How should I approach the initial assessment of a patient presenting with acute psychotic symptoms?

Approach to Initial Assessment of a Patient Presenting with Acute Psychotic Symptoms:

• Assess risk of harm to the person and others: Enquire about history of self-harm, suicidal ideation or plans, previous attempts, feelings of hopelessness, misuse of recreational drugs or alcohol, gambling-related harms, and whether the person experiences 'command' hallucinations with compulsion to act on them. Consider the likelihood of accidental or non-accidental injury and level of family/social support. Be aware that suicide risk is highest around the time of a psychotic episode and shortly after hospital discharge ¹,².
• Assess risk of unintentional harm: Evaluate risks from disorganized behaviour or poor judgement due to psychotic experiences and beliefs ¹,².
• Assess risk of harm to others: Consider potential neglect of dependents (family, children), any risk to the public (history of violence, carrying weapons, stimulant drug use), and whether delusions are focused on particular individuals. Follow local safeguarding procedures if necessary ¹,².
• If high risk of harm is identified: Arrange same-day specialist mental health assessment by early intervention in psychosis services or crisis resolution and home treatment teams. Attempt voluntary hospital admission if needed; if declined, consider compulsory admission under the Mental Health Act sections 2 or 4 ¹,².
• If not high risk: Urgently refer for specialist assessment, preferably to early intervention in psychosis services. If urgent intervention is not available, refer to crisis resolution and home treatment teams ¹,².
• Conduct a comprehensive assessment covering: psychiatric history, mental state, substance use, medical history and physical examination to exclude organic causes, psychological and psychosocial factors (social networks, trauma history), developmental history, physical health and wellbeing, social circumstances, educational and occupational status, and economic factors ⁴,⁵.
• For children and young people: Ensure assessment includes multidisciplinary input, involves the young person and their carers, and develops a care plan promoting physical health, social inclusion, and strategies for independence ⁴.