Psychosis Symptoms: How to Help in an Emergency

If you’re with someone who may be having a psychotic episode, it’s very important to not escalate erratic behavior that could become dangerous.

Mass General Brigham’s Phillip L. Rice, Jr., MD, chair of emergency medicine at Salem Hospital, reviews the symptoms and signs of psychosis in adults and lists some crucial steps you can take to keep everyone safe.

What is psychosis?

Psychosis is a mental state in which a person behaves in ways that suggest they are disconnected from reality. They may experience symptoms like hallucinations or delusions, including perceiving immediate sights or sounds that are not actually present. They may express beliefs in things that are known to be untrue. They may believe that they are on a special mission or that they have special powers or knowledge that others do not possess.

Step 1: Assess signs of psychosis in adults.

People with psychosis usually act in an excited and uncertain manner that can border on panic. If you believe that someone you’re with is experiencing psychosis symptoms, check for these common signs:

Psychosis signs and symptoms

• Using hurried or slowed speech
• Using language that is non-sensical or not properly constructed
• Changing topics frequently
• Expressing beliefs that are unrealistic
• Having difficulty with memory
• Perceiving sights or sounds that are not there
• Having difficulty concentrating or maintaining attention

Step 2: Project calm and offer support during a psychotic episode.

Psychotic episodes can often be triggered by fear and anxiety. The person may be reacting to feelings of uncertainty about where they are or what is happening in the moment, or they may be expressing symptoms of a more complex mental health disorder. The most important thing you can do when someone is experiencing psychosis is to recognize it and support the person. Follow these steps to try to keep an unpredictable situation under control:

Do:

• Remain calm and friendly.
• Listen to the person and pay attention to their words.
• Show empathy and understanding.
• Agree with and validate the person’s distress or frustration.

Do not:

• Escalate the situation by confronting the person, arguing, or criticizing them.
• Judge or disagree with the person’s beliefs or perceptions.

Step 3: Call 9-1-1 for help.

If a psychotic episode becomes violent or dangerous, call 9-1-1. If it hasn’t reached that point, there are mental health helplines available. They handle real-time situations like psychotic episodes.

If you need help in English or Spanish, call 1-800-662-HELP.

This number is the Mental Health Helpline of SAMHSA, the Substance Abuse and Mental Health Services Administration. Trained professionals can assess your situation and direct you to a service or agency that can help in an emergency. This service is free and available in English and Spanish.

Causes of psychosis in adults

Every case of psychosis is different. Psychosis is a symptom, not a disease, and the cause can often be unclear.

Psychosis is not uncommon. Up to 3 in 100 people will have a psychotic episode at some point in their lives. Psychosis often begins in the late teens or 20s, and approximately 100,000 young people experience psychosis every year in the United States. Older adults with dementia or other neurological disorders may also be at increased risk for psychosis.

There are several things associated with the onset of a psychotic episode. An episode can occur as a reaction to immediate conditions or events. Or it can be the result of a mental health condition. Mental health conditions that can lead to psychosis include:

• Schizophrenia
• Bipolar disorder
• Schizoaffective disorder
• Depression

What can trigger a psychotic episode?

Psychosis can be triggered by a broad range of mental, physical, and emotional factors, including the mental health conditions mentioned above. Any of the following causes can also contribute to triggering an episode:

• Physical illness or injury, including high fevers
• Immediate or past mental or emotional trauma
• Brain tumors
• Stroke
• Drug or alcohol use
• Reactions to medication
• Lead or mercury poisoning

Other warning signs of psychosis

A person may exhibit changes in behavior in the lead-up to a psychotic episode that can be telling. Some warning signs could include:

• Acting paranoid or with an air of suspiciousness
• Having trouble sleeping
• Having trouble thinking or communicating clearly or logically (speech issues, pauses)
• Spending more time alone; withdrawing socially 
• Having strange feelings or no feelings at all
• Showing a lack of care about cleanliness or personal hygiene
• Difficulty distinguishing between fantasy and reality
• Showing a sudden decline in grades or job performance

Managing a psychosis emergency

A psychotic episode can feel disturbing and unpredictable for everyone in the situation. But be aware that it’s probably even more frightening for the person who is experiencing it themselves. Stay calm, listen, and don’t escalate the situation. If you’re able, do your best to provide a soothing presence and keep things from getting worse.