The Psychiatric Record | September 24, 2026 | Digital Psychiatry
When a relative says a young adult recovering from psychosis is "on the phone all night," it sounds like data, but it is really a summary. It folds at least three questions into one complaint: what the person is doing online, whether the pattern has changed, and whether the family disagrees about it.
A Viewpoint by Parikh, Russell, Kane, and Miklowitz, published online August 26 in JAMA Psychiatry, takes up family-based psychosis care in the digital home. The clinical argument here is that online life deserves specific assessment of both support and risk. Family work itself rests on established guidance. NICE recommends offering family intervention to all families who live with or are in close contact with a person with psychosis, delivered over three months to a year with at least ten planned sessions. The open question is not whether to have the family conversation. It is whether online life gets examined in that conversation or only complained about.
Take the history before setting the rule
Consider a fictional composite case. A 22-year-old, eight months after a first episode, spends most evenings on a Discord server for people with lived experience of psychosis. It is his main peer contact. His mother wants the phone out of his room by 10 p.m. Both perspectives matter, and neither alone is the formulation.
Hours online is where the history starts. The useful details come after that:
What the patient does online, and which parts feel supportive.
Whether the pattern has changed recently, especially around sleep.
Whether any content maps onto symptoms: referential material, persecutory themes, or communities that seem to confirm them.
Whether there is exposure to harassment, scams, or exploitation.
What the patient wants the family to understand.
Keep each account identifiable in the record. "Patient reports the group is where he feels least alone" and "mother reports use past 3 a.m. most nights" are two separate observations. Merging them into "excessive phone use" loses the clinical content.
Assess the conflict as well as the use
Expressed emotion includes criticism, hostility, and emotional overinvolvement; high expressed emotion is associated with relapse in schizophrenia. That evidence does not make every disagreement about a phone an expressed-emotion problem. It does give clinicians a reason to ask how the disagreement unfolds. Repeated criticism, account checking, and reading private messages may become additional sources of tension, even when the underlying concern is legitimate.
This changes what counts as a good outcome. A plan that ends the nightly argument while keeping the patient's supportive contacts may be worth more than one that cuts screen time and leaves everyone more on guard.
Put digital change in the relapse signature
Relapse-prevention plans already list each person's early warning signs. For some patients, a change in online behavior belongs on that list. Examples include overnight use that displaces sleep, a sudden shift in posting, or withdrawal from online contacts who had been supportive.
This extends established relapse-signature work; it is not a validated digital marker. Its value is procedural. The patient and family agree in advance which change counts as a signal and what happens next, so they aren't arguing about it at 2 a.m.
Access depends on age and agreement
A parent overseeing a 16-year-old's accounts faces a different question from a parent monitoring a 24-year-old. With adult patients, family participation should settle three things explicitly: who is in the conversation, what the patient agrees to share, and how a concern gets raised. Routine family work should not quietly turn into an expectation of access to private accounts. Genuine safety concerns, such as exploitation, threats, or crisis content, call for a clinical risk discussion handled as one, not an ongoing surveillance arrangement.
Online activity is not inherently a symptom. Its clinical meaning depends on its content, context, and relationship to functioning. It deserves the same careful description as the rest of the history, with the same care about whose account is whose.
Sources and reading notes
Parikh, Russell, Kane, and Miklowitz. Adapting Family-Based Psychosis Care to the Digital Home. JAMA Psychiatry. Published online August 26, 2026. doi:10.1001/jamapsychiatry.2026.2570. Discusses how family-based psychosis care can address online experiences, communication, and recovery.
NICE CG178: Psychosis and schizophrenia in adults: prevention and management. Recommendations on family intervention, collaborative care planning, and support for recovery.
Butzlaff RL, Hooley JM. Expressed emotion and psychiatric relapse: a meta-analysis. Archives of General Psychiatry. 1998;55(6):547-552. doi:10.1001/archpsyc.55.6.547. Background evidence on the association between family expressed emotion and relapse.
The interview questions and practical applications in this article are editorial synthesis informed by these sources. They are intended to support individualized assessment and collaborative family discussion.
Educational Disclaimer: The Psychiatric Record provides general educational information for psychiatric and mental-health professionals. Content does not constitute medical, legal, regulatory, compliance, billing, or other professional advice; does not establish a standard of care; and is not a substitute for independent professional judgment. Appropriate assessment and treatment depend on the individual, setting, and current authoritative guidance. Decisions about family involvement, privacy, and safety require consideration of patient preferences, consent, and applicable requirements. The patient and family described are fictional composites; no individuals are depicted.