Psychotic symptoms: how to spot them and what to do

Hearing voices, believing something that's clearly not true, or suddenly acting very confused can be terrifying — and they’re all examples of psychotic symptoms. These symptoms aren’t a single diagnosis. They’re warning signs that something in the brain, body, or environment needs attention now.

What psychotic symptoms look like

Keep it simple: there are four easy-to-spot types.

• Hallucinations — seeing, hearing, smelling, or feeling things that aren’t there (hearing voices is common).
• Delusions — fixed false beliefs (for example, thinking neighbors are spying or that you have special powers).
• Disorganized thinking or speech — jumping between unrelated topics, making sentences hard to follow.
• Severe changes in behavior — acting bizarre, withdrawing, or being unable to care for daily needs.

Common causes you should check first

Don’t assume schizophrenia right away. Psychotic symptoms can come from many things. Look for clear triggers:

• Medications and prescriptions — high-dose steroids, some stimulants, and rare reactions to antidepressants or other drugs can cause psychosis.
• Illicit drugs — methamphetamine, high-potency cannabis, LSD, and heavy stimulant use often trigger hallucinations or paranoia.
• Withdrawal — sudden alcohol or benzodiazepine stopping can produce severe psychosis or delirium.
• Medical problems — infections, severe sleep loss, metabolic imbalances, or brain injuries may present with psychosis.
• Primary psychiatric disorders — bipolar disorder, major depression with psychotic features, and schizophrenia can cause ongoing symptoms.

Knowing the cause matters because treatment changes. If a medication or substance caused it, stopping or changing that treatment could resolve things quickly. If it’s a medical issue, treating the illness helps the symptoms fade.

What to do right now — a quick action plan

If someone is suddenly psychotic, follow clear steps:

• If there’s danger to themselves or others, call emergency services immediately.
• Stay calm. Speak softly and clearly. Avoid arguing about their beliefs — focus on safety and basic needs.
• Remove access to weapons, driving, and substances. Keep the environment quiet and well-lit.
• Contact their doctor, mental health crisis team, or bring them to an emergency room for assessment.
• Bring a list of current meds, recent drug or alcohol use, and any medical problems — this speeds diagnosis.

Treatment usually starts with short-term safety and may include antipsychotic medication, treating medical causes, and follow-up with psychiatry. Many people recover well when the cause is found and treated early.

If you’re worried about subtle changes — a friend who’s withdrawing, odd beliefs, or poor sleep — don’t wait. Early help lowers risk and improves recovery. Reach out to a doctor, local mental health service, or a crisis line today.