ASK THE DOC: When do we intervene and when can we hold off to see what happens if we don’t? This is a decision I had to make this past weekend when some organizers at a community event asked me to help out with a young man who had become psychotic.

Meeting with the man, it was clear to me that he wasn’t just having disturbances of his senses, as one might from a drug, but he certainly wasn’t able to think clearly. He was stringing together words that didn’t make sense. He was vacillating between positive and negative answers; and he couldn’t say where he was, if he had a medical or psychiatric history, or even what his name was. One thing I could get out of him was that he wasn’t taking his psychiatric medication.

I explained to the organizers that it appeared that he was psychotic, most likely with a psychiatric illness and not taking his medication. They understood and agreed that we should call 911 and get him properly evaluated and treated.

As we were about to call 911, another one of the organizers informed us that they just found out that the man had taken two doses of LSD. This was both good news and bad news. The good news was that this was probably a rare case of LSD psychosis and he would probably come down off his trip eventually. The bad news was that “eventually” could be up to 20 hours later and, with the event ending soon, he would be left alone with no way of taking care of himself. The organizers asked if they could just keep an eye on him.

In the medical field we have the term “watchful waiting.” It’s a term to describe holding off on treatment to see if a condition can resolve on its own. It’s often used regarding prostate cancer or ear infections. It is an ethical approach, provided an adequate amount of supervision/observation is provided and an evaluation by a professional has been conducted. In this case, I was comfortable with the idea of the man being kept under observation; but I had two concerns: 1) who could provide the observation, and 2) what would happen when everyone went home?

The organizers and I discussed this and agreed that they would spare one of their staff members to observe the man until the event ended. And if he was still psychotic at that time, they would then call 911 to make sure that he would be taken care of.

Epilogue: Approximately four hours later, the man’s psychosis resolved. This was just over an hour before the end of the event. Thanks to the concern of the organizers, and an approach called “watchful waiting” the man was able to return home without having to experience the inside of a psychiatric unit. Please remember, watchful waiting only applies when a professional has evaluated the individual. If you think there’s something wrong with someone, don’t delay, get medical attention; and then, if they say it’s alright, monitor the situation closely, and provide as much TLC as possible.

Email your health questions to Dr. Sharmat and, if your question is selected, he will post an answer here incorporating information from various specialists in the community.