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First episode psychosis

BMJ 2002; 324 doi: (Published 20 April 2002) Cite this as: BMJ 2002;324:976

Patients must be asked about suicidal ideation and substance misuse

  1. Andrew Sandor (, lecturer in social and community psychiatry
  1. Royal Free and University College, Medical School, London N19 5NF
  2. Department of Psychiatry, St George's Hospital Medical School, London SW17 0RE

    EDITOR—Lester's article on first episode psychosis is welcome,1 given that general practitioners have a low index of suspicion for the presence of psychosis and little confidence in diagnosing it.2 But the article omitted two essential considerations—namely, the need to ask about hallucinations and about the risk of self harm and of harm to others; these may be closely related when command hallucinations instruct the person to commit self harm or harm others.

    Exploration of suicidal ideation (which may be independent of depression) is essential. Suicide is the chief cause of premature death …

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