Principles of treating a first episode of psychosis in adults and young people
The principles in this topic apply to the acute treatment of a first psychotic episode. For principles of ongoing care, see here.
Ideally, a first episode of psychosis should be managed by a specialist—urgently refer patients to a psychiatrist or mental health service because early treatment reduces the period of untreated psychosis and improves outcomes. Young people should be referred to a youth mental health service such as Headspace, if available.
Evaluate whether admission to hospital is needed1. Considerations include:
- the risk of harm the patient poses to themselves or others
- the patient’s level of insight and disorganised thinking, and their competency to make decisions
- availability of community mental health resources and family or other social supports.
Treatment of a first episode of psychosis must be multifaceted and individualised (see Principles of treating psychoses including schizophrenia). Antipsychotic therapy is a key component of treatment and is continued after the acute episode to facilitate recovery, and prevent relapse (which is common after a first episode of psychosis) and suicide.
If possible, delay starting antipsychotic therapy for 24 to 48 hours to facilitate assessment and diagnosis. If interim treatment is required for acute agitation, see below. If the patient has trouble sleeping, see Insomnia for advice on whether short-term pharmacotherapy is indicated.