Schizophrenia spectrum and other psychotic disorders

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Target exams

Red flags

• New psychosis with fever, rigidity or fluctuating attention — exclude NMS, encephalitis and delirium before locking a primary psychiatric label
• First-episode psychosis after age 40, or focal neurology, seizure or rapid cognitive decline — intensified organic work-up including neuroimaging and autoimmune consideration
• Active suicidal intent or command hallucinations to harm — same-day senior review, means restriction, documented safety plan; do not discharge to an empty plan
• Treatment resistance after two adequate antipsychotic trials — do not delay clozapine
• Clozapine patient with fever, chest pain or tachycardia in the first month — stop and investigate myocarditis as an emergency
• Clozapine patient with constipation, distension or vomiting — treat as potential life-threatening ileus