Dr Steven Adelsheim Notes Key Issues When Assessing Potential Early Psychosis in Young Patients

When assessing young people for potential early psychosis, psychiatrists should keep in mind that reassurance is particularly important for this patient group, explained Steven Adelsheim, MD, clinical professor of psychiatry and behavioral sciences, Stanford University School of Medicine.

How should a psychiatrist conduct an assessment of potential early psychosis in a young person?
When a psychiatrist is meeting someone with early psychosis for the first time, there are a couple of issues. In addition to sort of the traditional mental health status exam, reviewing the symptoms, there are also key issues around reassurance and comfort level. For many young people who are facing a question of a psychotic illness, there’s a great deal of fear, there may be paranoia, there’s worry about “Am I going crazy? Is my brain playing tricks on me?”, so reassurance is important. Helping a young person understand that, even if they are developing psychotic symptoms, that by virtue of coming in for early care they can have a really positive outcome, is a very important piece, and for many of us as psychiatrists, that view’s not been part of our training. So, in addition to sort of the traditional evaluation, a really great history, looking at family history, the reassurance is important.

Another issue for adolescents also is that when someone develops a psychotic process, we may not know for a few years whether this will be a schizophrenia spectrum illness, a bipolar issue, depression with psychotic features, and so it’s important not to maybe rush to a diagnostic conclusion too early in the process.
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