5.2 Identify the resources and treatment required to manage a person with psychotic depression

This guide will help you answer 5.2 Identify the resources and treatment required to manage a person with psychotic depression.

Psychotic depression is a severe form of depression accompanied by symptoms of psychosis. Psychosis involves losing touch with reality, potentially experiencing delusions (false beliefs) or hallucinations (seeing or hearing things that aren’t there). This condition requires both medical and therapeutic intervention. A support worker plays a key role in ensuring the person receives the necessary treatment and has access to the right resources.

Medications to Manage Psychotic Depression

Pharmaceutical intervention is one of the main treatments for psychotic depression. The medications used typically combine antidepressants with antipsychotic drugs. These aim to treat both the depressive symptoms and psychotic features.

• Antidepressants: These help balance the chemicals in the brain to relieve depression. Common types include selective serotonin reuptake inhibitors (SSRIs), such as sertraline, and serotonin-noradrenaline reuptake inhibitors (SNRIs).
• Antipsychotics: These reduce symptoms of psychosis. Examples include olanzapine, quetiapine, and risperidone.

A psychiatrist will usually prescribe and monitor these medications. Any side effects or concerns need reporting to the medical team promptly. As a support worker, you can assist by observing changes in mood, behaviour, or physical health. Keeping a diary of symptoms may help the medical team adjust the treatment as needed.

Psychological Therapies

Psychotherapy, or talking therapy, is another key treatment for psychotic depression. Many people benefit from working with a trained therapist to explore emotions, manage stress, and address underlying issues.

• Cognitive Behavioural Therapy (CBT): This method helps people understand and manage the connection between thoughts, feelings, and behaviours. A therapist may focus on challenging the person’s delusions or distorted thinking patterns.
• Interpersonal Therapy (IPT): Useful for addressing relationship issues or dealing with major life changes that may have contributed to the depressive episode.

Encourage the person to attend scheduled therapy sessions. Psychological therapies are most effective when combined with medication. Working on coping mechanisms with a therapist can also reduce the likelihood of future relapses.

Electroconvulsive Therapy (ECT) in Severe Cases

If the person doesn’t respond to medications or therapy, Electroconvulsive Therapy (ECT) might be an option. This involves passing a small electrical current through the brain under general anaesthetic to trigger a brief seizure. ECT can be effective for severe and treatment-resistant psychotic depression, particularly when there is a high risk of suicide or inability to function.

As a support worker, your role may involve providing emotional reassurance about the procedure, ensuring the person understands what it involves, and arranging aftercare.

Support from Mental Health Professionals

A person with psychotic depression often requires care from a multidisciplinary mental health team. This team can include:

• Psychiatrists: They diagnose the condition, prescribe medications, and monitor progress.
• Psychologists and Therapists: Provide structured therapy sessions.
• Community Psychiatric Nurses (CPNs): Support the person in their home and monitor their mental health symptoms.
• Social Workers: Help with social needs, such as housing or benefits.

Ensure the person knows how to contact these professionals if needed. Support workers can ease communication between the team and the person. This is especially helpful if the person is feeling overwhelmed or unwell.

Crisis Services

Psychotic depression often leads to periods of crisis. These include severe suicidal thoughts, inability to care for oneself, or worsening psychotic symptoms. It’s important to identify the available crisis services.

• Crisis Helplines: Services like the Samaritans (116 123) provide immediate emotional support over the phone.
• Crisis Resolution and Home Treatment Teams (CRHTTs): These are specialist teams available through NHS mental health services. They intervene during emergencies and may provide treatment at home to avoid hospitalisation.
• A&E Departments: For urgent emergencies, Accident and Emergency in hospitals can provide immediate medical care.

Your role as a support worker includes recognising signs of crisis and contacting appropriate services quickly. Always discuss any concerns with a supervisor or the mental health team.

Hospitalisation

Severe cases of psychotic depression may require hospital admission. This allows the person to receive intensive treatment in a safe environment.

• Voluntary Admission: The person agrees to go to the hospital.
• Sectioning Under the Mental Health Act: If they refuse care but need it urgently to protect themselves or others, they may be detained or “sectioned.”

In a hospital, they may have access to the following:

• Regular medical care and monitoring.
• Occupational therapy to rebuild life skills.
• Structured group therapy sessions.

If the person you support is admitted to the hospital, keeping in touch and encouraging visits can help reduce feelings of isolation.

Practical and Social Support

People with psychotic depression can struggle with daily tasks. This is where practical support is essential.

• Assistance with Daily Needs: This could involve cooking meals, keeping their home tidy, or helping them attend appointments.
• Encouraging Social Interaction: Isolation worsens mental health. You could encourage them to meet friends or family or attend support groups if they feel ready.
• Developing Routine: Encourage a consistent routine, including regular sleep patterns, which can improve mental health stability.

Signpost the person to local organisations that provide practical support, such as Mind or Rethink Mental Illness.

Lifestyle Changes to Support Recovery

Making changes to lifestyle can positively affect recovery. Encourage:

• Healthy Eating: A balanced diet supports brain health.
• Physical Activity: Regular exercise releases endorphins, which boost mood.
• Avoiding Substances: Alcohol and drugs can make symptoms worse.

These changes play a part in reducing depressive symptoms over time. Small steps, like short walks or trying new recipes, can be easier for the person to manage.

Accessing Financial and Housing Support

Living with a severe mental health condition comes with financial strain. The person may struggle to work or manage finances.

You can help them:

• Apply for Benefits, such as Employment Support Allowance (ESA) or Personal Independence Payment (PIP).
• Contact housing charities or local councils if they face housing instability.

Signposting to organisations like Citizens Advice can provide further guidance on legal and financial matters.

Family Support and Education

Family members often feel confused or uncertain about how best to help. Encourage them to learn about psychotic depression to better understand the condition. Family therapy or psychoeducation sessions may assist with communication and improve family relationships.

Encourage the person to involve family in their care if they feel comfortable doing so. A good support network has a strong impact on recovery.

Community Resources

Community resources enhance the person’s sense of belonging.

• Support Groups: These bring together people with similar experiences to share coping strategies. Mind and Rethink Mental Illness run regular mental health support groups.
• Hobbies or Activities: Look for local clubs or social groups. If they have hobbies, such as art or gardening, encourage them to take part in community activities based on these interests.

Being part of a group helps reduce loneliness and provides structure.

Care Planning

A care plan outlines how the person’s needs are met. It may include:

• Medications and treatment.
• Contact details for professionals involved in their care.
• Strategies to manage future episodes.

Support workers often play a part in reviewing care plans alongside mental health teams. This makes sure the person’s preferences and needs are met.

Monitoring Progress

Recovery can take time. Small improvements, like eating regularly or maintaining hygiene, are important milestones.

• Keep a record of progress or setbacks.
• Talk to the person about how they are feeling.
• Share observations with the care team to adjust support if necessary.

This helps professionals refine treatment to suit the person’s needs better.

Conclusion

Psychotic depression requires a combination of resources and treatments. Medications, therapy, crisis intervention, and practical support all play roles in managing the condition. Support workers contribute by ensuring the person has access to these resources. Regular communication with the care team and encouraging small steps can aid their recovery.