Acute Psychosis

Acute psychosis is a mental health condition in which a person experiences a temporary or ongoing loss of contact with reality, marked by hallucinations, delusions, or disorganised thinking and behaviour. It can occur as part of a range of underlying conditions and requires prompt assessment.

• Hallucinations — seeing, hearing, or sensing things that are not there, most commonly hearing voices
• Delusions — strongly held false beliefs not shared by others, such as believing one is being watched, controlled, or persecuted
• Disorganised thinking or speech that is difficult to follow
• Agitation, unusual or disorganised behaviour, or social withdrawal
• Reduced insight into the fact that these experiences are not real

• Can occur as part of a primary mental illness, such as schizophrenia or bipolar disorder.
• Can be triggered or worsened by substance use, including alcohol, cannabis, or other drugs.
• Physical causes, such as high fever, severe infection (including cerebral malaria), head injury, or metabolic disturbance, can also cause psychotic symptoms, particularly with sudden onset.
• Severe sleep deprivation and extreme stress can contribute in some cases.

• Diagnosed through careful clinical assessment, including a detailed history from the person and, where possible, family or caregivers, together with a mental state examination.
• It is important to look for and exclude an underlying physical cause — such as fever, infection, head injury, or substance intoxication or withdrawal — especially with sudden-onset symptoms, as this changes management.
• Assessment of risk to self or others is an essential part of every evaluation.

Any underlying physical cause identified — such as infection, fever, or substance intoxication — is treated urgently, as this may resolve the psychosis.

An antipsychotic medicine, such as haloperidol, is used to control acute psychotic symptoms, at the lowest effective dose, with the person monitored for side effects.

Agitation may require calm, supportive de-escalation first, with medicine used if the person poses a risk of harm to themselves or others.

People experiencing acute psychosis, particularly with agitation, risk of harm, or an unclear cause, should be referred urgently to a facility with mental health expertise for further assessment and ongoing care.

Family and caregiver support and education are important parts of longer-term management once the acute episode is stabilised.

• Seek early assessment for any sudden change in behaviour, thinking, or perception rather than waiting for it to worsen.
• Avoid or reduce use of substances known to trigger or worsen psychotic symptoms, such as certain recreational drugs.
• Ensure prompt treatment of high fevers and infections, particularly in children and in malaria-endemic areas.
• Maintain regular follow-up and medicine adherence for anyone with a known psychotic illness to reduce the risk of relapse.