To reality check someone with psychosis, avoid direct confrontation; instead, validate their feelings, gently offer alternative perspectives (e.g., "I see it that way, but the sun is bright"), use simple, calm communication, focus on their distress, and encourage professional help rather than arguing about delusions or hallucinations. The goal is to build trust, not win an argument, by acknowledging their experience while guiding them towards professional support, not debating reality itself.
Avoid confronting, criticizing, blaming, joking, laughing at or using sarcasm with the person experiencing psychosis. Be honest and do not make promises that cannot be kept. Communicate in a brief and uncomplicated manner and repeat things if necessary.
People experiencing schizophrenia or psychosis often struggle with distinguishing reality from hallucinations (false sensory experiences) or delusions (strongly held false beliefs). Reality checking can help individuals with psychotic disorders assess whether their perceptions are consistent with objective evidence.
If you think the person's symptoms are severe enough to require urgent treatment and could be placing them at possible risk, you can:
You should not dismiss, minimize, or argue with the person about their delusions or hallucinations. Similarly, do not act alarmed, horrified, or embarrassed by such delusions or hallucinations. You should not laugh at the person's symptoms of psychosis.
With early diagnosis and appropriate treatment, it is possible to recover from psychosis. Some people who receive early treatment never have another psychotic episode. For other people, recovery means the ability to lead a fulfilling and productive life, even if psychotic symptoms sometimes return.
Treatment for psychosis involves a combination of antipsychotic medicines, talking therapies and social support.
In cases of hyperactive delirium, symptoms are often mistaken for those of a psychosis—typically schizophrenia or mania. In hypoactive cases of delirium, symptoms may lead to a misdiagnosis of severe depression.
But in general, 3 main symptoms are associated with a psychotic episode:
6. Use active listening. It's so important to give a person going through the crisis a safe space to express themselves and let them know they're being heard. Repeat back what they say, and don't add anything.
Positive symptoms can include experiences such as hearing sounds or voices that others cannot hear, seeing things that others cannot see, odd or upsetting thoughts, suspiciousness of others, beliefs about having special powers and confusion about what is a dream and what is reality.
When a client needs a reality check, I ask a question that compares whatever unrealistic, inaccurate or false thing they just said to something else that is 100% inarguable and 100% accepted as fact, such as: “Are you as sure about what you just said as you are that the sun will rise tomorrow?
Around the year 2000, psychiatric neuroscience research revealed that psychosis destroys brain tissue and causes brain atrophy (4) due to neuroinflammation and free radicals (5) both of which damage gray and white matter. Brain structure and function deteriorate with every psychotic relapse.
The sudden onset of psychotic symptoms, such as delusions, hallucinations, or disorganized speech, defines this mental health condition. Symptoms last for at least one day but less than one month, often triggered by a stressful event, and usually resolve independently.
Don't try to convince them it's not real
This means that the person has absolutely no doubt that what they think, feel, see, or hear is real. There's nothing you can do or say to convince them otherwise… But you also won't make the delusions more fixed if you talk about them.
REDIRECT THE PATIENT TO RELEVANT EDUCATIONAL OR MENTAL HEALTH RESOURCES appropriate to any clinically meaningful symptoms and experiences. These may include specialized care (e.g., an anxiety specialist, trauma informed care, neurology).
When supporting someone experiencing psychosis you should:
Self-awareness during psychosis exists on a spectrum—some people have partial insight, others recognize symptoms only after episodes end. Psychosis alters perception so profoundly that delusions and hallucinations feel completely real to the person experiencing them.
Examples in Psychosis
The acute stage is marked by the emergence of full-blown psychotic symptoms, often causing significant disruption to the individual's life. Key symptoms include. Audio and visual hallucinations (seeing or hearing things that aren't there) and in some cases tactile hallucinations (feeling things that aren't there)
Initially, some of the symptoms that are apparent in the acute phase may linger in the recovery phase but with appropriate treatment most people successfully recover and return to their normal, everyday lives.
The "25 rule" (or "rule of quarters") in schizophrenia suggests that outcomes fall into four roughly equal groups: 25% recover fully, 25% improve significantly with some ongoing support, 25% improve somewhat but need considerable help, and 25% have a poor outcome with chronic illness or suicide risk, highlighting the varied nature of schizophrenia's long-term course, though some sources use a "rule of thirds" with similar proportions for different outcomes.
Substances. Alcohol misuse and drug misuse can trigger a psychotic episode. A person can also experience a psychotic episode if they suddenly stop drinking alcohol or taking drugs after using them for a long time. This is known as withdrawal.
Oral antipsychotic medicines – namely aripiprazole, chlorpromazine, haloperidol, olanzapine, paliperidone, quetiapine, risperidone – should be offered for adults with a psychotic disorder (including schizophrenia), carefully balancing effectiveness, side-effects and individual preference.
Eat More: Clams
A number of reports have shown low levels of vitamin B12 in those with psychosis -- a set of mental disorders that schizophrenia is one of. Other research says a bit more B12 can ease symptoms. Clams are a big source of B12. It's found in liver, trout, and in some breads, too.