How to Act During a Psychotic Episode, According to Experts – November 6, 2025 – Balance
Psychotic episodes can be frightening, but understanding how to respond can substantially improve safety and facilitate appropriate care. Experts emphasize a calm, supportive approach focused on de-escalation and professional help. While not all psychotic conditions involve aggression, knowing how to react if it does occur is crucial.
Is Aggression Common During Psychotic Episodes?
According to doctors, agitation and aggression aren’t always present in psychotic conditions. However, in the most severe cases – acute psychotic episodes – a patient experiencing intense delusions may act on those beliefs.
Detecting the Onset of a Psychotic Episode
A psychotic break rarely happens suddenly, except in cases involving drug use. For conditions like bipolar disorder or schizophrenia,the onset typically unfolds over a few days. This timeframe allows for observation of behavioral changes.
In individuals with bipolar disorder experiencing mania, signs can include accelerated speech and activity, and a reduction in sleep. “She feels more powerful, she starts to think she is more than she really is,” explains a psychiatrist. Its also crucial to determine if a patient has stopped taking prescribed medication, as this can trigger an episode. In all cases, contacting the patient’s healthcare professional before the situation escalates is recommended.
What to Do If You Witness a Psychotic Episode
If a patient becomes aggressive, avoid being alone with them while they are agitated. if the individual has a known diagnosis, “you will quickly seek medical help,” advises a psychiatrist. If the patient’s psychiatrist is unavailable, or the situation is urgent, call Samu (Brazil’s emergency medical service).
The patient should be taken to the emergency room for immediate care, where they can be medicated to calm them and manage agitation or aggression.
Maria Fernanda Caliani, a specialist in Cognitive-Behavioral Therapy from USP, stresses prioritizing the safety of everyone involved. “The ideal is to remain calm, avoid arguments or attempts to convince as at this point no logical argument will make sense, the critically important thing here is to seek professional help promptly,” she explains.
she cautions against attempting physical restraint without proper training or support, as this could worsen the situation.Instead, a receptive attitude, a calm tone of voice, and the presence of a trusted person can be helpful while waiting for professional assistance. “Reception, a calm tone of voice and the presence of someone you trust make a difference until the specialized team arrives,” she adds.
Is Hospitalization Appropriate?
Brazil’s Psychiatric Reform Law (Law 10,216/2001) prioritizes treatment in freedom, close to family and community, minimizing hospitalization. Hospitalization should only be considered when there is a genuine risk to the patient’s life or the lives of others, and when outpatient treatment options are insufficient.
Dr.Caliani emphasizes that hospitalization is a phase of intensive care and should always be accompanied by a follow-up and reintegration plan. “the focus is to treat, protect and restore autonomy,” she says.
