Emerging psychosis in adolescents A practical guide

Background Emerging psychosis is a challenging presentation for the general practitioner as there is disagreement in the literature about classification and appropriate treatment protocols. Objective This paper highlights three main issues in primary care: recognising early signs of emerging psychosis, and how and when to refer patients; complexities associated with comorbid substance use; and management when the patient is referred back to primary care in the post-acute phase. Discussion Emerging psychosis is a complex presentation that warrants a considered approach right from the initial assessment. This paper emphasises the rationale for 'watchful waiting' in the interest of diagnostic certainty before potentially harmful treatments are commenced. There are also guidelines for a balanced approach to management, where engagement with the patient, monitoring medication effects and preventing relapse are the main aims.