10-minute consultation: First episode psychosis.

x Ask about symptoms suggesting psychological vulnerability, such as irritability, feeling uneasy, constant tiredness, suspiciousness, and withdrawal. x If you suspect psychosis, ask more about changes in social functioning, such as problems in relationships with friends and family; cognition, such as poor concentration or memory; mood, such as feeling depressed, anxious, or irritable; and thought content, such as preoccupation with strange thoughts or ideas that seem hard to ignore (for example, “have you felt lately that people are talking about you, plotting about you, or trying to hurt you?”). x Ask about drug misuse. Although there is no compelling evidence to suggest a causal role for drug misuse in first episode psychosis, drug misuse can cause prolonged and more severe symptoms. However, referral for assessment for psychosis should not be delayed just because, for example, he smokes cannabis. x Look for evidence of poor personal hygiene, delusional or bewildered mood, abstract or vague speech, or outbursts of anger or irritation; these also suggest psychosis. x Psychosis rarely presents in neat parcels, and symptoms are rarely volunteered spontaneously. You may need to see him more than once to gain a full picture. What you should do