Schizophrenia and Psychosis

Symptoms and clinical assessment

Psychosis can involve hallucinations, firmly held false beliefs, disorganized speech or behaviour, and difficulty judging what is real. Schizophrenia may also cause reduced motivation or expression, social withdrawal, cognitive difficulty and impaired self-care. Symptoms are not evidence of possession, moral failure or weak character.

• A first or sustained psychotic episode needs prompt specialist assessment, ideally through an early-intervention service. The team assesses safety, symptoms, mood, development, trauma, substances, physical health, medicines, daily function, housing and family/social support.
• Clinicians consider bipolar disorder, psychotic depression, substance/medicine effects, seizures, delirium, infection, thyroid/autoimmune or neurological illness and culturally shared beliefs before confirming a diagnosis.
• Brain imaging, EEG or special blood tests are used when history/examination suggests another cause; no single scan or laboratory test diagnoses schizophrenia.

Evidence-based treatment and recovery

• Antipsychotic medicine: the patient and clinician choose together after discussing likely benefit and metabolic, movement, heart-rhythm, hormonal, sedation and sexual side effects. Long-acting injections can help selected people who prefer them or have difficulty with daily tablets.
• Psychological and family care: offer CBT for psychosis, family intervention, illness education and practical relapse planning. Supported education/employment, social-skills work, cognitive remediation and help with housing or benefits support recovery.
• Persistent symptoms: clozapine is an evidence-based option after adequate trials of other antipsychotics and requires strict blood monitoring. Catatonia or selected severe, life-threatening illness may require hospital care and specialist treatment such as ECT.
• Continuity: agree early warning signs and a written crisis plan. Do not stop antipsychotic medicine abruptly; relapse and withdrawal effects can follow. Any gradual reduction should be specialist-led with close monitoring.

Medicine and physical-health monitoring

• Before and during antipsychotic treatment, monitor weight/waist, pulse, blood pressure, glucose/HbA1c, lipids, movement symptoms, nutrition and physical activity. Prolactin, ECG and other tests depend on medicine and risk.
• Report severe restlessness, stiffness, tremor, involuntary movements, fainting, breast/sexual changes, rapid weight gain or marked sedation so treatment can be adjusted rather than abandoned.
• High fever with severe muscle stiffness, confusion and unstable pulse/blood pressure may be neuroleptic malignant syndrome and needs emergency care.
• Anyone taking clozapine must follow the blood-monitoring programme and seek urgent advice for fever, sore throat, infection symptoms, chest pain, severe constipation, seizure or profound sedation.
• Review tobacco use. Starting or stopping cigarette smoking can change levels of some antipsychotics, especially clozapine and olanzapine; tell the prescriber promptly so monitoring can be adjusted.

Clinician-supervised Ayurvedic medicines and therapies

Traditional Ayurveda may describe severe mental disturbance within Unmada and use concepts involving manas, dosha, rajas and tamas. These cultural concepts cannot rule out delirium, substance effects or neurological disease and do not replace antipsychotic treatment. No Ayurvedic product has been shown to stop acute psychosis.

• Ashwagandha, brahmi and multi-herb “memory” or “mind” products can add to sedation or interact with thyroid, liver, immune, anti-seizure and psychiatric medicines. Piperine/black-pepper extracts may alter medicine absorption.
• Avoid cannabis and intoxicating preparations; cannabis can trigger or worsen psychosis and relapse. Avoid stimulant tonics, excess caffeine and sleep-depriving practices.
• Avoid unlabelled mixtures and herbo-mineral rasa/bhasma products unless regulated manufacture and independent contaminant testing can be verified. Lead, mercury or arsenic can produce psychiatric and neurological illness.
• During active psychosis, avoid fasting, purgation, emesis, intensive Panchakarma, isolation, prolonged meditation, forceful breathwork or sensory-overloading rituals. They can worsen dehydration, sleep loss, fear or agitation.
• When stable, gentle adapted yoga, relaxation or massage may support wellbeing if the mental-health team agrees and the person can consent. They do not substitute for medicine, CBT, family work or social rehabilitation.

Practical diet and daily support

• Use regular meals with vegetables and fruit, whole grains, pulses/beans, adequate protein and unsaturated fats. No food, fasting plan or dosha diet cures schizophrenia.
• Support shopping, cooking and hydration when motivation is low. Review unexpected weight loss, food refusal, swallowing problems or severe constipation promptly.
• Build activity gradually and monitor weight, diabetes and cardiovascular risk. Keep a consistent sleep/wake routine and avoid alcohol, recreational drugs and energy drinks.
• Use calm, respectful communication. Acknowledge distress without agreeing with or aggressively challenging a fixed belief; focus on safety and the person's goals.
• Families and carers also need education, respite and crisis contacts. Safeguarding is important when there is exploitation, homelessness, neglect or abuse.

Clinical sources and further reading

• US National Institute of Mental Health: schizophrenia
• NICE CG178: psychosis and schizophrenia in adults
• Government of India: National Mental Health Programme and Tele-MANAS
• NCCIH: ashwagandha safety and interactions
• NCCIH: Ayurvedic medicine evidence and safety

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Dr. Aditya Kulkarni

Psychiatry

📍 New Delhi

Experience: 10 yrs

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