Manas Prakriti – Ayurved Healing

Manah Prakriti Assessment: Evaluating Sattva, Rajas, and Tamas Dominance in Practice

Dr. Ananya Sharma — Sun, 07 Jun 2026 06:00:00 +0000

Consider two people who both use the word “anxiety.” One is restless, speaks rapidly, moves from plan to plan, lies awake thinking about unfinished work, and becomes irritable when progress is blocked. The other has withdrawn from ordinary activity, stays in bed, struggles to begin simple tasks, and worries from a place of hopelessness. Their symptoms overlap, but their histories, risks, and treatment needs may be very different.

Ayurveda offers manas prakriti, or mental constitution, as a traditional way of describing enduring psychological tendencies. It can enrich an interview by drawing attention to clarity and self-regulation, agitation and craving, or dullness and inertia. It cannot diagnose anxiety disorder, major depression, bipolar disorder, trauma-related illness, substance-use disorder, or another psychiatric condition; those require an appropriate clinical assessment.

The Three Gunas: A Classical Correction

The three terms are sattva, rajas, and tamas. Popular accounts often turn them into a simple moral ladder in which sattva is “good,” rajas is productive energy, and tamas is “bad.” That is too crude for compassionate practice and does not accurately reproduce Charaka’s wording.

Charaka Samhita, Sharira Sthana 4/36, describes three broad mental dispositions: shuddha or sattvika, rajasika, and tamasika. It calls sattvika adosha, associated with auspicious qualities, and calls rajasika and tamasika sadosha, associating them respectively with anger or agitation (rosha) and bewilderment (moha). The same passage says their varieties are innumerable because the qualities occur in differing proportions, and that body and mind influence one another.

The text is therefore not value-neutral, yet guna terminology should never be used to declare a person morally superior or inferior. A guna describes tendencies of mind, not human worth. Ordinary activity, ambition, sleep, grief, or fatigue should not automatically be called pathological; the relevant questions are whether the pattern is proportionate, flexible, wholesome, and compatible with health and daily functioning.

What Charaka Actually Classifies

The numerical classification in the original article was incorrect. Charaka Sharira Sthana 4/37-40 gives sixteen illustrative mental constitutions in total: seven sattvika, six rajasika, and three tamasika. It does not describe seven sattvika types plus sixteen additional rajasic and tamasic types.

Group	Number	Named types
Sattvika	7	Brahma, Arsha, Aindra, Yamya, Varuna, Kaubera, Gandharva
Rajasika	6	Asura, Rakshasa, Paishacha, Sarpa, Praita, Shakuna
Tamasika	3	Pashava, Matsya, Vanaspatya

These are symbolic portraits from the cultural language of the text, not modern diagnoses. Charaka also says the combinations are innumerable, which argues against converting a short checklist into a rigid personality label.

Assessment: Constitution Is Not the Current Episode

A careful assessment separates manas prakriti, a relatively enduring disposition, from the person’s present state. Sleep loss, pain, illness, grief, medicines, stimulant or substance use, and social stress can temporarily alter behaviour. Sattva bala, or present mental strength and capacity to endure, is another clinical consideration and should not be confused with sattvika constitution.

Sattvika Predominance

Charaka’s sattvika portraits repeatedly emphasize truthfulness, self-restraint, sharing, knowledge, memory, courage, cleanliness, gratitude, steadiness, and relative freedom from overpowering anger, greed, pride, envy, or delusion. The subtypes are not identical; the Gandharva type, for example, is associated with music, poetry, fragrance, beauty, and enjoyment.

Look for clarity of judgment rather than forced positivity.
Look for self-regulation without emotional suppression.
Consider memory, learning, courage, generosity, and proportionate conduct.
Do not infer sattvika constitution from religious speech, diet, quietness, or a polished public image alone.

Rajasika Predominance

The rajasika portraits in Sharira Sthana 4/38 emphasize anger, intolerance, jealousy, pride, cruelty, excessive craving, instability, and overinvolvement in food, activity, or sensory pursuits. These descriptions are broader than the modern shorthand “ambitious and productive”; healthy initiative is not itself a mental disorder.

Assess whether activity is purposeful or compulsive.
Ask whether desire, comparison, anger, or fear repeatedly overrides judgment.
Observe flexibility when plans are blocked instead of relying on speech speed alone.
When activation is marked, screen for sleep deprivation, stimulants, medication effects, mania or hypomania, trauma, and anxiety disorders.

Tamasika Predominance

The tamasika portraits in Sharira Sthana 4/39 include dullness, impaired understanding, excessive sleep, timidity, instability, preoccupation with gratification, and deficient intellectual engagement. These premodern images must not be used to shame someone who is depressed, exhausted, disabled, grieving, cognitively impaired, or living under severe adversity.

Assess alertness, comprehension, avoidance, initiation, and functional decline.
Ask whether apparent inertia is longstanding or a new change.
Consider depression, substance use, sleep disorders, medicines, physical illness, and other relevant causes.
Do not diagnose tamas from sleeping nine hours, preferring routine, slow digestion, or enjoying comfort; those cut-offs and associations are not established by the cited passage.

What the Framework Can and Cannot Predict

No verified classical passage or modern clinical evidence supports a fixed map in which sattvika people predictably shift into rajas under stress, rajasika people collapse into tamas after failure, and tamasika people inevitably progress to depression or addiction. Such sequences may be individual hypotheses, not established laws.

Domain	Reasonable use	Boundary
Manas prakriti	Traditional description of enduring tendencies	Not a psychiatric diagnosis or validated predictor
Current guna pattern	Organizes observations of clarity, agitation, craving, dullness, or withdrawal	May change with illness, sleep, stress, medicines, substances, and environment
Sattva bala	Considers present mental strength and endurance	Not the same as sattvika constitution
Modern assessment	Evaluates duration, severity, impairment, risk, and differential diagnosis	Cannot be replaced by guna terminology

Two anxious patients should therefore not receive opposite treatments merely because one appears rajasic and the other tamasic. First identify the syndrome, immediate risk, contributing medical or psychiatric conditions, existing treatment, and safety constraints. Guna language can then help tailor the pace of care, communication, routine, and supportive practices.

Treatment Principles

Charaka Sutra Sthana 1/57 identifies rajas and tamas as mental doshas, while 1/58 names knowledge, discriminative understanding, fortitude, memory, and samadhi among their therapeutic means. Sutra Sthana 11/54 defines sattvavajaya as restraining or withdrawing the mind from unwholesome objects. These principles support guidance and self-regulation, not a universal protocol based on a label.

When Agitation or Rajasic Features Dominate

The practical aim is to reduce harmful stimulation and restore regularity without suppressing healthy initiative. Measures may include protecting sleep, reducing excess caffeine or other stimulants, setting realistic work limits, eating regularly, using gentle yoga or paced breathing when suitable, and replacing compulsive performance with restorative activity.

Yoga and meditation may help some people as adjuncts, but claims should remain modest. Yoga nidra has not been established as “more effective than sleep,” and relaxation cannot replace adequate sleep. For diagnosed anxiety disorders, psychological treatments—particularly cognitive behavioural approaches—have a stronger evidence base. Stop a breath practice if it causes dizziness, panic, or distress.

When Withdrawal or Tamasic Features Dominate

The aim is often safe, graded re-engagement rather than forceful stimulation: a regular wake time, one manageable task, a short walk, contact with a supportive person, and gradual rebuilding of activity. Severe depression, psychosis, suicidal thinking, marked self-neglect, intoxication, or inability to function requires prompt professional assessment rather than a home “anti-tamas” programme.

Daylight, regular movement, and social structure may support wellbeing and sleep-wake regularity, but exact instructions such as twenty minutes of sunlight or adding five minutes of exercise weekly are not universal Ayurvedic rules. Climate, mobility, skin sensitivity, illness, and current treatment matter.

When Grief or Loss Is Central

Grief should not automatically be reclassified as a guna defect. Support may include listening, practical help, culturally meaningful rituals, family or community connection, and gentle routines. Persistent severe symptoms, inability to function, self-neglect, or thoughts of death warrant assessment by a qualified mental health professional.

Herbs: Evidence and Safety

The original herb section gave fixed regimens and mechanisms more confidently than the evidence permits. Herbal treatment should follow assessment of the person, formulation, dose, product quality, medicines, pregnancy status, and relevant liver, thyroid, autoimmune, or other risks. A trial of one standardized extract cannot be transferred automatically to every powder or capsule with the same plant name.

Brahmi (Bacopa monnieri): A 2008 randomized placebo-controlled trial studied 300 mg per day of a standardized extract for twelve weeks in 54 healthy adults aged 65 or older. It reported improved delayed recall and some questionnaire outcomes, but it was not an anxiety-disorder trial and does not validate 300 mg twice daily for a “rajasic” patient. Claims of clinically proven benefit through human neuronal dendrite proliferation go beyond that study.

Ashwagandha (Withania somnifera): A 2012 single-centre trial enrolled 64 adults with chronic stress and used 300 mg of a particular high-concentration root extract twice daily for sixty days. Stress scores and serum cortisol improved relative to placebo. This does not prove that every ashwagandha product treats anxiety disorders. NCCIH notes possible drowsiness or gastrointestinal effects, rare reports of liver injury, pregnancy and breastfeeding avoidance, and concerns about interactions, thyroid disorders, and autoimmune conditions.

Saffron (Crocus sativus): A 2019 meta-analysis found evidence of benefit in mild-to-moderate depressive symptoms. That evidence does not make saffron a stand-alone replacement for established care, and standardized extracts cannot be reliably converted into a fixed number of household saffron threads. Supplementation requires professional advice when psychiatric medicines, pregnancy, bleeding risk, allergy, or other medical issues are relevant.

Jatamansi (Nardostachys jatamansi): The cited 2018 paper was a mouse study. It reported anxiolytic-like effects and changes involving GABA and monoamine systems, but it did not establish human efficacy, a human dose, or a proven GABA-mediated treatment for anxiety. Presenting 500 mg in milk as a demonstrated regimen was unjustified.

Vacha and Shankhapushpi: Adequate human evidence was not found for the original claims that oral vacha activates the central nervous system and improves acetylcholine transmission, or that shankhapushpi specifically treats “depression-type tamas.” Vacha products also present standardization and safety concerns because Acorus calamus chemotypes differ in asarone content. Neither should be self-prescribed for depression or cognitive symptoms from a guna label.

Sattvavajaya and Sattva Cultivation

Sattvavajaya chikitsa is a genuine classical concept, but Charaka’s concise definition is restraint of the mind from unwholesome objects. Knowledge, discriminative understanding, fortitude, memory, and samadhi are also named in managing mental doshas. Modern parallels may include education, attention training, values, coping skills, and psychotherapy, but sattvavajaya is not identical to one contemporary therapy.

Jnana: sound knowledge about oneself, circumstances, and wholesome conduct.
Vijnana: discriminative understanding rather than action driven only by impulse or fear.
Dhairya: steadiness and the capacity to tolerate difficulty without harmful reaction.
Smriti: remembering what has been learned and what supports health.
Samadhi: disciplined mental settling within its classical spiritual context.

Truthful communication, moderation, adequate sleep, suitable food, meaningful study, supportive company, compassion, and limits on intoxicants or overwhelming stimulation may support these aims. They are flexible principles, not proof that one menu, faith, or lifestyle makes a person sattvika. Diet must also consider digestion, disease, allergies, culture, access, and nutritional adequacy.

Practical Clinical Sequence

A safer use of manas prakriti places it after risk assessment and before individualized supportive planning. This preserves the Ayurvedic lens without allowing it to replace diagnosis or necessary care.

Clarify symptoms: duration, severity, triggers, sleep, function, illness, medicines, supplements, and substance use.
Assess safety: suicidal thoughts, self-harm, psychosis, severe agitation, self-neglect, violence risk, or intoxication.
Separate trait from change: determine whether the observed pattern is longstanding or new.
Assess strength and support: coping, judgment, memory, relationships, practical burdens, and willingness to engage.
Use guna language tentatively: describe clarity, agitation, craving, dullness, or withdrawal without turning it into identity or destiny.
Coordinate and review care: combine appropriate professional treatment with safe individualized Ayurvedic support, and track function, distress, sleep, risk, and adverse effects.

Safety and Scope

Disclaimer: Manas prakriti is a complementary Ayurvedic framework, not a substitute for psychiatric or medical evaluation. Depression and anxiety disorders are treatable, and evidence-based psychological treatments or medicines may be needed. Seek urgent local medical help for suicidal thoughts, self-harm, psychosis, extreme agitation, dangerous behaviour, severe self-neglect, or inability to remain safe. Never stop prescribed psychiatric medication without the prescriber’s guidance. Consult a qualified Ayurvedic practitioner and an appropriately licensed healthcare or mental health professional before using herbs, especially during pregnancy or breastfeeding or when taking other medicines.

References

Unmada (Psychosis) in Ayurvedic Texts: Historical Classification and Modern Clinical Parallels

Dr. Ananya Sharma — Sun, 24 May 2026 06:00:00 +0000

Reading the descriptions of unmada in the Charaka Samhita can produce a sense of clinical recognition. The text records disturbed speech, inappropriate laughter or weeping, agitation, withdrawal, impaired memory and intellect, altered conduct, and difficulty regulating behaviour. These observations overlap with phenomena seen in modern psychiatry, including psychosis, mania, severe mood disturbance, catatonia, delirium, and some neurological or substance-related states. However, unmada is a classical Ayurvedic syndrome, not an ancient synonym for schizophrenia, bipolar disorder, or any single present-day diagnosis. Responsible comparison requires attention to similarities without claiming one-to-one equivalence.

Classical Definition and Scope

Charaka Samhita, Nidana Sthana 7 and Chikitsa Sthana 9 describe unmada as a broad disorder in which the functions of mind, intellect, memory, awareness, preferences, character, activity, conduct, and behaviour become disturbed. The online critical translation renders the term as frenzy, madness, or mental derangement and stresses that it represents a group of major mental disorders rather than one disease. The frequently quoted definition belongs to this classical framework; it should not be described as anticipating modern “multi-axis” diagnosis, because contemporary psychiatric systems use different concepts, criteria, and methods.

The Five Types Described by Charaka

Charaka Samhita, Nidana Sthana 7.3 lists five types: vata-dominant, pitta-dominant, kapha-dominant, sannipataja arising from the combined disturbance of all three doshas, and agantuja associated with exogenous causes in the classical worldview. These categories organise signs, causation, and treatment according to Ayurvedic theory. They are not validated substitutes for a psychiatric examination, medical work-up, toxicology assessment, or neurological evaluation.

Vataja Unmada

The classical description of vataja unmada includes constant wandering, irregular movements of the eyes and limbs, continuous irrelevant or incoherent speech, inappropriate smiling, laughing, dancing, singing or weeping, roughness, emaciation, and aggravation from factors considered to increase vata. This may resemble modern states marked by psychomotor agitation, disorganisation, mania, intoxication, delirium, or excited catatonia, but the signs are not specific enough to establish any of those diagnoses. Charaka’s treatment chapter begins the management of a vata-dominant presentation with unctuous measures and then modifies the plan according to obstruction, strength, digestion, and the patient’s overall condition.

Pittaja Unmada

Pittaja unmada is described with inappropriate anger, intolerance, agitation, threatening or assaultive behaviour, running about, bodily heat, a desire for shade, cold water or cooling food, and altered coloration of the eyes or complexion. The verse supports describing an activated, heated, irritable, and potentially dangerous presentation; it does not support equating pittaja unmada specifically with bipolar I disorder or substance-induced psychosis. In modern care, sudden aggression, severe insomnia, confusion, fever, intoxication, or a change in consciousness requires urgent assessment for psychiatric and medical causes.

Kaphaja Unmada

Kaphaja unmada includes immobility or remaining in one place, little speech, reduced movement, loss of appetite, preference for isolation, drowsiness or excessive sleep, salivation or nasal discharge, aversion to cleanliness, facial swelling, and dull or soiled-looking eyes. Some features may superficially resemble psychomotor slowing, depressive withdrawal, negative symptoms, medication effects, stupor, or catatonia. These similarities are descriptive only. A person with mutism, stupor, inability to eat or drink, marked drowsiness, or a rapid decline in self-care needs prompt clinical evaluation rather than dosha-based self-treatment.

Sannipataja Unmada

Sannipataja unmada presents with features of all three doshic types together. Nidana Sthana 7.7 states that this combined form is considered asadhya, and Chikitsa Sthana 9.15 describes it as severe and difficult to treat because the therapeutic principles may conflict. The text does not say that early cases are reliably curable, nor does it identify this category with schizoaffective disorder or “rapid cycling.” Those modern labels require their own diagnostic criteria.

Agantuja Unmada

Agantuja unmada is defined in the diagnostic chapter as having causes, prodromal signs, symptoms, distress, and responses to treatment that differ from dosha-origin unmada. Charaka discusses it through the religious and cultural language of deva, gandharva, yaksha, rakshasa, pishacha, ancestors, vows, conduct, and prajnaparadha. It is historically inaccurate to translate this entire category directly as trauma, infection, intoxication, or metabolic encephalopathy. A modern clinician should instead assess new psychotic or behavioural symptoms for psychiatric illness, medication effects, sleep deprivation, alcohol or drug use, neurological disease, infection, endocrine or metabolic disturbance, and other medical causes.

Comparison with Modern Psychiatry

The most defensible comparison is phenomenological: both systems notice changes in speech, perception, activity, sleep, emotional expression, memory, self-care, and social conduct. Modern psychosis is a collection of symptoms involving some loss of contact with reality and may occur in schizophrenia, bipolar disorder, severe depression, substance-related conditions, neurological disease, or other medical illness. The table therefore shows broad areas of overlap rather than diagnostic equivalence.

Classical Type	Verified Classical Features	Possible Modern Observations	Important Limitation
Vataja	Wandering, irregular movement, incoherent or irrelevant speech, inappropriate laughter, singing or weeping	Agitation, disorganisation, mania, delirium, intoxication, or excited catatonia	No one-to-one diagnosis
Pittaja	Anger, agitation, threatening or assaultive behaviour, heat, desire for cooling	Severe mood activation, psychotic agitation, intoxication, or medical delirium	Urgent risk and medical assessment may be needed
Kaphaja	Reduced speech and movement, isolation, excessive sleep, poor appetite, salivation	Depressive slowing, negative symptoms, sedation, stupor, or catatonia	Mutism or stupor is a medical priority
Sannipataja	Combined features of all three doshic types	Complex or mixed presentations	Not equivalent to schizoaffective disorder
Agantuja	Classically framed exogenous presentations with distinctive causes and signs	Prompts a broad differential diagnosis in modern practice	Classical spirit-language should not be relabelled as biomedical causation

What the Classical Treatment Chapter Actually Contains

Charaka Samhita, Chikitsa Sthana 9 presents an extensive, individualised programme rather than a simple herb list. It includes yukti-vyapashraya treatment selected according to dosha and patient strength, along with supportive or consoling measures, mental guidance associated with sattvavajaya, and religious practices appropriate to the text’s historical setting. The chapter also describes oleation, fomentation, emesis, purgation, basti, nasya, medicated ghee, massage, bathing, dietary progression after purification, and numerous specialised preparations. Several procedures are invasive, irritant, or otherwise unsafe outside trained clinical practice and should never be attempted at home.

Purification and Medicated Ghee

The treatment sequence is conditional, not universal. Charaka describes unctuous treatment for vata-dominant illness, emesis for selected kapha-dominant cases, and purgation for selected pitta-dominant cases, followed by a graded post-procedure diet. Formulations recorded in the chapter include Kalyanaka Ghrita and other medicated ghees. Their presence in a classical text verifies historical use; it does not establish efficacy for schizophrenia or acute psychosis by current clinical-trial standards. Panchakarma in a confused, medically unstable, dehydrated, restrained, pregnant, elderly, or heavily medicated patient may carry substantial risk and requires direct supervision by a qualified Ayurvedic physician working with the psychiatric team.

Brahmi: Correct Identity and Classical Properties

The Ayurvedic Pharmacopoeia of India, Part I, Volume II identifies Brahmi as the dried whole plant of Bacopa monnieri. Its monograph gives madhura, tikta and kashaya rasa; laghu and sara guna; shita virya; madhura vipaka; and actions including medhya and rasayana. It lists manasavikara among therapeutic uses and gives 1–3 g as the powder dose for the pharmacopoeial crude drug. This does not verify the original claims that Brahmi is the principal treatment for every unmada subtype, that 5–10 g powder or 20–30 ml juice twice daily is a standard psychiatric dose, or that 300 mg twice daily is a universally appropriate extract dose. Product strength and extract standardisation vary, and Brahmi should not be presented as an antipsychotic.

Shankhapushpi: Identity Matters

The same pharmacopoeial volume identifies Shankhapushpi as the whole plant of Convolvulus pluricaulis. It records katu, tikta and kashaya rasa; sara guna; shita virya; katu vipaka; and actions including medhya, rasayana, pittahara and kaphahara. The monograph lists manasaroga and apasmara as therapeutic uses and a powder dose of 3–8 g. It also notes that Clitoria ternatea and Evolvulus alsinoides are used as Shankhapushpi in some regions, making botanical identification important. No verified classical citation supports calling it the premier remedy specifically for vataja and pittaja unmada, and human evidence does not establish it as a treatment for psychosis.

Jatamansi, Ashwagandha and Guduchi

The online commentary accompanying Unmada Chikitsa includes Jatamansi and Ashwagandha in a compiled list of single drugs discussed in relation to unmada, but a compiled list is not proof that either herb treats modern psychosis. No verifiable classical passage or pharmacopoeial monograph was found supporting the original article’s precise claims about GABA modulation, rebound-free sedation, cortisol reduction in acutely agitated psychosis, or Guduchi as a specific remedy for pittaja unmada. Exact bedtime and twice-daily doses have therefore been removed. In psychosis, any herb should be selected only after reviewing the diagnosis, botanical identity, formulation, pregnancy, relevant liver or thyroid concerns, and possible interactions with antipsychotics, mood stabilisers, sedatives, anticonvulsants, and other medicines.

Diet and Supportive Care

Charaka includes dietary planning and a graded return from lighter to heavier food after purification. The treatment chapter specifically mentions cooling, sweet, and light food and drink in pitta-dominant management, while broader Ayurvedic practice individualises food according to digestion, strength, season, and dosha. The original rigid menu of warm-oily food for every vata presentation, coconut and bitter greens for every pitta presentation, and dry-pungent food for every kapha presentation was not supported by a cited verse and has been removed. In current care, regular meals, adequate fluids, sleep restoration, avoidance of alcohol and recreational drugs, and monitoring for inability to eat or drink are more immediately important than a dosha menu.

What Modern Research Can and Cannot Show

Human research on these herbs does not validate the classical subtypes or establish an Ayurvedic cure for psychosis. Systematic reviews of Bacopa monnieri have mainly examined memory and attention in adults without major cognitive impairment; they do not demonstrate antipsychotic efficacy. A small 12-week randomised placebo-controlled adjunctive study of a standardised Withania somnifera extract in people with schizophrenia reported signals for some symptoms, and a secondary analysis reported possible improvement in depression and anxiety scores. These early findings concern a particular extract used alongside standard treatment and are not grounds for replacing antipsychotic medication or generalising to all Ashwagandha products.

Mechanistic findings from cells or animals—such as effects on neurotransmitters, inflammation, or oxidative pathways—cannot by themselves prove clinical benefit in schizophrenia, bipolar mania, delirium, or acute psychosis. The original statements that Brahmi and Shankhapushpi act on central psychiatric drug targets, that Guduchi’s alkaloids “clear” pittaja psychosis, and that neuroinflammation forms a validated bridge between dosha theory and schizophrenia were overstated and have been removed.

Safety, Referral and Ethical Use

Psychosis may involve delusions, hallucinations, incoherent speech, disorganised behaviour, severe withdrawal, impaired self-care, or difficulty recognising reality. It can arise from psychiatric illness, sleep deprivation, prescribed medicines, alcohol or drugs, neurological disease, and other medical causes. Early assessment matters. Current evidence-based treatment commonly includes antipsychotic medication and may also include psychotherapy, family education, case management, supported work or education, and coordinated specialty care. Ayurvedic care, when desired, should be complementary and coordinated with a psychiatrist or other qualified mental-health professional.

Do not stop antipsychotics, mood stabilisers, benzodiazepines, anticonvulsants, or other prescribed medicines abruptly. Ashwagandha may cause drowsiness and gastrointestinal effects, has been linked rarely with liver injury, and may interact with sedatives, anticonvulsants, thyroid medicines, immunosuppressants, and medicines for diabetes or blood pressure. Safety data for many multi-herb and herbo-mineral products are limited, and product quality varies. Consult a qualified Ayurvedic practitioner and the treating healthcare provider before adding any herb or classical formulation.

Practical guidance: Do not begin a “Brahmi tea” routine as treatment for psychosis. A safer supportive action is to help the person obtain prompt professional assessment, keep the environment calm, reduce noise and confrontation, support regular food, fluids and sleep where possible, document all medicines and substances used, and remain alert for immediate danger. Seek emergency care when there is risk of self-harm or harm to others, extreme agitation, inability to eat or drink, severe confusion, fever, seizure, collapse, rapidly changing consciousness, or suspected overdose.