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Published on: May 15, 2020
Initial medical work-up of first-episode psychosis: a conceptual review
Oliver Freudenreich1, S Charles Schulz, Donald C Goff
1Massachusetts General Hospital Schizophrenia Program, Freedom Trail Clinic, Harvard Medical School, 25 Staniford Street, Boston, MA 02114, USA. ofreudenreich@partners.org
Aim:
To help clinicians carry out a comprehensive, medical diagnostic assessment in first-episode patients who are suspected of developing schizophrenia.
Methods:
Conceptual review of the published work with emphasis on the diagnostic goals of excluding medical causes of psychosis and establishing a medical baseline.
Results:
There is no agreed-upon standard for the initial medical work-up of first-episode cases. Excluding secondary causes of schizophrenia requires consideration of likelihood of disease; laboratory test performance; and relevance of positive test results.
Conclusions:
We propose a medical work-up for first-episode psychosis that combines: (i) broad screening; (ii) exclusion of specific diseases informed by treatability and epidemiology; and (iii) medical baseline measures.
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