The Initial Evaluation of Psychosis
People experiencing a first episode of psychosis and their families sometimes hesitate in seeking mental health evaluation and treatment. One reason may be that they do not know what to expect. In addition, old wives’ tales, stories from the media, or other ideas about what happens to people with psychosis may be frightening. This chapter explains the evaluation provided in a health-care setting when people seek help for a first psychotic episode. A thorough evaluation is the first step for mental health professionals to help people experiencing a first psychotic episode. The main reason for evaluation is to better understand what people with psychosis are experiencing. Just like medical illnesses, early psychosis differs greatly across individuals. It can include many different types of signs and symptoms that are caused by a number of different disorders. So, a thorough evaluation allows the mental health professional to compile all sorts of information, from different perspectives, to arrive at the most appropriate diagnosis and develop the most effective treatment plan. As described in Chapter 3, a thorough evaluation assesses three types of possible causes of psychosis. Are the psychotic symptoms a result of a medical condition that requires treatment? Are they stemming from a substance of abuse? Or, do they indicate a psychiatric illness, such as major depression, bipolar disorder, or a primary psychotic disorder? Importantly, the evaluation can provide families with an explanation for what their loved one is experiencing. It also may help the person with psychosis to feel better understood. This chapter describes the typical evaluation that is provided when someone first comes into a mental health facility with psychosis. Most importantly, interviews and observations allow the mental health professional to understand the nature of the psychotic symptoms, including when they started, how they progressed, etc. In addition to gathering information from the patient, the mental health professional will want to collect any other records that may be helpful and to contact others who know the patient to get their perspectives. The mental health professional will usually do a number of medical and psychological exams, including a physical exam, cognitive assessments, lab tests, and perhaps an electroencephalogram and an imaging study.