Schizophrenia and psychosis

Get help straight away if

These are uncommon, but they need same-day care — go to an emergency department, do not wait for an appointment.

• Thoughts of ending your life, or of harming someone elseCall 911, or call or text 988 for the Suicide Crisis Helpline.
• Voices instructing you to do something, particularly to hurt yourself or anyone elseGo to an emergency department, or call 911.
• Not eating, drinking or sleeping because of what you are experiencingGo to an emergency department.

Contact us promptly if

Not an emergency, but worth being seen sooner rather than waiting it out.

• A first episode of hearing or seeing things others do not, or of beliefs that people close to you find worryingWorth being seen quickly. How soon treatment starts is one of the few things that measurably changes how well people do afterwards.
• Having stopped medication, or being about toCome and talk to us first. Stopping suddenly is the commonest route to a relapse, and if the reason is side effects — and it usually is — there are alternatives worth trying.
• New physical symptoms while on antipsychotic medication: marked weight gain, thirst and passing urine often, or muscle stiffnessThese are treatable and are worth acting on rather than tolerating.

What usually happens

Schizophrenia is not a split personality. It is a disturbance in how the brain processes perception and belief, and the confusion with multiple personalities is entirely a matter of the name.

People with schizophrenia are considerably more likely to be the victims of violence than the perpetrators of it. The association most people carry is not supported by the evidence, and it is one of the main reasons people delay seeking help.

How long psychosis goes untreated predicts how well someone recovers, more clearly than almost anything else we can influence. That is why a first episode is worth acting on within days rather than watching for months.

Recovery is a realistic goal. Many people have one episode and no more; many work, study and raise families. The picture of inevitable deterioration reflects an era before effective treatment, and it is still what most people assume.

The physical health side is where much of the avoidable harm now sits — weight, diabetes, cholesterol, smoking and heart disease all run higher, partly from the illness and partly from the medication. This is treatable and gets less attention than it should, which is why we monitor it deliberately.

At your appointment

We will ask about what you have been experiencing directly and without alarm, including things you may not have told anyone because of how they sound.

With your agreement, we will ask what someone close to you has observed, since the picture is often clearer from outside.

Blood tests and a review of medications and substances, because a number of physical conditions and drugs can produce similar symptoms and are treatable in their own right.

Regular physical health monitoring — weight, blood pressure, blood sugar, cholesterol — alongside the mental health care, since that is where the greatest avoidable harm lies.

Worth asking

• —What are my early warning signs, and what should I do if I notice them?
• —How long am I likely to need this treatment?
• —What side effects should I watch for, and which ones can be changed?
• —Who do I contact out of hours?