A full history should be carried out, with particular attention paid to:
A full mental status exam should also be completed, including evaluation of capacity to consent.
Collateral history is extremely valuable, and seek it from many sources. Interview with family members if possible and consent is given.
Signs and Symptoms of first-episode psychosis include:
Substance use, especially marijuana, is very common in people with psychosis. It is important to avoid diagnosing substance-induced psychosis when a primary condition is present. Look for:
There is evidence that marijuana can trigger psychotic disorders - see under schizophrenia - causes and risk factors.
Diagnoses are made based on comprehensive assessment
A physical and neurological exam should be carried out
lab work includes
A head CT is usually done, primarily for patients and families to know you've ruled everything else out.
Followup assessments should be set up weekly at first and then tapered according to patient progress.
continue to assess positive symptoms, negative symptoms, mood disturbances, cognitive effects. A mental status exam should be carried out during each meeting.
Follow up with substance use.
Clinical rating scales can be used to monitor symptoms and recovery. These include:
Clinical global impression scale for severity (CGI-S) and CHange (CGI-C) and global assessment of functioning (GAF)
Evaluate extrapyramidal signs and symptoms.
assess weight, BMI, waist circumference, and blood pressure regularly
follow especially fasting glucose and lipid levels