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Feature Article

Acute psychosis: community care after hospital discharge

NICHOLAS CARR, ANTHONY W.F. HARRIS
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© ROLFFIMAGES/DEPOSITPHOTOS
© ROLFFIMAGES/DEPOSITPHOTOS

Abstract

Successful transition of a patient back to community care after an episode of acute psychosis requires good communication between the hospital and GP, and clear planning. GPs have a crucial role in ensuring medication concordance and psychosocial support, and monitoring the patient’s physical health needs.

Key Points

  • Community care of patients with a psychotic illness requires good communication between specialists, GPs and mental health services; this remains a challenge.
  • Antipsychotic medication is an essential foundation for recovery after an episode of acute psychosis; however, more than medication is needed.
  • Patients often discontinue antipsychotic medications; careful discussion and monitoring can help improve medication concordance.
  • GPs can use their knowledge of local services to refer patients for appropriate psychosocial support and rehabilitation.
  • The physical health of people with psychosis is easily overlooked but is a key responsibility of the GP.

The patient with acute psychosis has seen the community mental health team and been treated in an inpatient psychiatric unit, their medication has been optimised and the psychotic symptoms are reasonably under control. The psychiatrist is now ready to transfer the patient back to the GP in the community. What happens now? 

In a previous article in the April 2020 issue of Medicine Today, we discussed the important role of GPs in the initial identification and triage of patients with acute psychosis.1 Here, we describe the role of the psychiatrist and the GP in the follow-up phase, after an acute episode of psychosis has resolved and the patient is discharged back to community care.

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Discharge planning 

Good discharge planning starts on patient admission, is undertaken in advance of discharge, involves the patient and their supports, including their GP, and links the specialist care received in hospital with future recovery or rehabilitation. Discharge planning is often noted by its absence, when a patient arrives unannounced in the GP’s office with no paperwork and no forewarning. Planning that is done well decreases the risk of readmission and improves treatment concordance.2 

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© ROLFFIMAGES/DEPOSITPHOTOS
© ROLFFIMAGES/DEPOSITPHOTOS
Dr Carr is a Clinical Senior Lecturer (Honorary) at Melbourne University; and a General Practitioner at St Kilda Medical Group, Melbourne, Vic. Professor Harris is Head of the Discipline of Psychiatry at Sydney Medical School, The University of Sydney; Clinical Director of the Brain Dynamics Centre at the Westmead Institute of Medical Research, Sydney; and Staff Specialist at the Prevention Early Intervention and Recovery Service, Western Sydney Local Health District, Sydney, NSW.