How to Help Someone Who is Having a Psychotic Episode

The majority of schizophrenia spectrum disorders are identified after a first psychotic episode in teenagers and young adults. Schizophrenia refers to a group of illnesses that are chronic and, like diabetes, benefit from specialized long-term treatment. Early diagnosis and intervention can improve the ability of individuals to live full lives in their communities, Dr. Srihari says.

Not everyone who has a psychotic episode has schizophrenia—there are other conditions that can trigger symptoms. The list includes high fevers, infections (like HIV), and among older people, Alzheimer’s or Parkinson’s diseases (as mentioned above).

In rare cases, some medications—including even such common ones as antibiotics, antihistamines, corticosteroids, heart medications (such as beta-blockers), and amphetamines—can cause psychotic symptoms.

Research shows a strong link between use of cannabis and psychosis, although scientists are still investigating the connection. “For a small subset of people, stopping the cannabis resolves the psychosis," Dr. Srihari says. "But in most of these cases, we're also going to be treating a primary psychotic disorder that might have been hastened in its onset by cannabis.”

A person who is experiencing psychotic symptoms may be more willing to talk about them when they first notice that something feels wrong, Dr. Srihari says. This is one key reason why early medical help is important. “Once they develop fully formed delusions, they may not be willing to accept that something is wrong with them,” he says.

If you are in conversation with someone who is expressing concerns about possible psychotic symptoms, the following actions can help.

• Remain patient and calm, avoid being confrontational or judgmental, and communicate clearly using short sentences.
• Listen with concern and curiosity when the person is talking. Validate their feelings, maybe saying, “I can see this is making you very anxious.”
• If possible (i.e., you live with the person or are close to someone who does), make sure that firearms, medication, and other potentially harmful items are safely locked up.
• Calmly, but firmly encourage the person to go to a doctor for a mental health assessment. Ideally, the person should make an appointment as soon as possible with a mental health provider with whom they can establish a trusting relationship, so they have someone to turn to if the situation worsens.

It may be necessary to call 911 if a psychotic episode becomes severe—if the person is exhibiting extreme agitation, severe paranoia, uncontrollable aggression, or is threatening harm or violence to themselves or others, according to National Alliance for Mental Illness (NAMI). This grassroots mental health organization recommends telling the 911 operator that a person is having a mental health crisis or psychotic episode and making it clear that you are seeking medical help—and not an arrest. If you are at home, NAMI suggests meeting the emergency responder outside to brief them on the situation and share any helpful information.

Not all police officers are trained to handle psychiatric crisis calls—but it’s important to ask if a trained officer is available, Dr. Srihari says. Those with training have learned how to help calm the person and convince them to go to the hospital voluntarily. More police departments around the country now host crisis intervention teams that include trained clinicians and can offer a more effective response to a situation in which someone appears to be a threat, but, in fact, requires treatment rather than a law enforcement response, he says.

State laws regarding involuntary hospitalization vary significantly. It’s considered a last resort, but if a psychotic episode is severe enough to pose a danger to anyone, it may be a necessity, Dr. Srihari says.

Early treatment of a first episode can reduce the chance of recurrence or the intensity of future episodes significantly, Dr. Srihari says. “With appropriate care and treatment, a few people will never have another psychotic episode, and many will have recurrences but will learn to manage them better. For all, recovery can mean the ability to lead a fulfilling and productive life, even if psychotic symptoms sometimes return,” he adds.

Caregivers in a hospital emergency department can stabilize a person experiencing psychosis, usually by creating a calm environment and administering antipsychotic medications. There are a number of medications that can reduce psychotic symptoms within hours or days, although they can take weeks to reach full effect, Dr. Srihari says. Psychotherapy and support for basic needs, along with educational and vocational goals, is important as well, he adds.

Regardless of where you live, if you or someone you know is struggling with symptoms of psychosis, these resources might help:

• If you are looking for resources in your area or want to talk to someone: The Substance Abuse and Mental Health Services Administration (SAMHSA) has an Early Serious Mental Illness Treatment Locator. NAMI also offers a helpline, among other resources.
• If you or a loved one is in danger of self-harm: People with psychosis are at increased risk for suicide. Call or text the government’s Suicide & Crisis Lifeline at 988, (TTY users can use their preferred relay service or dial 711 then 988), or chat at 988lifeline.org to connect with a trained crisis counselor 24/7/365. In life-threatening situations, call 911.

If you live in Connecticut, are age 16 to 35, and need a referral for care, call the STEP Learning Collaborative at 203-200-0140 or submit an online referral form. Assessment coordinators screen for psychosis over the phone and connect people to care. All calls are confidential.

“Never worry alone,” Dr. Srihari says. “Psychosis is a social puzzle, and I’d like to encourage people to think of it as a solvable puzzle and not a catastrophe. This means that educating yourself about how to get help—either for yourself or others—will empower you. And remember you are not alone. Someone else in your community probably has some experience with the same problem. You’d be surprised at how many people in your community have dealt with a psychotic episode.”