Acute first psychotic episode in adolescents: A diagnostic approach in emergency settings
First psychotic episode in adolescence in emergency settings
DOI:
https://doi.org/10.65549/8xk5ax54Keywords:
Emerging psychosis; adolescence; first-episode psychosis; emergency diagnosis; duration of untreated psychosis.Abstract
Objective: To establish a structured and hierarchical diagnostic approach to the first acute psychotic episode in adolescents in emergency settings, in order to optimise initial management and improve short- and long-term prognosis.
Methods: Narrative review of the literature based on a search of PubMed and Cochrane (articles in French and English; keywords: first episode psychosis, early-onset psychosis, emerging psychosis, adolescent, emergency, secondary psychosis, duration of untreated psychosis), supplemented by a manual search of the reference lists of included articles, the Encyclopédie Médico-Chirurgicale (EMC), reference textbooks and learned society guidelines, covering epidemiological, clinical and diagnostic data on first-episode psychosis in adolescents in emergency settings.
Results: The recommended diagnostic approach is organised in three complementary steps: (1) receiving the patient and ruling out organic aetiologies, guided by red flags, through medical history and investigations; (2) establishing the positive diagnosis, integrating developmental and illness history and an estimate of the duration of untreated psychosis (DUP); (3) identifying prognostic severity factors in order to stratify the risk of relapse and chronicity and to adapt the intensity of follow-up.
Conclusion: Early, multidisciplinary intervention guided by a hierarchical diagnostic approach involving child and adolescent psychiatrists, somatic physicians, family and school is likely to improve short- and long-term prognosis by limiting the transition to chronic psychotic disorders.
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