The question: A friend of mine has gone through what I think is a psychotic episode. Her family is getting her help, but she's months away from a full diagnosis. How should I proceed? Reach out to her, or stand back and let her get the help she needs before making contact?
The answer: A psychotic episode involves a set of cognitive and behavioural symptoms that include the hallmark features of hallucinations (mostly commonly seeing or hearing things that aren't there) and/or delusions (a false belief or opinion, held with strong conviction despite evidence to the contrary). The most common causes are a primary psychotic disorder (such as schizophrenia), a primary bipolar mood disorder (e.g., psychosis that occurs during a manic state), alcohol or drug abuse that is often, but not always, severe and chronic, or a severe depression. Psychotic states can sometimes be an atypical side effect of prescription medications or other complicated health conditions (a head injury, for example).
If a psychotic episode is in fact what your friend has experienced, this can be one of the most frightening and confusing experiences she has ever had. One of the most important factors that can help all of us cope with and get through difficult life experiences is the support of those who are close to us. Of course, we all differ in how much social contact we want at different times in our life, but having support right now is absolutely key for your friend.
The best thing you can do is let your friend know that you are there for her. Ask her what she feels she needs and would be helpful. Tell her that you love and care about her, but that you want to be mindful of her privacy. Be non-judgmental in your approach and behaviour. Many individuals who experience psychotic symptoms, particularly for the first time, are terrified. She may not understand what is happening, be unsure about the future (particularly since she's still in the process of getting help) and worry that others will perceive her as being "crazy." Because of that fear, she may be inadvertently pushing others away. Not making contact with her may only serve to further isolate her.
Let her know that she is the same friend in your eyes, and that her recent experiences don't change how you think or feel about her. Offer to attend appointments or get more information for her (there are a number of websites that offer useful educational material, particularly for loved ones, such as heretohelp.bc.ca and psychosissucks.ca).
Send psychologist Joti Samra your questions at email@example.com. She will answer select questions, which could appear in The Globe and Mail and/or on The Globe and Mail web site. Your name will not be published if your question is chosen.
The content provided in The Globe and Mail's Ask a Health Expert centre is for information purposes only and is neither intended to be relied upon nor to be a substitute for professional medical advice, diagnosis or treatment.