Early-onset psychosis

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Target exams

Red flags

• New psychosis with fever, fluctuating attention, seizure, dysautonomia, movement disorder or rapid cognitive decline — exclude encephalitis, delirium and other organic causes before locking a primary EOP label
• Childhood onset under 13 with progressive decline — rare, often severe; intensify medical, developmental and genetic work-up
• Active suicidal intent, command hallucinations to harm, severe aggression, or child protection risk — same-day senior review, means restriction, multi-agency safety plan
• Catatonia, NMS features, or severe agitation with medical compromise — treat as medical-psychiatric emergency
• Two adequate adherent antipsychotic failures — escalate toward clozapine pathway rather than endless non-clozapine cycling
• Rapid weight gain or emerging metabolic syndrome after first antipsychotic exposure in youth — act early; do not wait for adult thresholds