Psychotic disorders

Presentation and immediate needs

Psychosis may involve delusions, hallucinations, disorganisation, negative symptoms and functional change. These experiences occur in several psychiatric and medical conditions.

Begin assessment → History, examination and context

History, examination and context

Describe experiences, conviction, distress, impact and associated behaviour. Assess attention, consciousness, mood episodes, neurological findings and substance exposure before assigning a primary psychotic disorder.

Consider the branch → Acute inattention, altered awareness or substance/medical clues?

Acute inattention, altered awareness or substance/medical clues?

Use clinical findings and collateral. Uncertainty needs clarification, not a default negative answer.

Yes / concerning features → Priority assessment; No / not established → Formulation and care discussion; Uncertain / not assessed → Obtain the missing information

Priority assessment

Prioritise medical/substance assessment and reassess the psychotic presentation.

After appropriate assessment → Formulation and care discussion

Obtain the missing information

Review the examination, timeline, relevant investigations and consented collateral. Escalate urgent concerns while uncertainty is resolved.

Reassess the branch → Acute inattention, altered awareness or substance/medical clues?

Formulation and care discussion

Provide collaborative engagement and early specialist assessment. Care can combine a monitored antipsychotic trial, psychological and family interventions, and support for education, work and physical health.

Agree follow-up → Reassess and follow up

Reassess and follow up

Review positive and negative symptoms, function, adherence and metabolic, movement, cardiac or prolactin-related effects relevant to the medicine. Reassess apparent nonresponse before escalation.