Managing the acute psychotic episode

doi:10.1136/bmj.39148.668160.80

BMJ 2007;334:686-692 (31 March), doi:10.1136/bmj.39148.668160.80

Clinical Review

Managing the acute psychotic episode

Peter Byrne, consultant psychiatrist

Early Intervention Team for Ealing, Southall UB2 4EU

Correspondence to: p.byrne@ucl.ac.uk

The first 150 words of the full text of this article appear below.

People with a first or recurrent psychotic episode tend to presentlate for medical attention, and many do not present at all.Presentation is often initiated by others, not by patients themselves.Psychosis can also become apparent during a manic presentation,when patients act on their delusions in a public forum, or whenthey have the complications of substance misuse. Patients whoexperience intolerable symptoms (distressing delusions or voices;box 1) often seek medical help. In emergency settings, familymembers' concerns contrast with the patient's apparent indifference.The highest risk of suicide in people with schizophrenia occursduring the first five years of illness ("the critical period"),and interventions are most fruitful during this time. Importantly,patients experiencing their first episode should quickly begiven competent assessments and access to appropriate services.

Acute psychosis is a common psychiatric emergencythat may present to health services other than mental healthpractitioners

. . . [Full text of this article]

Antipsychotic drug treatment but no psychosocialinterventions
Placebo treatment andno psychosocial interventions
Antipsychotic drug treatment and psychosocial intervention(s)

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