How to act before a psychotic outbreak? 8 guidelines and steps to follow

When a subject experiences a psychotic break, a break with reality occurs in his mind; he experiences unusual perceptions, ideas, or behaviors. In addition, typically the individual also has decreased awareness of the pathology.

Before the expression of the first symptoms of the psychotic outbreak, it is already possible to observe some different behaviors in the subject, such as an increase in social isolation, a decrease in personal hygiene, or an increase in suspicion, of the distrust. If we perceive these signs that anticipate the presentation of the affectation, we can act preventively and reduce the severity of the symptoms.

But... What to do when the symptoms of this pathology are already present? In this article we will see what to do with a person who is experiencing a psychotic break, favoring their recovery and minimizing risks and dangerous situations.

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What is a psychotic break?

We understand the psychotic break as

a psychiatric disturbance characterized by a temporary break with reality; the subject stops perceiving or interpreting the environment or his internal state as he really is, for a more or less long period of time. The causes can be multiple, both organic (such as substance use) and psychological (linked, for example, to psychotic disorders).

Although there may be an internal predisposition (that is, the individual shows more facility to develop the psychotic break) they are usually necessary environmental conditions that precipitate the outbreak, such as experiencing a stressful situation or a decrease or increase in stimulation.

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Characteristic symptoms of psychotic break

The appearance of the outbreak does not usually occur abruptly. It is usual that before the main symptoms of the psychotic episode appear, we observe behaviors and the patient himself notices changes in himself that serve as an indicator of the next outbreak appearance.

Some of these prior behaviors, also known as prodromal period, are: strange ideas, which move away from habitual thought; suspicion (intuits a bad intention in others); decreases hygiene and personal care; he isolates himself and separates himself from his surroundings; and disorganized behavior (involved in the predisposition to act in an unusual way).

When the outbreak is already present, the actual psychotic symptoms will appear, such as hallucinations, which consist of perception through the senses without there being a real stimulus; delusions (false beliefs held by the subject); psychomotor inhibition, and disorganized thought and speech. These symptoms can present different degrees of intensity, and may require hospitalization of the patient.

We must take into account that in most cases the subject shows little or no awareness of the symptoms of involvement, a situation that in Psychology we know as anosognosia. The individual believes that what he is perceiving or the thoughts and ideas he has are actually true to reality and that there really is an external stimulation or a real cause that explains these sensations.

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What to do with a person who is suffering a psychotic outbreak?

Given the type of symptoms and the different variety with which they can be shown, it is necessary that we support and help the person who presents psychotic symptoms as much as possible. It will be essential that we act to try to maintain control of the situation and prevent it from harming or injuring another person.

1. behave calmly

Before the appearance of a psychotic outbreak, where the situation can be altered, it is crucial not to lose our temper and appear calm. In this way, it is easier to transmit this sensation to the subject who is manifesting the symptoms and help to reduce his activation state. Likewise, tranquility also allows us to act in a more organized way and to be able to make more appropriate decisions, it will be easier for us to react.

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2. Find a quiet environment

As we have seen, stressful or highly stimulating situations can lead to the appearance of psychotic symptoms. For this reason, in the event of an outbreak, we must take the subject to a quiet environment, so that it is easier for him to calm down or at least so that the symptoms do not increase.

It will be preferable to avoid places with people, trying to separate it from the crowd to achieve greater control. If possible, it is recommended that there be two individuals to be able to support it and to have more capacity to act before the different circumstances that may occur.

3. Help the subject as much as possible

Another strategy that can be useful to help calm and promote the person's condition is to stay close to the subject, acting according to what he does not say and ask us as long as it cannot be a behavior dangerous. We will stay close, so that he can notice our presence, but we will avoid touching him or looking him directly in the eye, since these behaviors can upset him more. It is better to sit next to him and try to get between the subject and the door, but without completely blocking the exit..

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4. be understanding

We must be aware of the situation in which the subject presenting the outbreak finds himself, the behaviors that he shows he does not do them intentionally, that is, he is in a situation of mental alteration in which not fully aware of their behavior, thus diminishing the responsibility he has for his actions. We cannot blame him for his actions, since he is in a situation of breaking with reality and losing control.

Once the affectation of the outbreak decreases, it is also essential that we show empathy and act emotionally supporting the subject.

5. Communicate with the subject easily

Since the subject is already nervous, we must ensure that our reaction does not further increase his discomfort.

The disorganized behavior that can present can range from shouting, rapid speech or violent behavior. For this reason it is essential that we do not yell at him; We will talk to you calmly, with simple, short sentences that you can easily understand. We won't try to talk too much either, just as much as necessary to help you calm down and feel supported.

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6. Call the emergency services

As we have already seen, the behavior of the subject who is in an outbreak situation can become dangerous, both for the patient himself and for the individuals around him, for this reason we must act with caution. Similarly, when the subject is out of control and has lost contact with reality, the best option is to contact the emergency room or mental health professionals so they can intervene.

It will be necessary to guide the taking of drugs, especially the first days before the outbreak, to try to reduce and control the pathology. Thus, psychological treatment will also be useful, introducing it when the intensity of the symptoms have decreased and the subject can already interact with the professional.

In cases where the situation is overwhelming, it may be necessary to hospitalize the subject for a few days to keep him under observation and carry out closer treatment and follow-up. Despite being the best option in situations where great affectation appears and there may be dangerous behaviors directed at ourselves to others, we cannot force the patient to be hospitalized, we will not force him if we do not get his consent.

7. Cooperate to make improvement happen

One of the options that we have proposed in the event of a psychotic outbreak is the possibility of hospitalizing the subject for a limited period of time. The stigma that hospitalization can have, especially if it is linked to mental health, can lead the individual to resist accepting the proposal. For this reason, We must try to ensure that he does not see this option as so unfavorable.

We will tell you that in the hospital it will be much easier to treat your symptoms, achieving a speedy recovery and that the length of stay hospital is not permanent, when the improvement occurs and you feel ready you can leave or you can also do it at any time of the process if he wants it.

8. Support to follow the treatment

Once the first intervention has been carried out before the psychotic outbreak, it will be necessary to maintain a treatment, both pharmacological (especially short-term) and psychological, which will persist for a longer time. It is essential that we support you in complying with the treatment and that we show ourselves to collaborate with the professionals in everything we can help.

Correct adherence to treatment and following the treatment prescribed by both the psychiatrist as well as by the psychologist to reduce the risk of symptoms showing again and another appearing outbreak. So we will have to make sure that he complies with the established doses and that he attends the visits with his therapist. In this way, seeing that we support the intervention, it will be easier for him to perceive it as something good.