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

Clinical Review

Managing the acute psychotic episode

Early Intervention Team for Ealing, Southall UB2 4EU

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

People with a first or recurrent psychotic episode tend to present late 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 when they have the complications of substance misuse. Patients who experience intolerable symptoms (distressing delusions or voices; box 1) often seek medical help. In emergency settings, family members' concerns contrast with the patient's apparent indifference. The highest risk of suicide in people with schizophrenia occurs during 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 be given competent assessments and access to appropriate services.

Acute psychosis is a common psychiatric emergency that may present to health services other than mental health practitioners . . . [Full text of this article]

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

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