6 signs someone is experiencing a psychotic episode

By Kai Conibear,
updated on Apr 9, 2024

6 signs someone is experiencing a psychotic episode

Awareness of these signs of psychosis could allow you to support a friend in need sooner

Psychosis causes people to lose touch with reality, and experience either hallucinations, delusions, or both. Hallucinations include seeing, hearing, or feeling something that isn’t there, while delusions involve holding a belief that isn’t true, and may seem irrational and unbelievable to others.

In the early stages of a psychotic episode, it might not be clear what’s happening, and changes may be gradual. You may not realise someone is dealing with hallucinations or delusions until they become very ill. However, there are other ways to identify if someone you care about might be in a psychotic episode.

Early signs of psychosis

These include finding it difficult to focus, not understanding what others are saying, or struggling to keep track of their own thoughts. They might seem more irritable, suspicious, and paranoid. They could feel disconnected from the world around them, or feel overwhelmed.

Withdrawing from social activities

Isolating from others is common for someone in a psychotic episode, which also hampers efforts to get them help. Hallucinations and delusions may make someone feel they need to hide from the world. They might stop going to social events, answering messages, or cease communicating altogether. If you notice someone withdrawing from their support network, try to check in with them in person.

Changes in behaviour

This might manifest as mood changes, or socially inappropriate behaviour. They may experience mood swings, particularly if they have a mental illness like schizophrenia or bipolar disorder. Psychosis can also be a symptom of severe depression. They may drastically change, such as experiencing a high, elevated mood, known as mania, or a low, withdrawn mood resulting in depression. Both mood states may also happen in quick succession.

Due to the psychosis, some of their behaviour may become inappropriate or out of character. They might regress and become childish, or become extremely dependent on others. They could start to become paranoid and suspicious, and have new ideas and opinions they’ve never expressed before. There’s a chance they’ll show signs of stress and irritability, or become rude and distressed for seemingly no reason.

Not looking after themselves

A psychotic episode can cause someone’s self-care to break down to the point that they no longer look after themselves properly. Depending on what they’re experiencing, this could manifest in a number of ways, such as not showering, washing their hair, or brushing their teeth. Their home may become messy, as they’re no longer able to clean and tidy. It might mean they can’t or won’t sleep. Sometimes, psychosis can make eating and drinking difficult, so there can be signs of weight loss.

Severe anxiety

Anxiety is common during psychosis, as losing touch with reality is often a frightening and overwhelming experience. It contributes to withdrawing from friends and family, and people can often feel too anxious to leave their home, or even bedroom. Anxiety often leads to disrupted sleep and insomnia, which can exacerbate symptoms.

Disordered thinking and/or speech

You may notice they find it hard to stay focused, and follow a conversation. They seem easily distracted, or as if they’re having an entirely different conversation with someone you can’t see. If they’re delusional, they can seem laser-focused on one topic, and keep bringing the conversation back to it. This may manifest as rapid or continuous speech with few breaks. They might quickly switch from one topic to another, often with no connection. Speech may be garbled, or confused and difficult to understand. They may often pause mid-sentence, or lose their train of thought. They may seem preoccupied or distracted while you’re talking to them.

If these signs sound familiar, and you think a loved one is experiencing psychosis, it’s incredibly important to find help for them as soon as possible. Unfortunately, there’s not much you can do to help if someone is in the middle of a psychotic episode, except stay calm, patient, and find help. Speak to a medical professional about your concerns – either a GP, or your loved one’s mental health team or psychiatrist. In an emergency, take them to A&E.

If you can identify any of these signs before the psychotic episode is in full swing, it will give you a head start in helping your loved one get the care they need before it becomes more serious. Your support could make a world of difference.

By Kai Conibear

Kai Conibear is a writer and mental health advocate. His first book, ‘Living at the Speed of Light’, about bipolar disorder, is out now.'

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