First-episode psychosis pathway — assessment to recovery (MEQ)

(i) FEP and DUP. First-episode psychosis is a clinical/service pathway for a first clear psychotic presentation, not a single DSM/ICD final label. Working diagnosis: first-episode schizophrenia-spectrum psychosis (duration still may sit in schizophreniform range depending on total continuous signs). DUP here is at least about 8 weeks of frank psychosis (phone tracking, commentary) and longer if prodromal withdrawal is counted under DUI definitions — already clinically important because longer DUP associates with poorer outcomes and should be stopped by starting adequate treatment now.[2]

(ii) Organic exclusion and baseline tests. History for fever, seizure, head injury, neurological symptoms; physical examination; observations already reassuring. Baseline before antipsychotic: BMI/weight, BP, glucose or HbA1c, lipids, FBC, U&E, LFT, ECG QTc, pregnancy test if applicable, substance timeline. Image/EEG/autoimmune pathway if red flags later emerge. Urine drug screen supports but does not exclude primary illness.[1]

(iii) Antipsychotic plan. Example: aripiprazole 10 mg orally daily after baselines, with education about akathisia. Review within days; trial about 4–6 weeks at therapeutic dose with adherence support. Alternatives: risperidone 1–2 mg titrating carefully, or olanzapine 5–10 mg if sedation needed but metabolic risk disclosed. Avoid high first-episode doses without justification.[1]

(iv) Multi-element EIS. Refer to early intervention / coordinated specialty care: low-dose medication, family psychoeducation, case management, CBTp access, cannabis counselling, vocational/education support (IPS). Evidence: RAISE-ETP (NAVIGATE superior to usual care at 2 years), OPUS intensive early intervention benefits, and Correll meta-analysis favouring EIS versus treatment as usual.[1][5]

(v) Maintenance and cannabis. After remission, counsel that stopping medication early carries high recurrence risk; plan continued antipsychotic treatment for a guided period commonly framed as at least 1–2 years, with any later taper supervised and paired with an early-warning plan.[3] Cannabis: frequency and high-THC use worsen course; continued use after onset associates with earlier relapse — motivational cessation support is core secondary prevention, integrated with psychosis care.[4]