Reference
Guide | Reference

68  First Episode Psychosis Prototype

68.1 Summary

  • A first clear presentation of reality distortion or psychosis-spectrum symptoms with functional change or risk.

68.2 Prototype Features

  • New onset hallucinations or unusual beliefs.
  • Reduced insight or disorganized thinking.
  • Noticeable functional change or behavioral disruption.

68.3 Threshold Guidance

  • Use when psychosis-spectrum symptoms are new and clinically significant.

68.4 Expected Domain Profile

  • Psychosis and Reality Testing: moderate to high.
  • Mood and Drive Dysregulation: variable.
  • Cognitive Control and Executive Function: variable.

68.5 Time-Course and Trajectory

  • Acute or subacute onset.
  • High variability early in course.

68.6 Differential and Red Flags

  • Delirium or acute confusional states.
  • Substance intoxication or withdrawal.
  • Medication or iatrogenic effects.
  • Seizure, autoimmune, infectious, or neurodegenerative mimics.

68.7 Specifiers (treatment-relevant, non-prescriptive)

  • Course/time pattern (acute, episodic).
  • Contributors (substance use, sleep loss, medical factors).
  • Risk modifiers (safety risk, self-care impairment).

68.8 Measurement Prompts

  • Brief psychosis screening items.
  • Collateral timeline and functional baseline.

68.10 Documentation Snippet (1-2 lines)

  • “New onset hallucinations with reduced insight and functional change; Psychosis 3; acute course.”