Clients and Antipsychotic Medications

As hypnotherapists, we may encounter clients who seek our services while managing complex mental health conditions, including psychosis. However, there are critical considerations regarding duty of care and safeguarding when working with individuals in such states.

Why We Wouldn’t See a Client in a Florid State of Psychosis
A client in a florid state of psychosis is experiencing an acute phase of symptoms, including hallucinations, delusions, disorganised thoughts, and possibly erratic behaviour. This can impair their ability to differentiate between reality and imagination, potentially heightening their vulnerability and reducing their capacity to engage safely and effectively in hypnotherapy.

Example of Identifying Florid Psychosis
If a client arrives visibly distressed, speaking about seeing or hearing things that aren’t present (e.g., describing a "voice in the room" or a person others cannot see), this may indicate they are in a florid psychotic state. Other signs might include confused speech, paranoia, or a lack of coherent thought. Observing any of these symptoms is a cue to refrain from providing hypnosis  and to direct the client to appropriate mental health services immediately.

Importance of Knowing a Client’s Antipsychotic Medication
As hypnotherapists, we are not trained in pharmacology, but understanding whether a client is taking antipsychotic medication is essential for safeguarding and tailoring appropriate support. Antipsychotic medications, such as chlorpromazine or risperidone, are prescribed to manage symptoms of psychotic disorders, including schizophrenia and bipolar disorder.

Knowing a client’s medication regimen enables us to identify any contraindications:

Hypnosis may interact with medications by potentially amplifying or mitigating effects such as sedation, anxiety, or emotional response. Recognising this can help avoid practices that could unintentionally exacerbate a client’s symptoms.

Assess psychological stability: Antipsychotic medications often indicate a more severe mental health condition that requires careful, stable management. For clients on these medications, our awareness helps us remain vigilant to changes in mental health and better prepared to pause sessions if signs of deterioration emerge.

Support appropriate referrals: If a client presents symptoms beyond our scope, knowing they are on antipsychotics supports a more informed and prompt referral to mental health services or emergency care.

Our Duty of Care and Role Limits
It is crucial to remember that we are not trained or qualified to assess or advise on medication. We should make it clear to clients that while we can ask about medication for safeguarding purposes, we will always refer them to medical professionals for guidance about their prescriptions.

If you have any concerns or questions about a client’s presentation or their suitability for hypnotherapy, it is essential to consult your supervisor. Your supervisor can help you navigate these situations responsibly and in alignment with best practices for safeguarding.

Here is Antipsychotics Identification Sheet to assist with safeguarding your clients: 

Generic Name: Chlorpromazine
Brand Name: Largactil
Type: First-generation
Common Uses: Psychosis, Schizophrenia
Notes: Known for sedation; may cause extrapyramidal side effects.

Generic Name: Flupentixol
Brand Name: Depixol
Type: First-generation
Common Uses: Schizophrenia, Depression (low doses)
Notes: Also used as a long-acting injection for chronic management.

Generic Name: Haloperidol
Brand Name: Haldol
Type: First-generation
Common Uses: Schizophrenia, Acute Psychosis
Notes: High risk of extrapyramidal side effects; effective for agitation and severe psychosis.

Generic Name: Levomepromazine
Brand Name: Nozinan
Type: First-generation
Common Uses: Psychosis, Severe Agitation
Notes: Often used for sedation; side effects include drowsiness.

Generic Name: Pericyazine
Brand Name: -
Type: First-generation
Common Uses: Anxiety, Schizophrenia
Notes: Primarily used for anxiety with psychosis; sedative properties.

Generic Name: Perphenazine
Brand Name: Fentazin
Type: First-generation
Common Uses: Schizophrenia, Nausea
Notes: Combines antipsychotic and anti-nausea properties.

Generic Name: Pimozide
Brand Name: Orap
Type: First-generation
Common Uses: Tourette's Syndrome, Psychosis
Notes: Used especially for chronic tic disorders; risk of QT prolongation.

Generic Name: Prochlorperazine
Brand Name: -
Type: First-generation
Common Uses: Nausea, Vertigo, Psychosis
Notes: More commonly used for nausea and vertigo than psychosis.

Generic Name: Promazine
Brand Name: -
Type: First-generation
Common Uses: Anxiety, Agitation
Notes: Low-potency antipsychotic; generally mild sedation effects.

Generic Name: Sulpiride
Brand Name: Dolmatil, Sulpor
Type: First-generation
Common Uses: Schizophrenia, Depression (low doses)
Notes: Can also be effective for depressive symptoms.

Generic Name: Trifluperazine
Brand Name: Stelazine
Type: First-generation
Common Uses: Schizophrenia, Anxiety
Notes: Primarily for anxiety with psychosis; may have strong calming effects.

Generic Name: Zuclopenthixol
Brand Name: Clopixol
Type: First-generation
Common Uses: Schizophrenia, Mania
Notes: Often used in long-acting depot form for chronic psychosis.

Generic Name: Amisulpride
Brand Name: Solian
Type: Second-generation
Common Uses: Schizophrenia, Dysthymia
Notes: Primarily for negative symptoms of schizophrenia; fewer side effects than first-generation types.

Generic Name: Aripiprazole
Brand Name: Abilify, Abilify Maintena
Type: Second-generation
Common Uses: Schizophrenia, Bipolar Disorder
Notes: Partial dopamine agonist; often used as an adjunct for depression.

Generic Name: Clozapine
Brand Name: Clozaril, Denzapine, Zaponex
Type: Second-generation
Common Uses: Treatment-resistant Schizophrenia
Notes: Risk of agranulocytosis; requires regular blood monitoring.

Generic Name: Lurasidone
Brand Name: Latuda
Type: Second-generation
Common Uses: Schizophrenia, Bipolar Depression
Notes: Often preferred for low metabolic impact; fewer sedation effects.

Generic Name: Risperidone
Brand Name: Risperdal, Risperdal Consta, Okedi13
Type: Second-generation
Common Uses: Schizophrenia, Bipolar Disorder
Notes: Available in long-acting injection form; can cause weight gain and metabolic effects.

Generic Name: Olanzapine
Brand Name: Zypadhera, Zyprexa
Type: Second-generation
Common Uses: Schizophrenia, Bipolar Disorder
Notes: High risk of weight gain and metabolic side effects.

Generic Name: Quetiapine
Brand Name: Seroquel, Seroquel XL
Type: Second-generation
Common Uses: Schizophrenia, Bipolar Disorder, MDD
Notes: Sedative properties; often used for insomnia in low doses.

Generic Name: Paliperidone
Brand Name: Invega, Xeplion, Trevicta, Byannli
Type: Second-generation
Common Uses: Schizophrenia, Schizoaffective Disorder
Notes: Long-acting injectable options available; similar to risperidone.

Remember if any doubt contact your supervisior.