What is Psychosis?
Diagnosing Psychosis
However, preliminary assessment is performed in primary care for referral onward.
Psychosis may be preceded by a ‘prodromal period’ that can last from a few days to around 18 months, which is characterised by emotional and behavioural changes leading to a deterioration in personal functioning and social withdrawal.
Identifying the prodromal stage offers a critical treatment window to delay or prevent the person's transition to frank psychosis.
Penrose Health Action Plan
The management of adults with confirmed psychosis should be initiated and coordinated in secondary care. Once their condition has stabilised, prescribing and monitoring of health and medication may be carried out under Shared Care Protocol arrangements with primary care.
This long term condition is reviewed annually within Penrose Health (see Severe Mental Illness (SMI)).
⚠️ Safety netting
If a person with a psychotic disorder is being managed solely in primary care, re‑refer them to secondary care if:
- there is a poor or partial response to treatment or treatment adherence is poor;
- patient’s functioning declines significantly;
- patient develops intolerable or medically important adverse effects from medication;
- comorbid alcohol or drug misuse is suspected;
- there is potential risk to the patient or others;
- patient is female and is pregnant or planning a pregnancy.
Secondary and External services may be better placed to help/support patients than we are.
- Secondary services offer psychological treatments (e.g., interpersonal/psychodynamic therapies, CBT)
- External services in the community offer many options for social and psychological help through relationships with the wider service network (e.g. Social Prescriber, Befriender, Care Coordinator, Therapist, Lifestyle Coach, etc.)
We do not provide any form of psychotherapy within our surgeries.
Psychosis is a notifiable condition for the DVLA - see Psychosis and driving - GOV.UK (www.gov.uk)
Lithium may impair performance of skilled tasks (e.g. driving, operating machinery), so patients must be made aware of the risk of driving whilst taking this medication.
Patient Journey - Determining Schedule of Reviews
Click toggle for a schematic of the action plan/treatment policy for all Penrose Health Surgeries, or follow the guidance below.
Suspected Psychosis → Liaise with other professional (e.g., PCMHT team or GP) for diagnosis/management.
If patient in crisis and not yet managed in a secondary MH service → refer to crisis service and/or discuss with another professional (e.g. GP, PCMHT team) as appropriate.
If not in crisis, and not yet managed in secondary services → consider re-booking in 2-6 weeks for follow up, depending on risk assessment.
Pre-existing Psychosis diagnosis → Liaise with other professional (e.g., PCMHT team or GP).
If patient in crisis, identify if patient already under secondary MH service and which service → refer/discuss with patient’s secondary MH team.
If patient has:
- no acute issues and current review did not identify any psychosis symptoms → follow annual review pathway for SMI: Severe Mental Illness (SMI).
- acute issues and evidence of hallucinations/delusions, and has been rejected from secondary services → discuss with other professional (e.g., PCMHT team or GP) and consider re-booking in 2-6 weeks for follow up, depending on risk assessment.
Medication
- Medication for these patients will be initiated by a psychiatry team and handed over to primary care under a Shared Care plan.
- Any changes in meds or adverse events → Liaise with seniors as appropriate.
Signpost/refer to services as appropriate (see Referring Onward below).
- If a patient is actively managed by another mental health provider → liaise with services as required and conclude routine MHN appointments.
- If rejected by secondary services and patient is at high risk → review again in <1-2 weeks.
If patient remains on medication for a long-term, routine review should occur every 6 months.
If patient is not being actively managed by secondary services and still having issues, after second review → book appointment with GP.
Signpost/refer to services as appropriate (see Referring Onward below).
Routinely review patient and their family/partners/carers, using clinical judgement on a case by case basis, to ensure that they are coping well/receiving suitable support → signpost to support services, as appropriate.
Referring/Signposting Onward
Below are some services to which you can signpost/refer patients. More services can be found on the Penrose Portal in Mental Health Services Database.