Medical Workup for Psychosis

Initial Clinical Assessment

A thorough physical examination and targeted laboratory testing should be performed to rule out medical causes of psychosis, with neuroimaging reserved for patients with atypical presentations, abnormal neurological findings, or focal deficits, as recommended by the American Academy of Child and Adolescent Psychiatry and the American College of Radiology 1, 2
Obtain detailed evaluation of psychotic symptoms including delusions, hallucinations, disorganized speech/thought, abnormal motor behavior, and negative symptoms, according to the American Academy of Child and Adolescent Psychiatry 1, 3

Toxicology screens as indicated by history and examination should be considered, as recommended by the American Academy of Child and Adolescent Psychiatry 1
Baseline laboratory monitoring for potential adverse effects of antipsychotic medications should be performed, according to the American Academy of Child and Adolescent Psychiatry 1

CT head without IV contrast is usually appropriate as first-line neuroimaging when focal neurologic deficits are present, as recommended by the American College of Radiology 2
Consider neuroimaging in new-onset psychosis when the clinical picture is unclear, presentation is atypical, or there are abnormal findings on examination, according to the American College of Radiology and the American Academy of Child and Adolescent Psychiatry 2, 1
Brain MRI is preferred over CT when neuroimaging is indicated, as it provides more detailed information, as recommended by the American College of Radiology 2

Electroencephalography should be ordered as indicated based on history and physical examination, particularly if seizure disorder is suspected, as recommended by the American Academy of Child and Adolescent Psychiatry 1
Consultation with other medical specialties may be required in some cases, according to the American Academy of Child and Adolescent Psychiatry 1

Don't miss delirium: Fluctuating consciousness, disorientation, and inattention distinguish delirium from psychosis and require different urgent evaluation, as recommended by the American Academy of Child and Adolescent Psychiatry and the American College of Radiology 3