The acutely psychotic patient--assessment and initial management

Acute psychosis is a medical emergency; apart from distress and behavioural dysfunction, there may be danger to the patient and others. Urgent assessment and management is essential. Although involvement of specialist services is usual, general practitioners may need to initiate initial treatment and, in more remote areas, provide complete care.

This article aims to update the GP about the initial management of the acutely psychotic patient.

General practitioners will frequently be the initial source of assistance for patients with acute psychosis and their families. The patient with first episode psychosis may pose particular challenges, especially as insight about the need for treatment is often poor. The first step is to establish a therapeutic alliance, enabling history, examination and investigations. While it is necessary to establish the presence of psychosis, precise diagnosis is usually a secondary consideration. Risk assessment must be carried out to decide whether the patient can be managed in the community or needs inpatient care.