Risk to self or others, severe self-neglect, or marked agitation: arrange urgent assessment and consider admission (and the Mental Health Act if needed). Always exclude an organic cause: delirium, substance use and intoxication can mimic psychosis.
Assessment
- History: prodrome, substance use, family history, functional decline
- Mental state: hallucinations, delusions, thought disorder, insight
- Risk to self and others, and ability to self-care
- Collateral history is valuable
Organic screen
- Bloods: FBC, U&E, LFTs, glucose or HbA1c, calcium, TFTs
- Urine drug screen; consider infection screen
- HIV and syphilis serology if indicated
- CT or MRI head if atypical age, abnormal neurology or treatment resistance
Suspected / at risk
- Attenuated symptoms
- Refer to early intervention
- Avoid antipsychotic before assessment if possible
First-episode psychosis
- Oral antipsychotic plus CBT and family work
- Baseline physical and metabolic checks
- Early intervention team
Acute risk / crisis
- Risk to self or others, severe agitation
- Crisis team or admission
- Mental Health Act if needed
Care pathway
1
1. Engage early
Refer to the Early Intervention in Psychosis service promptly. Build a therapeutic alliance; treat as early as reasonably possible.
Refer to the Early Intervention in Psychosis service promptly. Build a therapeutic alliance; treat as early as reasonably possible.
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2
2. Antipsychotic
Start a single oral antipsychotic at a low dose and titrate; discuss choice and side effects with the person. Monitor response over weeks.
Start a single oral antipsychotic at a low dose and titrate; discuss choice and side effects with the person. Monitor response over weeks.
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3
3. Psychosocial
Offer CBT for psychosis and family intervention to everyone. Add supported employment or education and carer support.
Offer CBT for psychosis and family intervention to everyone. Add supported employment or education and carer support.
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4
4. Physical health
Baseline and ongoing metabolic monitoring (weight, glucose, lipids, ECG), promote healthy lifestyle, and treat cardiovascular risk from the start.
Baseline and ongoing metabolic monitoring (weight, glucose, lipids, ECG), promote healthy lifestyle, and treat cardiovascular risk from the start.
Remember
- People with psychosis have a markedly reduced life expectancy, mostly from physical illness
- Duration of untreated psychosis affects outcome: act early
- Involve carers with consent
Pitfalls
- Missing delirium or drug-induced psychosis
- Delaying referral to early intervention
- Neglecting physical health monitoring
- High-dose or multiple antipsychotics
MedPrep - www.medprep.uk - Educational revision aid only. Not clinical guidance. Doses are adult examples; check the BNF, current guidelines and local policy, and seek senior advice. Nov 2026