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acute crisis

Paranoid or Psychotic Episode

When When someone, during or after substance use, hears voices, feels persecuted, describes delusional content, or loses touch with reality — persistent, not just brief.

review pending

Content is undergoing medical and legal review. Changes possible.

Emergency

Call 112. Calling for help is required by law (German Criminal Code § 323c). levelll cannot promise immunity from criminal or administrative consequences.

Immediate

  1. 1. Move them to a calm, safe environment. Reduce stimulation.
  2. 2. Validate without confirming: 'I understand that this feels real to you right now.'
  3. 3. If there is risk to self or others, a persistent episode (> hours), or a known psychiatric history: call 112 or the Berlin Crisis Service (Berliner Krisendienst).

Don't do

  • Don't argue about the content of the perception — it reinforces the delusion.
  • Don't restrain or force them — it reinforces the sense of threat.
  • Don't leave the person alone, not even 'just briefly' to step outside.

Substance-induced psychotic episodes can arise from:

  • Stimulant overdose (cocaine, amphetamines, methamphetamine) — usually combined with sleep deprivation
  • Cannabis — especially in young people with pre-existing vulnerability or with high-potency products
  • Psychedelics — rarely as an acute psychosis, more often as a “bad trip” with psychotic elements
  • Ketamine in high doses or with continuous use
  • Substance withdrawal (alcohol, benzos)

Most episodes are transient and subside as the substance wears off. If symptoms persist for hours after the effects end, or if there is a history (personal or family experience of psychosis): medical assessment is mandatory.

Duty to assist when there is risk to self or others: § 323c of the German Criminal Code (StGB) makes it a legal obligation. levelll cannot rule out prosecution, but anyone who gets help is acting within the law.

Berlin crisis support services:

  • Berliner Krisendienst (Berlin Crisis Service) — 24/7, nine regional offices
  • Acute psychiatric admission at the Charité and Vivantes hospitals (via 112)
  • Rummelsburger Initiativ-Kreis — peer-based support for people with experience of psychosis