Refer a patient with psychosis to secondary mental health services if there is a poor or partial response to treatment, treatment adherence is poor, or their functioning declines significantly NICE CG178.
Refer if the patient develops intolerable or medically important adverse effects from medication NICE CG178.
If there is suspected comorbid alcohol or drug misuse, or potential risk to the person or others, secondary care referral is indicated NICE CG178.
Additionally, refer if the person is pregnant or planning a pregnancy NICE CKS.
In cases of suspected psychosis or if in the prodromal phase, refer without delay to specialist mental health services or early intervention in psychosis services NICE CG178,NICE CKS.
Re-refer if the person’s social functioning declines, or if they experience persistent symptoms, distress, or impairment despite initial management NICE CG178.
Key References
- CG178 - Psychosis and schizophrenia in adults: prevention and management
- CKS - Psychosis and schizophrenia
- CG120 - Coexisting severe mental illness (psychosis) and substance misuse: assessment and management in healthcare settings
- CKS - Schizophrenia and psychosis
- NG58 - Coexisting severe mental illness and substance misuse: community health and social care services
- CG155 - Psychosis and schizophrenia in children and young people: recognition and management