13.8.2 Management of chronic psychoses
The main objectives in the management of chronic psychoses are:
- to maintain good mental health
- to support the person’s rehabilitation and resettlement in the community, including their return to work and/or normal domestic activities
- to minimise the risk of permanent disability arising from the illness.
Anyone identified with a chronic psychosis should be referred to the local health centre or hospital, where they may receive a course of antipsychotic medication (drugs used to treat psychosis). Once the patient has completed their in-house treatment at the health centre or hospital, they will return to the community, where you should draw on their support networks to ensure their continued adherence to treatment as prescribed by the doctor (see also Section 11.2.4 in Study Session 11).
If you decide that there is a need for an adjustment in the medication, or you believe that a relapse has occurred, the patient should be referred back to the treating doctor. In most cases, the use of antipsychotic medication continues for at least six months after the symptoms disappear. Clear information should be given to the patient and their family about their illness and the importance of adhering to the instructions for their medication. You should also stress to the patient (and their family) the serous risks of taking this medication while also using other substances. Inform them that cigarettes, khat, cannabis and alcohol are all likely to reduce the effectiveness of medication and — particularly in the case of cannabis and alcohol — may make the symptoms worse or result in relapse. Table 13.2 lists the two most commonly prescribed antipsychotic drugs in Ethiopia, with their usual dosages.
|Drug||Usual adult dose|
|Chlorpromazine||50–300 mg orally/day (one or divided dose)|
|Haloperidol||2–6 mg orally/day (one or divided dose)|