Psychotic episodes can be frightening for everyone. It’s also completely normal to feel unprepared. To support someone with psychosis, it helps to understand what these issues really are about, as opposed to what the general public often believes.
The word “psychosis” describes conditions that affect the mind, causing loss of contact with reality. This break from reality is a psychotic episode. During a psychotic episode, a person may experience delusions and hallucinations, among other issues. They may suddenly say they can hear voices, withdraw socially, or even violently lash out.
Because many people don’t know how to respond to these behaviors, they feel helpless and the stress and fear start to pile up. Learning how to communicate with someone with psychosis is key to both their—and your—mental health.
Recognizing the Signs of a Psychotic Episode
The typical image of a psychotic episode is a loud and dramatic event. Some episodes can be quite intense, but many are more subtle. Sometimes the only evident symptom is a slight behavioral change.
Plus, studies indicate that psychotic experiences are far more common than most people realize. About 6 percent of people report having a psychotic experience at some point in their lifetime. For these reasons, it’s essential to learn and recognize both the obvious and less prominent signs of a psychotic episode.
In general, psychosis symptoms fall into one of three categories. Positive symptoms include delusions and hallucinations, while negative ones involve a loss of function. The third category entails changes in thoughts and behaviors.
Early Warning Signs
Typically, people with psychosis will show cognitive and behavioral changes first. Some of the biggest warning signs include:
- Suspiciousness of other people
- Paranoia
- Uneasiness around others
- Social isolation and spending more time alone
- Confused speech and difficulty talking
Some of the other early signs are less obvious. For example, grades or job performance may suddenly worsen without a clear cause. A person may begin to express new ideas that are intense or unusual. In some cases, they may describe feeling strange or even seem to have no feelings at all.
Delusions
Delusions are fixed, false beliefs. Even if they seem obviously unrealistic, the person experiencing them will continue to believe the delusions. They can vary dramatically, but persecutory delusions—where a person feels someone is out to get them—are among the most common. Some other types of delusions include:
- Referential delusions: a person feels that things they hear or see refer to them
- Grandiose delusions: a person has grand or self-inflating, yet unrealistic, views of themself
- Erotomanic delusions: a person feels that someone is in love with them
- Nihilistic delusions: a person believes that a major catastrophe is about to occur
Hallucinations
Hallucinations are experiences that lack the proper trigger or stimulus to produce such a sensation. An example of this is smelling an odor that has no origin or seeing an animal that isn’t actually there. While most people think of hallucinations as purely visual or auditory, they may involve any of the senses. In fact, they may involve multiple senses at once. In contrast with delusions, people who hear auditory hallucinations describe them as occurring outside of their heads.
Loss of Function
Someone experiencing any of the other symptoms of psychosis may also have difficulty functioning overall. It’s common to lose the ability to initiate or participate in activities like hobbies or going to work. Some people notice a drop in their ability to feel pleasure, as well as a loss of motivation. These issues often overlap with the symptoms of conditions like depression and anxiety.
What Not To Say When Someone Is Psychotic
The way you respond to someone with psychosis can play a major role in your relationship with them and even affect the severity of their symptoms. Because psychotic episodes can vary so much, it’s often easier to focus on what not to say—bearing in mind the following….
Nobody Is at Fault
Understand that neither you nor the person going through the episode is at fault. The situation is an adjustment for everyone and most people have little preparation for it. Don’t try to assign blame or hold anyone responsible for the psychosis, especially the person experiencing it.
The Delusions and Hallucinations Are Real
To people with psychosis, the delusions are real, no matter how unrealistic they seem to you. Avoid laughing at, diminishing, or ignoring their thoughts. Never call them or their behavior crazy or stupid and avoid challenging delusions too directly. Beyond these tips, remember that your mental health matters, too. You don’t need to continue any conversation that you feel is distressing or confusing.
They’re Not Lazy
Labeling a person with psychosis as lazy is not only harmful but inaccurate as well. Their behavior is a symptom, not disobedience or intentional slacking. Don’t argue about tasks, chores, or responsibilities, and avoid overwhelming them with too many instructions. Also, don’t bring up how they used to feel or act. This can add additional negative feelings about how they’ve changed, aggravating their symptoms. Even if a person doesn’t show any emotion, they still have feelings.
How To Deal With Someone Having a Psychotic Episode
When it comes to knowing how to support someone with psychosis, the most important part is to focus on the emotion and themes of the conversation. Be on their side and don’t challenge them head-on. While they may say or describe things that aren’t realistic, you’ll often find threads of reality that you can follow.
An Example of Psychotic Thoughts
Imagine that your loved one tells you that a car is monitoring them. It parks on their street and every time they leave, a car drives by to track their habits. They claim the car follows them everywhere they drive.
Don’t dismiss these thoughts as unrealistic. However, remember that you should never encourage their psychosis. Instead, recognize their feelings. Let them know that you empathize with how scary these things feel. Ask if there’s anything you can do to help. Doing so will make it clear that you’re here to help and that they are free to reach out to you.
Keeping in Touch
People with psychosis often withdraw from social situations. Without pressing them to interact, you should always remain in contact. Simply letting them know that you’re there whenever they need you can be a major relief.
Handling Aggression
It’s a fact that sometimes psychotic episodes involve aggression and even violence. Remember that while a person may be directing their anger and aggression at you, it’s not necessarily a personal attack. Usually, they are a bigger risk to themselves than to you. Listen to them and attempt to understand why they are upset. Try to use a calm voice and a neutral facial expression.
Ultimately, take any threats or violent actions seriously. Your safety is as important as theirs, so leave the room or house quickly if things begin to escalate. Give them time to cool off.
How to Help Someone in a Manic Episode
Psychosis and mania can overlap, and some people experience psychotic symptoms during a manic episode. If the person you’re supporting has bipolar disorder, the guidance below may also help.
What Are the Signs of a Manic Episode?
A manic episode has distinctive signs that you can learn to recognize, alerting you to the fact that someone in your life is experiencing a period of mania. You might notice the individual being abnormally jumpy, being extremely upbeat, having high energy, becoming agitated more easily or exhibiting an unusual level of self-confidence.
A person in an episode of mania might also make poor decisions that are out of character for them. This could look like engaging in risky sexual activity, going on shopping sprees or gambling.
Additional symptoms of a manic episode that you can look for in a loved one include:
- Racing thoughts
- Increased talkativeness
- Not sleeping much or at all
- Easily distracted
If someone in your life is showing three or more of these symptoms, they’re likely experiencing a manic episode.
Process the Situation Rationally
During manic episodes, you can face emotional challenges with your loved one because they might exhibit explosive behavior toward you or behave recklessly. Although these behaviors may affect you, it’s important to take a step back and process the situation rationally.
Mental health conditions and mood disorders like bipolar that result in episodes of mania are beyond the individual’s control. As such, you shouldn’t take their behavior during a manic episode personally. Attempt to remain calm and consider ways you can help calm the situation.
Educate Yourself on the Condition
To support someone having a manic episode, you need to learn as much about the condition as possible. Turn to credible online resources for information about bipolar disorder and managing episodes of mania. Educate yourself about available treatment options and support programs in your local area.
Understand the Risks Involved
Before attempting to calm someone who’s having a manic episode, it’s critical to understand that there are inherent risks involved. According to a study in the Medical Journal of Australia, mania presents risks of poor judgment, risk-taking and, sometimes, aggressive behavior. When you attempt to intervene, this aggression could potentially be directed at you.
There’s also a chance individuals in a manic episode may be consuming excessive amounts of alcohol or misusing psychoactive substances, further altering their behavior. Additionally, there’s the potential for grandiose actions due to overconfidence, such as someone attempting to take over piloting an aircraft or driving a vehicle they’re not qualified to operate, potentially putting others in harm’s way.
It can be challenging to know what to do when someone is manic. A person in a manic episode may be unpredictable, which is why it’s important to remain calm and logical and avoid approaching them about their behavior in a way that appears confrontational or judgmental.
Learn How to Calm a Manic Episode
Learning how to calm someone with bipolar disorder takes time and requires you to be consistent and patient. If your loved one’s behavior is reckless and puts them or someone else at risk, you may need to seek emergency help rather than attempting to calm the episode yourself.
However, during a typical episode of mania, there are a few things you can do to help.
Provide Support
Offering your support to a loved one during a manic episode is one of the most important ways to help calm the situation and stabilize their behavior. You may need to help the individual determine what is and isn’t real if they’re experiencing psychosis. You can also work with them to put a plan in place for managing these mood changes before they occur. This could include ways to help them regulate their behavior or cutting them off from substances they can misuse (like drugs and alcohol).
If you live with the person, try to help them reduce their stress levels and maintain a consistent sleep schedule. Keeping up with a daily routine can also provide some stability to your loved one’s life. Spend time with them, regardless of their behavior, and don’t take any rude or insensitive comments personally during a manic episode. Limit the stimulation they’re exposed to by trying to create a soothing, calming environment.
Keep Communication Channels Open
When learning how to support someone in a manic episode, communication is key. Your loved one may have questions for you about reality vs their perceived reality or regarding their actions. Be honest with them to build trust so they can turn to you as an anchor of truth during this time of uncertainty.
If you want to support this person, make yourself available to them at all times when they’re having an episode. This doesn’t have to mean spending time with them 24/7. Letting them know they can call you if they need assistance making decisions at any time of the day or night is one way to keep communication open.
People with mania often feel isolated during these episodes, so spending time with them and letting them know you’re available to talk can help them cope better.
Tips for Supporting Someone in a Manic Episode
One of the most challenging things about how to help someone in a manic episode is knowing what to do when someone is having a manic episode. If you don’t know how to support someone in a manic episode, this can be frightening. It’s scary for you and the person experiencing the manic episode.
- Stay calm. The person going through the manic episode will fare better without frantic looks and expressions of fear from you. The calmer you are, the easier it will be to proceed with how to help someone in a manic episode.
- Don’t take their unkind remarks personally. When someone is experiencing a manic episode, they may say things that hurt, are untrue, or are out of the realm of possibility. Please recognize that this is their mania taking over. It’s not your loved one’s true feelings.
- Show compassion and express empathy.
- Try to distract or redirect their attention. This is especially important if the person having the manic episode wants to do something unsafe or risky. Suggest something else or initiate an activity where they could not immediately do what they asked.
- Avoid arguments and conflict during this time. That will only exacerbate the situation and isn’t suitable for anyone. Do not try to challenge them, have intense discussions, or confront their beliefs. This could escalate their agitation.
- Recognize that your loved one may resist or reject your efforts to help. If this happens, and the manic episode is severe enough that the individual may harm themselves or you, emergency hospitalization may be necessary. First, encourage them to get professional help independently because you are worried about them. Only if they refuse should you call for help.
How to Help Someone Realize They Need Help
How many people know how to help someone in a manic episode realize they need help? This can be challenging, even for those who have researched mania and feel they understand this aspect of mental illness well.
The most crucial aspect of how to help someone in a manic episode realize they need help is initiating the discussion. Finding time to discuss your concerns is vital when they’re receptive to the conversation.
Be prepared with a list of resources for getting professional help for your loved one. These can include:
- Treatment facilities specializing in treating mental health disorders
- The National Alliance on Mental Illness (NAMI)
- International Bipolar Foundation
- American Psychiatric Association
- Depression and Bipolar Support Alliance
Plan for the Future
One of the most important parts of helping someone with psychosis is building a plan for the future. You may be able to help manage a person’s psychotic episodes for a short period, but it is a heavy responsibility to carry and there’s only so much you can do. People with psychosis have medical conditions and need professional help.
Studies show that it’s common for people with psychotic symptoms to go without treatment for an entire year. Reducing this period will not only be better for their recovery but will also save you and the other members of their support network a significant amount of stress.
Involve the individual in the treatment plan. Their specific goals and needs will drive the path to recovery and giving them an active role will help them combat feelings of paranoia. It’s typical for people to reject treatment. You should still reach out to specialists so they can help guide you on the best path for you and your loved one.
If someone is at risk of harming themselves or others, it’s critical to get help quickly. Call or text 988 to reach the 988 Suicide & Crisis Lifeline, or call 911 in an emergency.
Restore Mental Health in Deerfield Beach provides comprehensive, personalized care to those with psychosis and mood disorders such as bipolar disorder. Call (877) 810-2074 or contact us today to learn more about how we can help with psychotic and manic episodes and other mental health issues.
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