GP Vivas · mental-health
First-episode psychosis — structured viva
Structured oral on first-episode psychosis: defending early referral with DUP evidence, ranking antipsychotics on efficacy versus metabolic load, excluding the medical mimics, and arguing the physical-health monitoring case.
On this page
Study tools
Target exams
RACGP CCEFRACGP oralsMRCGP SCA
Prompt
The examiner opens: 'A partner in your practice says suspected first-episode psychosis should wait a month to see if it settles — defend your same-week referral habit with evidence.' The viva branches through DUP, antipsychotic choice, the differentials, monitoring, cannabis, and family work.
Stem
You are the GP. A practice colleague suggests watching and waiting a month whenever psychosis is suspected in a young person. [2]
References19ShowHide
- [2]Marshall M, Lewis S, Lockwood A, Drake R, Jones P, Croudace T Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Arch Gen Psychiatry, 2005.PMID 16143729
- [3]Perkins DO, Gu H, Boteva K, Lieberman JA Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. Am J Psychiatry, 2005.PMID 16199825
- [12]Boonstra N, Klaassen R, Sytema S, Marshall M, De Haan L, et al. Duration of untreated psychosis and negative symptoms--a systematic review and meta-analysis of individual patient data. Schizophr Res, 2012.PMID 23025994
- [24]Huhn M, Nikolakopoulou A, Schneider-Thoma J, Krause M, Samara M, et al. Comparative efficacy and tolerability of 32 oral antipsychotics for the acute treatment of adults with multi-episode schizophrenia: a systematic review and network meta-analysis. Lancet, 2019.PMID 31303314
- [31]Schneider-Thoma J, Chalkou K, Dörries C, Bighelli I, Ceraso A, et al. Comparative efficacy and tolerability of 32 oral and long-acting injectable antipsychotics for the maintenance treatment of adults with schizophrenia: a systematic review and network meta-analysis. Lancet, 2022.PMID 35219395
- [42]Furukawa Y, Lin X, Rodolico A, Tian J, Wu H, et al. Antipsychotic dose and efficacy for acute schizophrenia spectrum disorders: an updated systematic review and dose-response meta-analysis. EClinicalMedicine, 2026.PMID 41953819
- [33]Zhou T, Pu C, Huang Z, Gao T, Zhou E, et al. Weight changes following treatment with aripiprazole, risperidone and olanzapine: A 12-month study of first-episode schizophrenia patients in China. Asian J Psychiatr, 2023.PMID 37094459
- [35]Carolan A, Hynes-Ryan C, Agarwal SM, Bourke R, Cullen W, et al. Metformin for the Prevention of Antipsychotic-Induced Weight Gain: Guideline Development and Consensus Validation. Schizophr Bull, 2025.PMID 39657713
- [9]Mitchell AJ, Delaffon V, Vancampfort D, Correll CU, De Hert M Guideline concordant monitoring of metabolic risk in people treated with antipsychotic medication: systematic review and meta-analysis of screening practices. Psychol Med, 2012.PMID 21846426
- [38]Klau J, Gonzalez-Chica D, Raven M, Aboustate N, Jureidini J Cardiometabolic monitoring in children and adolescents prescribed antipsychotics in Australian primary care, 2011 to 2017. Aust N Z J Psychiatry, 2025.PMID 40801228
- [41]Mengistu T, Subedi A, Unamba U, Khan SA, Mowoe E, et al. Anti-NMDA Receptor Encephalitis Presenting as Acute Psychosis. Clin Case Rep, 2026.PMID 41641166
- [27]Mohamed MFH, Danjuma M, Mohammed M, Mohamed S, Siepmann M, et al. Myxedema Psychosis: Systematic Review and Pooled Analysis. Neuropsychiatr Dis Treat, 2021.PMID 34447249
- [23]Di Forti M, Quattrone D, Freeman TP, Tripoli G, Gayer-Anderson C, et al. The contribution of cannabis use to variation in the incidence of psychotic disorder across Europe (EU-GEI): a multicentre case-control study. Lancet Psychiatry, 2019.PMID 30902669
- [19]Schoeler T, Petros N, Di Forti M, Klamerus E, Foglia E, et al. Effects of continuation, frequency, and type of cannabis use on relapse in the first 2 years after onset of psychosis: an observational study. Lancet Psychiatry, 2016.PMID 27567467
- [30]Rodolico A, Bighelli I, Avanzato C, Concerto C, Cutrufelli P, et al. Family interventions for relapse prevention in schizophrenia: a systematic review and network meta-analysis. Lancet Psychiatry, 2022.PMID 35093198
- [43]Benazzi TA, Arturi VR, da Silva LHT, Baldez DP, Baroni G, Gama CS Optimizing Early Psychosis Care through Family Psychoeducation: A Systematic Review and Meta-Analysis. Braz J Psychiatry, 2026.PMID 42068331
- [22]Killackey E, Allott K, Jackson HJ, Scutella R, Tseng YP, et al. Individual placement and support for vocational recovery in first-episode psychosis: randomised controlled trial. Br J Psychiatry, 2019.PMID 30251616
- [20]Schoeler T, Petros N, Di Forti M, Klamerus E, Foglia E, et al. Poor medication adherence and risk of relapse associated with continued cannabis use in patients with first-episode psychosis: a prospective analysis. Lancet Psychiatry, 2017.PMID 28705600
- [39]de Bruijn MAAM, Leypoldt F, Dalmau J, Lee ST, Honnorat J, et al. Autoimmune encephalitis. Nat Rev Dis Primers, 2025.PMID 40935848