In short
If a loved one is in acute psychosis (hearing voices, convinced they are being persecuted, speaking incoherently, severely agitated or frightened), the main thing is to ensure safety: speak calmly, do not argue with the delusions, remove dangerous objects, do not leave the person alone, and call a doctor as soon as possible. If there is a threat to life, aggression, talk of suicide, seizures, or confusion after alcohol or drugs, call 103 or 112 immediately. If there is no immediate danger, you can request a psychiatrist’s home visit: the doctor will examine the person, start treatment, and decide whether hospitalization is needed.
Key points in one minute
- Psychosis is a state in which a person loses touch with reality: hallucinations, delusions, and disorganized behavior appear.
- Speak to a person in psychosis calmly and briefly; do not argue with the delusions or try to prove anything by force.
- If there is a threat to life, aggression, or suicidal thoughts, call 103 or 112 right away without waiting.
- A psychiatrist’s home visit is suitable when the person refuses to go to a doctor but there is no immediate danger.
- In Kazakhstan, involuntary hospitalization is possible only in accordance with the law and under court supervision.
How to Tell If a Loved One Is in Psychosis
Psychosis is not a diagnosis but a state that can occur in various disorders: schizophrenia, bipolar disorder, severe depression, with the use of alcohol and drugs (including during withdrawal), and with certain physical and neurological illnesses. Its common feature is a break with reality: the person perceives things that are not there or firmly believes things that are not true, and it is impossible to talk them out of it.
The onset can be acute, over hours or days, or gradual. Family members are usually the first to notice that the person is “not themselves”: they do not sleep, say strange things, listen intently, close the curtains, check their phone for bugs, refuse food, or suddenly become anxious or aggressive. Sometimes psychosis shows up as agitation, and sometimes, on the contrary, as stupor and silence.
- Hears voices or sees things that are not there, answers invisible companions
- Is convinced they are being persecuted, that someone wants to poison them, or that they are being watched through devices
- Speech is incoherent, thoughts jump around, and the meaning is hard to follow
- Severe agitation and restlessness or, on the contrary, freezing and silence
- Does not sleep for days, refuses food and water
- Inappropriate or dangerous actions, with no awareness of being ill
- Confusion and disorientation in time and place, especially after a drinking binge
What to Do When a Loved One Is in Acute Psychosis
The first priority is safety: the person’s own, that of others, and yours. Put knives, sharp objects, medications, and car keys out of reach if you can do so calmly and unnoticed. Do not leave the person alone, especially if they talk about death or their voices are giving them orders. Reduce stimulation: turn off the TV, ask other people to leave, and speak more quietly.
Communicate briefly, calmly, and respectfully. Do not argue with the delusions or laugh at them: this only increases fear and mistrust. There is no need to agree with them either. It is better to acknowledge the feelings: “I can see you’re very scared. I’m here and I want to help.” Avoid sudden touching, keep your distance, and do not block the exit. If the situation is getting out of control, go to a safe place and call 112.
What Not to Do
Do not shout, threaten, lock the person in, or try to tie them up or restrain them by force unless you have the skills and there is an immediate threat. Do not give them alcohol “to calm down” or someone else’s medications: this can cause a dangerous interaction and make their condition worse. Do not trick them into seeing a doctor: it undermines trust for the future.
If the Psychosis Is Linked to Alcohol or Drugs
Alcohol withdrawal delirium (delirium tremens) usually develops on days 2–4 after stopping a long drinking binge: the person is disoriented, sees terrifying images, trembles severely, and sweats. This is a life-threatening condition that requires inpatient treatment. Psychosis after stimulants, synthetic cannabinoids, or “bath salts” (synthetic cathinones) also requires emergency help: call 103.
| Situation | What to do |
|---|---|
| Aggression, a threat to oneself or others, a suicide attempt | Call 112 or 103 urgently and ensure your own safety |
| Seizures, confusion, severe tremor after a drinking binge | Call 103: this may be alcohol withdrawal delirium, which requires a hospital |
| Psychosis after drugs, high fever, unconsciousness | Call 103 and report what is known about the substance taken |
| Delusions, voices, insomnia without immediate danger | Request a psychiatrist’s home visit or book an urgent appointment |
| Early signs of a relapse in a person with a known diagnosis | Contact their psychiatrist; do not change treatment on your own |
When to Call 103 and When to Request a Psychiatrist’s Home Visit
An ambulance (103) or the unified emergency service (112) is needed when there is an immediate threat to life and health: aggression, an attempt to harm oneself or others, suicidal statements, seizures, loss of consciousness, high fever with confusion, or suspected poisoning or delirium tremens. In these cases, do not spend time choosing a clinic or waiting; call emergency services right away.
If there is no danger right now, but the person clearly needs help and refuses to go to a doctor, you can request a psychiatrist’s home visit. The doctor will carry out an examination in familiar surroundings, talk to the person and their family, assess the risks, start treatment with the person’s consent, and arrange hospitalization if necessary. This often reduces stress for both the patient and the family.
How Narcology 24 Can Help
At Narcology 24, psychiatrists and addiction specialists make home visits around the clock. If the psychosis is linked to a drinking binge or substance use, the doctor assesses both the mental and physical condition, provides the necessary care on the spot, or arranges transfer to an inpatient facility. A preliminary consultation by phone or online is available for family members.
What to Do If a Loved One Has Started Showing Signs of Psychosis
- Assess the dangerAre there threats, weapons, attempts at self-harm, seizures, or confusion? If so, call 103 or 112 right away and think about your own safety.
- Remove dangerous objectsCalmly and without sudden movements, put away knives, medications, and car keys. Do not get into a struggle over objects if the person is agitated.
- Reduce the tensionSpeak quietly and briefly, turn off unnecessary noise, ask others to leave, do not block the exit, and keep your distance.
- Do not argue with the delusionsAcknowledge the feelings, not the content: “You’re scared, I’m with you.” Do not mock them or try to talk them out of it logically.
- Call a doctorIf there is no immediate threat, request a psychiatrist’s home visit; if there is a threat, call an ambulance. Tell them what the person has taken and how long ago it started.
- Prepare informationGather documents, a list of medications, and discharge summaries, and try to remember whether there have been episodes before and whether alcohol or drugs were used.
- Do not handle it aloneCall another adult whom the person trusts. After the episode, take care of your own well-being too.
What Happens During a Psychiatrist’s Home Visit for Psychosis
The doctor arrives, learns about the situation from the family, and then talks calmly with the patient. They assess consciousness, orientation, the presence of delusions and hallucinations, the risk of aggression and suicide, and the person’s physical condition: blood pressure, pulse, and signs of intoxication or withdrawal. It helps to prepare information in advance: when it started, what the person has taken, whether there have been similar episodes before, and which medications have been prescribed.
After the examination, the doctor explains what is happening and proposes a plan. If the person agrees, treatment may be started at home with follow-up monitoring. If the condition is severe, hospitalization is arranged, either voluntary or according to the procedure provided for by law. The doctor will advise you on how to act over the next few days, what to watch for, and when to get back in touch.
What Kazakh Law Says About Involuntary Hospitalization
In Kazakhstan, the rights of people with mental health disorders are protected by the Code “On Public Health and the Healthcare System.” Medical care is, as a rule, provided on the basis of voluntary informed consent. Psychiatric examination and hospitalization without consent are permitted only in cases expressly provided for by law: usually an immediate danger to oneself or others, helplessness, or a risk of serious harm to health without medical care.
The decision on involuntary hospitalization is made by a commission of psychiatrists and is subject to judicial review within the established time limits. The patient retains the right to information, contact with relatives, and legal assistance. Relatives cannot simply “commit” a person to a hospital on their own, but they can and should call for help if the person is a danger to themselves or others. Information about treatment is protected by medical confidentiality.
What to Do After an Acute Episode
Once the acute state has been relieved, an equally important stage begins: maintenance treatment and recovery. The cause of the psychosis needs to be identified: whether it is a first episode of schizophrenia, a manifestation of bipolar disorder, or a consequence of substance use or a physical illness. Further treatment depends on this. It is very important not to stop treatment on your own as soon as things get better: this is a common cause of repeat psychoses.
It is helpful for the family to work out a plan with the doctor in case things get worse: early warning signs (disturbed sleep, suspiciousness, irritability), who to call, and where the documents and the list of medications are kept. If the psychosis was linked to alcohol or drugs, the risk of recurrence is very high without treatment of the addiction, so an addiction specialist, psychotherapy, and rehabilitation are brought in. Family members also need support, including consultations with a psychologist.
When to see a doctor
- Your loved one hears voices, sees things that are not there, or is convinced they are being persecuted
- The person has not slept for several days in a row and refuses food and water
- Their speech has become incoherent and their behavior strange and unpredictable
- Confusion and tremor have appeared a few days after stopping a drinking binge
- Psychotic symptoms appeared after using drugs or “bath salts”
- A person with a known mental health disorder is showing signs of a relapse
When urgent help is needed
Call 103 or 112 without delay if the person threatens themselves or others, talks about suicide, has voices ordering them to cause harm, or has seizures, loss of consciousness, or high fever with confusion. Do not try to cope on your own. The free helpline 150 is available for children and young people.
How Narcology 24 can help
Round-the-clock home visits, inpatient care and detox, coding, rehab and online consultations with an addiction doctor or psychiatrist. Confidential, with no registry entry.
- Acute psychosis: urgent helpfrom 15 000 ₸ · Online 24/7
- Psychiatrist home visitfrom 15 000 ₸ · Online 24/7
- Schizophrenia treatmentfrom 15 000 ₸ · Online 24/7
Questions and answers
What should I do if someone has started showing signs of psychosis?
Ensure safety: remove dangerous objects, do not leave the person alone, speak calmly, and do not argue with the delusions. If there is a threat to life, aggression, or suicidal statements, call 103 or 112. If there is no immediate danger, request a psychiatrist’s home visit or see a doctor urgently.
Can I request a psychiatrist’s home visit without the patient’s consent?
A relative can call a doctor for a consultation, and the psychiatrist will come and talk with the person and their family. However, examination and treatment are carried out with the patient’s consent, except in cases expressly provided for by the law of the Republic of Kazakhstan, for example when there is an immediate danger to the person or others. In such situations, an established procedure applies, followed by judicial review.
How long does acute psychosis last?
The duration depends on the cause. Psychosis caused by poisoning or substance withdrawal may pass within days, while an episode of schizophrenia or bipolar disorder can last for weeks or months without treatment. With timely therapy, acute symptoms usually decrease noticeably within a few weeks.
How can I tell delirium tremens from psychosis?
Alcohol withdrawal delirium usually develops 2–4 days after stopping a long drinking binge and is accompanied by disorientation, severe tremor, sweating, a rapid pulse, and terrifying visual hallucinations, often getting worse toward evening. This is an emergency that requires hospital treatment: call 103.
Can psychosis be treated at home?
In some cases, if there is no danger to life, the person agrees to treatment, and family members are close by, treatment can begin at home under a psychiatrist’s supervision. With a severe condition, refusal to eat, aggression, suicide risk, or delirium, inpatient care is needed. At Narcology 24, the doctor decides on the treatment format after an examination.
How can I persuade a loved one to get treatment after psychosis?
Talk about what matters to them: sleep, anxiety, and the chance to return to school or work. Do not blame them or remind them of what they did while ill. Suggest talking to a doctor together. The decision to accept treatment needs to be supported by the person themselves, so trust and patience are important.
Is a person in psychosis dangerous?
Most people in psychosis are not aggressive and are more frightened than dangerous. But the risk of actions that are dangerous to themselves or others increases with command hallucinations (voices giving orders), persecutory delusions, and alcohol or drug use. That is why it is important not to provoke them, to keep your distance, and to call for help immediately if there is a threat.
Sources and methodology
- ICD-10, Chapter V “Mental and behavioural disorders,” WHO
- ICD-11, Chapter 6, section “Schizophrenia or other primary psychotic disorders,” WHO
- NICE guideline CG178 “Psychosis and schizophrenia in adults: prevention and management”
- Clinical protocols for diagnosis and treatment, Ministry of Health of the Republic of Kazakhstan
- Code of the Republic of Kazakhstan “On Public Health and the Healthcare System”
This article was prepared by the Narcology 24 medical editorial team and reviewed by a doctor. It is for reference only and does not replace a specialist consultation. Editorial policy
Medically reviewed by
Arman Magzhanov, MDPsychiatrist · experience 24 yearsSchizophrenia, bipolar disorder and acute psychosis, including substance-induced psychosis; psychiatrist home visits.
