Managing people at risk of psychosis

Refer people at risk of psychosis for urgent management by a specialist centre (eg Headspace for people aged 12 to 25 years) or, if a specialist centre is unavailable, a psychiatrist. Ideally, the person’s family, carers or significant others should be involved in their treatment. Psychosocial interventions, particularly cognitive behavioural therapy for psychosis (CBTp), are the treatments of choice for people at risk of psychosis. Combined with close monitoring, these interventions appear to be most effective at stopping a full episode of psychosis from developing.

Do not start an antipsychotic for a person at risk of psychosis unless they:

• have had frank psychotic symptoms for 1 week or longer, in which case, undertake assessments for a first psychotic episode and use one of the regimens here, or
• are at risk of harming themselves or others because of the psychotic symptoms—see Approach to managing acute behavioural disturbance for immediate treatment, including links to drug regimens, then undertake assessments for a first psychotic episode and use one of the regimens here.