First-episode psychosis: a clinical approach

Psychotic illnesses, such as schizophrenia and bipolar illness, are relatively common and clearly devastating diseases. Most scientific literature focuses on research and care of patients suffering from psychotic illnesses in the middle age-group; subsequently, the first episode or early stages of psychotic illnesses have been relatively ignored, especially the issues of early diagnosis and intervention. The purpose of this article is to highlight issues of first-episode schizophrenia for the family physician and to discuss (1) diagnosis, (2) neuropsychiatry research, (3) new medications, and (4) family issues.

To approach the issues of first-episode schizophrenia, we describe a case of a young woman who suffered her first episode of psychosis. Relevant literature related to the early stages of psychosis, including new pharmacologic treatments, is addressed.

This report of our patient, a 19-year-old woman, illustrates the problems of a long prodromal phase of her illness, the use of medications that might have worsened her condition, and the successful use of new antipsychotic medications. Her family's issues as the patient went through this phase of her illness and recovery are reviewed.

Patients at the outset of a psychotic illness are frequently first seen by a family physician. Familiarity with current diagnostic criteria and effectiveness of new treatments can lead to improved detection and overall outcome.