Psychiatry
AKT · Psychiatry/Psychotic
Psychotic disorder
Overview
An umbrella for presentations with loss of contact with reality — delusions, hallucinations, disorganisation — including brief psychotic disorder and first-episode psychosis before a specific diagnosis is established.
Recognise
- Delusions, hallucinations, disorganised thought/behaviour
- First-episode psychosis: refer to Early Intervention in Psychosis
- Brief psychotic disorder: <1 month, often post-stressor, full recovery
Red flags
- Risk to self/others, command hallucinations → urgent assessment
Differentials & how to tell them apart
Schizophrenia≥6 months total disturbance
Drug-induced psychosisresolves as the drug clears; urine screen
Deliriumfluctuating consciousness, organic cause, acute
Mood disorder with psychosispsychosis confined to the mood episode
Investigations
Exclude organic and drug-induced causes (bloods, urine drug screen, imaging if indicated). Same antipsychotic baseline work-up as schizophrenia.
Management
- 1Refer first-episode psychosis to EIP. Antipsychotic + CBT + family intervention.
- 2Treat the underlying cause where identified (substance, organic).
Oral atypical antipsychotic — as for schizophrenia
Key points
Always exclude organic delirium and substance-induced psychosis first.
Monitor & prognosis
As for antipsychotic use; reassess the diagnosis over time.
Depends on cause; brief psychotic disorder recovers fully.
Source: NICE CG178; StatPearls