Psychosis

What is Psychosis?

Psychosis is a group of symptoms in which a person loses contact with reality. It is the hallmark of schizophrenia and related disorders, and it also occurs in mood disorders, substance use disorders, and neurological and medical conditions. About 1.5 to 3.5 percent of people will meet criteria for a psychotic disorder in their lifetime, and more will have at least one psychotic symptom.^[1]

A first episode or a relapse needs prompt psychiatric and medical evaluation, not complementary care.

Common symptoms

Psychosis changes how a person perceives, thinks and behaves, and it causes great distress for patients and families.^[1]

• Hallucinations: hearing voices or, less often, seeing, feeling, smelling or tasting things that are not there
• Delusions: fixed false beliefs, such as being watched or persecuted, having special powers, or having a serious illness without evidence
• Disorganized thinking and speech: jumping between topics or speech that is hard to follow
• Changes in behavior: agitation, withdrawal, reduced emotional expression or unusual movements
• Reduced insight: not recognizing that these experiences are symptoms, which can make it hard to seek help

Causes and risk factors

Psychosis has many possible causes. They include schizophrenia and schizoaffective disorder, bipolar disorder, severe depression, drugs such as cannabis and stimulants, alcohol or drug withdrawal, and medical conditions affecting the brain, such as infections, tumors, epilepsy, dementia, and hormonal or metabolic disorders.^[1]

Family history raises risk, and so does early life stress. A meta-analysis found that people exposed to childhood adversity were nearly three times as likely to develop psychosis.^[2] Severe sleep loss can also bring on or worsen symptoms.^[3]

How it is diagnosed and treated conventionally

Diagnosis is made by a psychiatrist or other physician through an interview, a physical examination, and blood tests or brain imaging when needed to look for medical causes.^[1]

Treatment depends on the cause. Antipsychotic medication is the mainstay for psychotic disorders, usually combined with psychological therapy, family education and help with work or school; some people need a hospital stay for safety. Early intervention programs for first-episode psychosis improve quality of life, employment and relapse and admission rates.^[4]

Why Psychosis calls for a whole-person approach

Medication and psychiatric care treat the psychotic symptoms. Recovery also depends on sleep, stress, physical health and daily routine, and these are areas where supportive care may help.

Supportive care does not treat psychosis itself. It belongs only alongside psychiatric treatment, once the condition is under medical management and the treating team knows about it.

Sleep

Sleep problems are common and matter in psychosis. In a systematic review, about half of patients had insomnia, and disrupted sleep predicted the onset and persistence of paranoia and hallucinations. Treating sleep may modestly ease those experiences.^[3]

Stress and past adversity

Stress is closely tied to psychosis. Childhood adversity and trauma are strongly associated with later psychosis across many study designs.^[2]

Inflammation

People with schizophrenia show changes in immune signaling. A meta-analysis found raised blood levels of inflammatory markers such as interleukin-6 during acute illness.^[5] Whether lowering inflammation improves symptoms is still being studied.

Physical health and medication side effects

Antipsychotic medicines can affect weight, cholesterol and blood sugar, and the size of this effect differs between drugs.^[6] These effects are reasons to work with the prescriber, not to stop medication.

Acupuncture as supportive care in Psychosis

What the research shows

Acupuncture has been studied mainly as an addition to antipsychotic medication in people with schizophrenia, and the evidence is low quality. A Cochrane review of 30 trials found limited evidence that adding acupuncture may improve overall and mental state, and it called for better-designed studies.^[7]

A 2026 meta-analysis of 55 trials (4,256 participants) found that acupuncture plus standard-dose antipsychotics improved symptom scores compared with antipsychotics alone, with low certainty. In the two trials that used sham acupuncture, real acupuncture was not clearly better than sham, so it is uncertain whether needling itself is responsible. Acupuncture with a reduced medication dose was no better than standard-dose medication, with very low certainty.^[8] This does not support lowering medication.

For sleep, one trial of 96 patients with schizophrenia found that shallow needling five times a week for six weeks improved sleep scores about as much as a sleeping pill, with fewer side effects.^[9] An earlier systematic review also concluded that acupuncture may improve sleep and quality of life in psychiatric patients, while finding only limited evidence for schizophrenia symptoms.^[10]

How acupuncture may work

How acupuncture might help in psychosis is not established. Brain imaging research suggests that needling changes activity in networks involved in emotion and sleep, which could explain better sleep and well-being.^[10] The lack of clear difference from sham acupuncture in two small trials leaves the specific effect of needling uncertain.^[8]

What treatment involves

Supportive acupuncture is considered only once the condition is under medical management and the treating team knows about it. Fine, sterile, single-use needles are placed for about 20 to 40 minutes over a course of several visits, followed by reassessment.

Serious problems from acupuncture are rare; about 9 in 100 patients have a minor reaction such as brief bleeding or soreness at a needle site.^[11] Tell the practitioner about all medicines, bleeding problems, pregnancy, a pacemaker or a seizure disorder.

Ayurvedic medicine as supportive care in Psychosis

The Ayurvedic view

Classical Ayurveda treats hallucinations as a symptom of mental disorder (manasa roga), not as a disease on their own. The texts call them false perceptions (mithyajnana) or confusion (bhrama) and link them to disturbance of the three doshas.^[12] These are traditional concepts, not biomedical explanations.

Therapies that may be used

Supportive Ayurvedic care, once the condition is under medical management, focuses on routine:

• Regular times for sleeping, waking and meals
• Calming practices such as gentle oil massage
• Selected herbs such as ashwagandha, only with the psychiatrist's agreement

Panchakarma cleansing procedures, fasting and strong purgative or emetic therapies are not appropriate during psychosis or for anyone whose condition is unstable. In one older trial, the Ayurvedic formula brahmyadiyoga commonly caused nausea and vomiting.^[13]

What the research shows

The evidence is limited. A Cochrane review found only three small trials (250 participants in total). Ayurvedic herbs were less effective than the antipsychotic chlorpromazine, and results against placebo were mostly unclear.^[13]

Ashwagandha has been tested as an add-on. In a 12-week placebo-controlled trial of 66 patients with a recent flare of schizophrenia, adding ashwagandha extract to antipsychotic medication reduced negative and general symptoms and perceived stress, but not hallucinations or delusions. Drowsiness and loose stools were more common.^[14] A network meta-analysis of add-on supplements found that no compound improved total symptoms in acute-phase studies overall, although ashwagandha did in an analysis limited to low-risk-of-bias acute-phase studies, and it rated the quality of evidence in this field low to very low.^[15]

Herbal medicine as supportive care in Psychosis

Herbs and formulas that have been studied

Wendan decoction, a Chinese formula, and ginkgo extract have been studied in schizophrenia, in each case mainly as additions to antipsychotic medication.^{[16, 17]}

What the research shows

Herbs have not been shown to be a safe substitute for antipsychotics. In a Cochrane review, the one trial comparing Chinese herbs alone with antipsychotics favored the medication, and combining herbs with antipsychotics gave some short-term benefit.^[18] A Cochrane review of Wendan decoction (15 trials, 1,437 participants) found possible short-term benefit when it was added to an antipsychotic, with evidence that was not high quality.^[16]

A meta-analysis of eight placebo-controlled trials (1,033 patients), all in China, found that ginkgo extract added to antipsychotics improved total and negative symptoms in chronic schizophrenia. The authors said safety needs more evidence.^[17]

Safety and herb-drug interactions

Herbal safety is a serious concern in psychosis. In one case report, St John's wort was followed by psychotic symptoms in a man at risk.^[19] In a review of 147 adverse events from combining herbal products with psychiatric medicines, ginseng, ginkgo, milk thistle and rhodiola were the most frequent causes, and the events included heart rhythm problems when ginseng was taken with haloperidol.^[20]

Do not start any herb or supplement without telling your psychiatrist and pharmacist. This matters most with antipsychotics and medicines for seizures, mood or sleep, and during pregnancy or breastfeeding. Herbs should be prescribed individually and come from tested sources.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine describes psychotic states with images such as phlegm clouding the mind. Ayurveda speaks of disturbed doshas producing false perceptions.^[12]

Researchers study sleep regulation, stress responses, brain network activity and inflammatory markers.^{[3, 5, 10]} The ashwagandha trial, for example, measured both stress and an inflammatory marker; stress scores improved, but the marker did not differ significantly from placebo.^[14] No study has shown that a traditional pattern corresponds to a specific biological process in psychosis.

How this care fits with your medical care

For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care. We do not diagnose or manage psychosis. Keep taking prescribed medication exactly as directed, and keep all psychiatric appointments. Stopping antipsychotic medication is a common cause of relapse, so never reduce or stop it because you feel better.

Please bring your diagnosis, the name of your psychiatrist, and a full list of medicines and supplements. If warning signs of relapse appear, contact your psychiatric team or go to the nearest emergency department.

When to seek urgent medical care

New or worsening psychosis needs same-day medical or psychiatric assessment.^[1]

• Thoughts of suicide or self-harm, or thoughts of harming someone else
• Hearing voices, seeing things or strongly held unusual beliefs for the first time
• Sudden confusion, especially with fever, severe headache or a seizure
• Symptoms starting after childbirth, a head injury, or drug or alcohol use or withdrawal
• Not eating, drinking, sleeping or caring for oneself
• High fever with stiff muscles while taking antipsychotic medication

Call 911 or go to the nearest emergency department for any of these. In the United States, you can also call or text 988 to reach the Suicide and Crisis Lifeline.