From the Guidelines
Electroencephalography (EEG) is a crucial part of the initial assessment for first episode psychosis to rule out organic causes that may present with psychotic symptoms, as recommended by the most recent guidelines 1. The inclusion of EEG in the initial assessment is vital for detecting potential underlying neurological conditions that may be causing the psychotic symptoms, such as seizure disorders, encephalopathies, or structural abnormalities.
- The American College of Radiology's 2024 update on altered mental status, coma, delirium, and psychosis emphasizes the importance of considering organic causes of psychosis, including tumors, infarcts, and infections 1.
- Early identification of these conditions is critical, as they often require specific treatments that differ from standard antipsychotic medications, and delaying treatment can lead to poor outcomes.
- While the American Psychiatric Association's practice guideline for the treatment of patients with schizophrenia focuses on pharmacological and psychosocial interventions 1, it also highlights the importance of a comprehensive initial assessment, including a review of physical health and a mental status examination.
- The use of EEG in this context is supported by its ability to detect abnormalities that may not be apparent through other means, such as clinical examination or imaging studies 1.
- Overall, the inclusion of EEG in the initial assessment for first episode psychosis is a valuable component of a comprehensive evaluation, allowing clinicians to distinguish between primary psychiatric disorders and secondary psychosis due to medical conditions, and to provide targeted treatment for underlying neurological conditions.
From the Research
Importance of EEG in First Episode Psychosis
- Electroencephalogram (EEG) is a valuable tool in the initial assessment of first episode psychosis, as it can provide insights into brain dysfunction and help predict treatment response 2, 3, 4.
- Studies have shown that EEG abnormalities are associated with poorer prognosis and treatment outcomes in patients with first episode psychosis 4.
- The inclusion of EEG characteristics in clinical prediction models can improve the accuracy of treatment response prediction, although the combined model may not be significantly better than a clinical model alone 2.
EEG Findings in First Episode Psychosis
- EEG investigations have revealed that patients with first episode psychosis exhibit more pathological EEG abnormalities than healthy controls, particularly in temporal or fronto-temporal regions of the brain 3.
- Abnormal EEG findings, such as dysrhythmia, have been linked to poorer treatment outcomes and reduced symptom remission in patients with first episode psychosis 4.
- EEG source analysis has also shown that changes in brain network organization, such as decreased tree hierarchy in the alpha band, are associated with treatment response and symptom reduction 2.
Clinical Implications of EEG in First Episode Psychosis
- The use of EEG in the initial assessment of first episode psychosis can help identify patients who may be at risk for poorer treatment outcomes and inform treatment decisions 3, 4.
- Early intervention and treatment may improve outcomes in first episode psychosis, and the use of EEG can help guide treatment strategies and predict response to antipsychotic medication 5, 6.