nursing staff work to get to know each individual well enough to be able to provide support in finding a place within community life. Those who need individual attention to structure their day or find their way into the community can enter a program that provides daily nursing contact.
At Riggs, we recognize that symptoms have meaning. Symptoms that may appear illogical or irrational often mark a story the individual has not yet been able to put into words. We take an extensive individual and family history that helps us discover these stories that may need to be worked through and addressed more directly. Helping the family make sense of the symptoms their loved one has been experiencing can be an important learning tool for all family members. Feedback from our intensive evaluation and treatment process can help family members to better understand the difficulties encountered by their loved ones and themselves in ways that reduces strain in the family. Much as we hope to help patients better understand their vulnerabilities and make use of their strengths, we hope to help family members recognize ways their good intentions may go awry, so that they can better support one another through difficult times.
Medications often play a role in treatment of psychotic disorders. We attend carefully to a patient’s preferences and concerns, educate patients about the benefits and risks of medications and attend not only to the potential biochemical effects of medications, but also to what they mean to patients and families—an approach called “psychodynamic psychopharmacology” that Riggs has introduced to the field.
Psychotic disorders can be quite varied and complex, making our intensive integrated, comprehensive psychodynamic treatment and evaluation important, to help to locate the types of difficulties that the individual encounters and thereby devise a treatment plan that targets those particular difficulties.
What benefits does a therapeutic community provide in the treatment of psychotic disorders?
Exploring Different Roles with the Clinical Staff and the Therapeutic Community
At the Austen Riggs Center we have substantial clinical expertise and experience working with patients who have psychotic disorders. Our treatment program is intensive, including four times weekly psychodynamic psychotherapy within a therapeutic community. The psychotherapists are all doctors (MDs, DOs, PhDs and PsyDs) who recognize the specific treatment dilemmas involved in working with someone with psychotic disorders.
Patients have rich opportunities to learn about themselves within the therapeutic community. Through experiences in the therapeutic community they learn how others affect them, how they affect others, and are often able to shed unproductive roles. As a result of successful treatment at Riggs patients develop a better understanding of the meanings of their symptoms, and learn to recognize signs of strain and discomfort in ways that allow them to develop greater confidence and more adaptive coping skills. The goal of this comprehensive approach is to help patients develop ways of facing their future with greater competence and integrity.
How does an integrated treatment team approach work in treating psychotic disorders?
An Integrated, Multidisciplinary Treatment Team Works with the Patient
Each patient works with a multidisciplinary team that develops with them a treatment plan. Members of the team include doctoral level psychotherapists, at least one psychopharmacologist (who may also be the therapist to some patients), team nurses and a substance abuse counselor. A therapeutic community staff member helps patients find their way into the formal groups and informal leisure activities within the therapeutic community program. A team social worker provides liaison contact with the patient’s family, convenes family meetings, provides family therapy with the patient’s therapist if indicated, and works with the patient on such practical issues as getting a driver’s license, applying to school, preparing for job interviews, and making discharge plans when the patient is ready to transition to life outside Riggs. The same multidisciplinary team of clinicians generally works with a patient throughout their entire treatment at Riggs.
How does psychiatric treatment in an open setting work?
One of the distinguishing features of the Austen Riggs Center is the open setting--our way of saying patients have complete freedom, but in return take up responsibility for their safety. There are no locked units or physical restraints and no privilege system. All admissions are voluntary. That means that after being carefully assessed as potentially suitable for the open setting both prior to and during a face-to-face preadmissions consultation, patients must decide whether to accept an offer of admission. But with freedom comes responsibility. Patients learn what it means to take responsibility for their behavior and for the decisions they make. There is ample opportunity for staff input and recommendations, but also an emphasis on developing a partnership between patients and staff that keeps in mind the patients’ developmental needs and goals.
How does our comprehensive treatment prepare patients to return to a world beyond Riggs?
Patients Can Take On New Roles and Responsibilities During Their Stay
As patients move through our treatment program, this they may take on new responsibilities, learn new skills, and build confidence by accepting a position of leadership within the patient community. All these efforts are designed to enable the individual develop greater skills and more adaptive functioning in preparation for the transition to life after discharge from Riggs. As patients progress, they may step down in level of care, increasing their involvement in the world beyond Riggs as they taper their participation in the therapeutic community of Riggs.