Psychosis can be thought of as toxic to the brain, so after a psychotic episode, whatever the cause, continue the antipsychotic for six months to a year. When the picture is uncertain, the priority is keeping the patient engaged in monitoring and follow-up, which matters more than winning the argument about medication. Talk with patients about their diagnosis, since many leave the hospital with one they never heard.
Why it matters
Duration of untreated psychosis rests on the idea that psychosis is almost toxic to the brain: the longer someone is psychotic, the more damage, potentially irreversible, it can do.
“what Dr. Fu is mentioning is what's called duration of untreated psychosis. And the core concept there is that psychosis, the process of psychosis can be thought of as almost toxic to the brain. And the longer time that someone is in psychosis, the more damage, potentially irreversible damage that it can do”
27:54Psychosis: History, Delusions, Diagnosis, Theories, and Modern CareNov 2024 In the proper psychotic disorders and in bipolar disorder, every episode that goes untreated is burning brain.
“when it comes to the proper psychotic disorders and the severe mental illnesses of bipolar disorders, every episode that you go untreated for without medication is burning brain”
26:43Psychosis: History, Delusions, Diagnosis, Theories, and Modern CareNov 2024 One way to picture it: the longer the world is processed wrongly, the more beliefs get chipped away. An hour of psychosis might knock off a few unimportant ones; a longer stretch reaches deeper.
“The longer that you're having a dysfunction in the way that you're processing the world, the more you're chipping out the beliefs. So if you're in psychosis for an hour, it's probably enough incorrect information going in that you might knock off some of the beliefs that aren't that important”
34:41Psychosis: History, Delusions, Diagnosis, Theories, and Modern CareNov 2024
Treatment approach
Regardless of the cause of the psychosis, continue antipsychotic treatment for six months to a year.
“regardless of the cause of psychosis, you should continue antipsychotic treatment for six months to a year”
47:31What is Psychosis? Look at the DSM, Common Mimics, and a Framework for the DifferentialJan 2026 When the case is uncertain, your priority is keeping the patient in treatment and monitoring. In treatment does not necessarily mean on a medication; it means engaged with monitoring and follow-ups.
“your priority is keeping the patient in treatment and monitoring. And in treatment is not on a medication necessarily. In treatment means engaged with monitoring and follow-ups”
46:00What is Psychosis? Look at the DSM, Common Mimics, and a Framework for the DifferentialJan 2026
Talking to patients
Better a patient tapers off safely and stays monitored than is told they must stay on medication and then never follows up. Autonomy is one of our guiding principles.
“I'd rather a patient safely taper off and safely be monitored than tell a patient they need to be on a medication and have them not follow up. Autonomy is one of our guiding principles”
48:44What is Psychosis? Look at the DSM, Common Mimics, and a Framework for the DifferentialJan 2026
Pitfalls and myths
Patients often come off the inpatient unit with a completely definite diagnosis, such as schizophrenia, that was never discussed with them. Ask about it at intake: many genuinely did not know.
“Often they come off the inpatient floor with a completely definite diagnosis, which was never talked to with the patient. Like it'll say schizophrenia. And then on the intake, you'll go like, okay, so you were diagnosed with schizophrenia. And authentically they go, oh, I didn't know that”
44:05What is Psychosis? Look at the DSM, Common Mimics, and a Framework for the DifferentialJan 2026
From these episodes
Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.