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What to Do if a Family Member or Friend Has Psychotic Symptoms

If someone you care about is displaying psychotic symptoms, it can be frightening. Psychosis is a mental state characterized by a break from reality, and it can include delusions or hallucinations. It’s a symptom of serious mental illness, including schizophrenia and bipolar disorder.

Often, the ill person is unaware that the symptoms are unusual or that he or she should seek help. That’s where family members and friends often come in, though the experience can be distressing for them as well.

It’s important to seek help from a mental health professional to deal with psychotic symptoms because early treatment can improve outcomes long term.

Identifying Early Psychotic Symptoms

The earliest phase of a psychotic disorder consists of nonspecific symptoms that can be difficult to recognize as serious, says Karen Graham, MD, medical director at OASIS, a clinic in the Department of Psychiatry at the UNC School of Medicine that treats young people with psychotic disorders and those who are at high risk of developing them. “Many of these symptoms might just seem like fairly typical behavior, especially in teenagers,” Dr. Graham says.

These symptoms include:

  • Moodiness
  • Sleep difficulty
  • Poor performance in school
  • Social withdrawal
  • Lack of interest
  • Lack of enjoyment

Many things can cause these symptoms, including depression, anxiety, drug use, trauma, bullying or teenage angst. But Dr. Graham says “if these symptoms progress to unusual experiences such as thinking others can read your mind, paranoia, misperceiving events, or hearing and seeing things, then the likelihood that the person is developing a psychotic disorder goes up.”

When a teen or young adult withdraws socially, starts to fail at school or work, begins to use drugs or displays other unusual behavior, it’s worth pursuing a mental health evaluation. A good place to start is with your family doctor, the OASIS program or another local mental health center.

Emergency Psychiatric Help for Psychotic Symptoms

Under certain circumstances, it’s important to seek emergency psychiatric help. You can look for signs such as:

  • Expressing thoughts about suicide
  • Hearing disturbing voices, especially voices that command suicide or injury to self or others
  • Experiencing uncontrollable anxiety
  • Exhibiting manic or otherwise bizarre behavior, severe depression, disorientation or extreme confusion
  • Reacting unusually to psychiatric medication
  • Feeling uncontrollable anger

If the person having these symptoms is already in treatment, contact the clinic or provider immediately. Most mental health centers have 24-hour emergency numbers; it may be a good idea to keep the number handy in case of a crisis.

If your loved one is not receiving psychiatric care and is having an emergency, call 911.

Preparing for Psychiatric Emergencies

For people with severe and persistent mental illness, it can be helpful to have a plan of action in case of psychiatric emergencies. The person who is ill, family members and caregivers can create the plan together with guidance from a mental health professional.

The plan should allow the person with the illness, in consultation with family members and mental health professionals, to designate who can decide if hospitalization or emergency care is necessary. This allows the person with the illness to have input in the process in advance.

The plan should include:

  • Emergency phone numbers
  • List of medications the person is taking and their doses
  • Name of the person’s doctor and case worker, therapist or counselor
  • Insurance or related information
  • Plan for notifying pertinent health care professionals
  • List of family members or other caregivers who should be notified

What to Do if Someone with Psychotic Symptoms Refuses Treatment

Because schizophrenia and other psychotic disorders affect the brain, the person experiencing symptoms often doesn’t recognize them as being unusual and may refuse treatment. If symptoms aren’t too severe and the person refuses treatment, there may be nothing you can do but remain in contact and try to support the person.

Here are some ways to approach someone who refuses treatment:

  • Be yourself. This will help the person trust you and perhaps listen to your suggestions.
  • Give yourself and the person emotional and physical space. Avoid touching the person without permission, even to give comfort. If the person becomes hostile or aggressive, suggest a cooling-off period, emphasizing that you plan to return to the issue at hand when everyone is calmer. Leave yourself an avenue of escape if the person is agitated.
  • Calmly but firmly suggest that you take the person to see a doctor, therapist, case worker or counselor for evaluation. Don’t confront refusals or argue, but rather continue to listen and reiterate your suggestion. It may help to sit or stand beside the person while discussing this, rather than be face-to-face.
  • Go with the person to the doctor or mental health center to provide information about when the symptoms started and what medications the person is taking, and to answer any other questions. In a crisis, the ill person may not be able to answer these questions clearly, so your input is valuable.

If the person threatens violence or becomes violent, especially if there’s a history of violence, get help from the police as necessary. Remember that your loved one’s illness may cause him or her to act in a way that doesn’t reflect his or her true feelings or wishes.

Involuntary Commitment

In very serious episodes of mental illness, a person may need to be committed involuntarily to a hospital or mental institution.

To involuntarily commit someone in North Carolina, it must be clear that the person is mentally ill and a danger to self or others. “Danger to self or others” includes threats of suicide or suicidal gestures or plans, significant self-injury, threats of violence to others or behaviors that cause harm to others or to property, and a lack of self-care so serious and persistent that injury or disease is likely to result.

If someone displays these behaviors and refuses to seek care, another person may petition the local magistrate for psychiatric evaluation. This involves signing a legal document stating the facts that indicate the person is mentally ill and a danger to self or others. The affidavit must be filed in the magistrate’s office, usually in a local jail. If the magistrate determines there are reasonable grounds for psychiatric evaluation, a custody order will be issued and a law enforcement officer will pick up and transport the person to a mental health center or hospital for examination.

If the examining physician recommends inpatient care, the law enforcement officer will take the person to a local psychiatric unit or the state psychiatric hospital, where a second physician will perform an examination and may recommend involuntary commitment. The patient has a right to a court hearing within 10 days and the right to an attorney. The hearing is closed to the public, and court records are kept confidential. If the judge decides the person who was hospitalized does not meet standards for inpatient commitment, the person will be discharged from the hospital, though the judge could still order outpatient commitment.


If you are concerned someone is showing signs of a psychotic disorder, you can call OASIS for advice, or a psychiatric evaluation if appropriate, at (919) 962-1401.