Psychiatric Care for Psychosis and Schizophrenia

Psychosis describes symptoms in which a person loses some contact with reality: hearing or seeing things others don't, holding firm beliefs others don't share, or thinking that becomes disorganized. It can occur in schizophrenia, and also with bipolar disorder, severe depression, substance use, and some medical conditions. Schizophrenia is a long-term condition in which psychotic symptoms persist or return, often with changes in motivation and emotional expression.

How our physicians help

Our physicians begin with a thorough evaluation that considers medical, substance-related, and mood causes, then build a long-term plan that can combine medication, psychotherapy, and family involvement. Some situations need a higher level of care, such as a hospital stay, a residential program, or a specialized early-psychosis program. Outpatient care does not replace those settings; we help connect patients to them and coordinate closely with those teams.

What psychosis can look like

Psychosis often builds slowly. In teens, it can be hard to tell apart from depression or the normal ups and downs of growing up, so a steady change from how your teen used to be is the clue. People and families often describe:

• Seeming to listen or respond to something others cannot hear
• Feeling watched or singled out for no clear reason
• Finding private meaning in everyday things, such as a song
• Speech that jumps around or is hard to follow
• Speaking less, showing less emotion, or losing interest in people

How psychosis is diagnosed

No single test can diagnose psychosis. A diagnosis comes from a careful conversation about when symptoms began and how they changed, along with sleep, mood, stress, trauma, family history, medicines, and any cannabis or other drug use. We also look for medical causes, such as thyroid disease, seizures, infections, or a medication side effect. Blood work or brain imaging may be needed. Schizophrenia is considered only when symptoms last for months and other causes are ruled out, so a firm answer can take time.

Treatment options and their limits

Antipsychotic medication is the main medical treatment. It can ease voices, distressing beliefs, and confused thinking, often over days to weeks, though full benefit can take longer. It tends to help less with low motivation. Side effects can include sleepiness, restlessness, stiffness, and changes in weight or blood sugar, so regular check-ups matter. Finding the right medicine can take more than one try. How long to stay on it is a decision made with your physician, because symptoms can return when medication is lowered or stopped. Please do not stop it on your own.

Other supports include the following. These often come from separate programs, and we help connect you.

• Cognitive behavioral therapy for psychosis (CBTp): talk therapy for coping with voices and unsettling beliefs
• Family education: helps everyone understand the condition and talk more calmly
• Coordinated specialty care: a team-based program for people early in psychosis

Supporting a family member or friend

A person with psychosis may not see that anything has changed. This is often part of the condition, not stubbornness. It can help to talk about what bothers them, such as poor sleep, rather than the word psychosis.

• Speak calmly, in short sentences
• You do not have to argue with a belief or agree with it
• Write down changes to share with the care team

Knowing when to call

Call us when new symptoms appear, even if they come and go, or when someone is slipping at work, school, or home. Earlier care matters, because long gaps without treatment can make recovery harder. Many people living with psychosis or schizophrenia work, go to school, and keep close relationships.

If someone cannot stay safe, is too unwell to care for themselves, or talks about suicide, call or text 988 (the Suicide & Crisis Lifeline) or call 911. We are not an emergency service.

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