Psychosis - Diagnosing psychosis

You should visit your GP if you're experiencing psychotic episodes.

It's important to speak to your GP as soon as possible, because early treatment of psychosis usually has better long-term outcomes. 

Initial assessment

There's no test to positively diagnose psychosis. However, your GP will look at your symptoms and rule out short-term causes, such as drug misuse.

Your GP may ask questions to determine the cause of your psychosis. For example, they may ask you:

• whether you're taking any medication
• whether you've been taking illegal substances
• how your moods have been – for example, whether you've been depressed 
• how you've been functioning day-to-day – for example, whether you're still working
• whether you have a family history of mental health conditions, such as schizophrenia
• about the details of your hallucinations, such as whether you've heard voices
• about the details of your delusions, such as whether you feel people are controlling you
• about any other symptoms you have

Referral

The evidence supporting the early treatment of psychosis means you're likely to be referred to a specialist urgently. This will either be during or after your first episode of psychosis.

Who you're referred to will depend on the services available in your area. You may be referred to:

• a community mental health team – a team of different mental health professionals who provide support to people with complex mental health conditions
• a crisis resolution team – a team of different mental health professionals who treat people currently experiencing a psychotic episode, who would otherwise require hospitalisation
• an early intervention team – a team of mental health professionals who work with people who have experienced their first episode of psychosis

These teams are likely to include some or all of the following healthcare professionals:

• a psychologist – a healthcare professional who specialises in the assessment and treatment of mental health conditions
• a psychiatrist – a qualified medical doctor who has received further training in treating mental health conditions
• a community mental health nurse – a nurse with specialist training in mental health conditions

Your psychiatrist will carry out a full assessment to help identify and diagnose any underlying mental health condition that could be causing your symptoms. This will help when planning your treatment for psychosis.

Helping others

The lack of insight associated with psychosis means that people experiencing psychosis aren’t always able to recognise their strange behaviour.

They may be reluctant to visit their GP if they believe there's nothing wrong with them, and you may need to get help for them.

Someone who has had psychotic episodes in the past may have been assigned a mental health worker (someone who works in social services), so try to contact them to express your concerns.

Someone who is having a psychotic episode for the first time may need a friend, relative or someone else close to them to persuade them to visit their GP.

If they're having a psychotic episode that's rapidly getting worse, you should contact their crisis team or – if not available – the duty psychiatrist at their nearest accident and emergency (A&E) department.

If a person who is having a psychotic episode refuses to seek help, and is believed to present a risk to themselves or others, their nearest relative can request that a psychological assessment is carried out. Your local mental health trust can advise you about this.

If someone has very severe psychosis, they can be compulsorily detained at hospital for assessment and treatment under the Mental Health Act (1983) (external link).

Mental Health Act (1983)

The Mental Health Act (1983) is the main piece of legislation that covers the assessment, treatment and rights of people with a mental health condition.

Under the Act, a person can only be compulsorily admitted to hospital or other mental health facility (sectioned) if they:

• have a mental disorder of a nature or degree that makes admission to hospital appropriate
• should be detained in the interests of their own safety, for the protection of others, or both

Two doctors need to agree on the above assessment. Depending on the nature of the mental health disorder and the individual’s circumstances, the length of time a person can be sectioned is:

• 72 hours
• 28 days
• 6 months

Before these time periods have elapsed, an assessment will be carried out to determine whether it's safe for the person to be discharged, or whether further treatment is required.

If you're held under the Mental Health Act (1983), you can be treated against your will because it's felt can’t make an informed decision about your treatment. However, certain treatments, such as brain surgery, can't be carried out unless you consent to treatment.

Any person compulsorily detained has the right to appeal against the decision to a Mental Health Review Tribunal (MHRT). A MHRT is an independent body that decides whether a patient should be discharged from hospital.