Feature Article

Management of acute psychosis

Judy Hope, Nicholas Keks



Urgent clinical evaluation, risk assessment and risk management are required in patients with acute psychosis. Guidelines are given for the pharmacological treatment
of this condition and psychosocial and long-term management are described.

Key Points

  • Patients with acute psychosis require an urgent clinical evaluation, risk assessment and risk management. Referral of the patient to specialist psychiatric services and involuntary hospitalisation need to be considered.
  • Recognition of early prodromal or prepsychotic symptoms may enable intervention when the patient still has insight and is more amenable to treatment. The trauma of acute psychosis and possibly hospitalisation may therefore be prevented and long-term outcome improved.
  • The diagnosis of psychosis in general is far more important for treatment in the short term than diagnostic distinctions between various subcategories of psychosis.
  • Antipsychotic medication is essential for the treatment of psychosis. It reduces and eliminates positive psychotic symptoms such as delusions, hallucinations, formal thought disorder and bizarre behaviour.
  • Some patients may require immediate intervention with tranquillising medications, such as sedative antipsychotics or benzodiazepines, in order to control acutely disturbed behaviour.
  • Mood stabilisers and antidepressants are useful in patients with mania, psychotic depression and schizoaffective disorder, in addition to antipsychotic drugs.