What is the evaluation and treatment for adult-onset psychosis?

From the Guidelines

For adult-onset psychosis, the initial evaluation should include a comprehensive psychiatric assessment, and treatment should be guided by a documented, comprehensive, and person-centered treatment plan that includes evidence-based nonpharmacological and pharmacological treatments, as recommended by the American Psychiatric Association 1. The evaluation process should start with a thorough assessment, including the reason for presentation, patient goals and preferences, psychiatric symptoms, trauma history, substance use, psychiatric treatment history, physical health assessment, psychosocial and cultural factors, mental status examination, and risk assessment for suicide and aggressive behaviors 1. Key components of the treatment plan may include:

• Pharmacotherapy with an antipsychotic medication, with monitoring for effectiveness and side effects 1
• Nonpharmacological interventions such as cognitive-behavioral therapy for psychosis (CBTp), psychoeducation, supported employment services, and assertive community treatment for patients with a history of poor engagement 1
• Consideration of clozapine for patients with treatment-resistant schizophrenia or those at substantial risk for suicide attempts or aggressive behavior 1
• Use of long-acting injectable antipsychotic medication for patients who prefer it or have a history of poor adherence 1
• Management of side effects such as acute dystonia, parkinsonism, akathisia, and tardive dyskinesia with appropriate medications or dosage adjustments 1 A comprehensive and person-centered approach to treatment, as outlined in the American Psychiatric Association's practice guideline 1, is crucial for reducing morbidity, mortality, and improving quality of life for individuals with adult-onset psychosis.

From the FDA Drug Label

The provided drug labels do not directly address the evaluation and treatment for adult-onset psychosis. The FDA drug label does not answer the question.

From the Research

Evaluation of Adult-Onset Psychosis

The evaluation of adult-onset psychosis involves a thorough assessment to distinguish between primary and secondary psychosis [(2,3,4)]. This includes:

• A thorough history and examination to identify underlying medical or neurologic conditions [(2,3,4)]
• Laboratory, encephalographic, and imaging studies to rule out secondary causes 3
• A collateral history to gather information from family members or caregivers 5
• Assessment of mental state, including appearance, speech, mood, and thought patterns 5

Treatment of Adult-Onset Psychosis

Treatment of adult-onset psychosis is geared towards the specific cause of psychosis and tailored based on comorbid conditions 2. This may include:

• Environmental and psychosocial interventions as first-line treatments 2
• Judicious use of pharmacotherapy as needed 2
• Referral to early intervention services for patients with first episode psychosis 5
• Consideration of new medications that target negative symptoms and cognitive deficits in psychotic illness 4

Differential Diagnoses

Differential diagnoses for adult-onset psychosis include [(2,3,5,4)]:

• Delirium
• Disease
• Drugs
• Dementia
• Depression
• Delusions
• Bipolar disorder
• Schizophrenia
• Other psychiatric disorders

Importance of Early Detection and Intervention

Early detection and intervention of psychosis are crucial to prevent or delay the onset of psychosis 6. This includes:

• Monitoring and intervention in families with a history of severe mental illness 6
• Assessment and intervention in patients with prodromal symptoms, such as anxiety and depression, personality disorders, and social decline 6