Engaging With Patients With Acute Psychosis: A Conversation With Peter J. Weiden, MD

TALKING WITH TITANS

At the 2026 American Society of Clinical Psychopharmacology (ASCP) Annual Meeting, Psychiatric Times' Editor in Chief, John J. Miller, MD, sat down with leaders in the field to discuss the topics they find most important.

Peter J. Weiden, MD, the Psychiatric Times Schizophrenia Section Editor, was keen to discuss how best to engage with patients with acute psychosis. Acute psychosis is one of the most common psychiatric emergencies,¹ with between 15 and 100 people out of 100,000 developing psychosis each year.²

With new breakthrough medicines available, engaging people experiencing psychosis has become a lost art. He also believes the initial engagement in treatment holds a lot of significance. Engaging someone who is acutely psychotic should be the first priority, even before assessment in order to prevent losing patients, shared Weiden. He advises against validating delusions to avoid collusion and suggests using active listening, normalizing language, and maintaining appropriate social distance. Weiden also highlights the need to understand patients' past experiences and to use a nonjudgmental, third-person approach to avoid challenging the patient directly. Additionally, keeping the language neutral and using a computer-like mode helps to maintain objectivity.

Weiden also recommended explaining the necessity of asking personal and potentially stressful questions as part of the clinician’s job in order to help the patient understand the process. Ultimately, clinicians must respect the patient as an individual and engage in a way that builds trust.

He plans to write an article on these techniques for Psychiatric Times. You can find his January 2026 cover story here.

References

1. Byrne P. Managing the acute psychotic episode. BMJ. 2007;334(7595):686-692.

2. Understanding psychosis. NIH. Accessed May 26, 2026. https://www.nimh.nih.gov/health/publications/understanding-psychosis