Psychosis - Diagnosis 

Visit your GP if you are experiencing psychotic episodes. It is important to speak to your GP as soon as possible because people who have their psychosis treated early have better long-term outcomes. 

Visit your GP

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

Your GP may ask you a number of questions to try to determine the cause of your psychosis. For example, you may be asked:

• whether you are currently taking any medication
• whether you have been taking any illegal substances
• how your moods have been – for example, whether you have been depressed 
• how you have been functioning day-to-day – for example, whether you are 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 have heard voices
• about the details of your delusions, such as whether you feel that people are controlling you
• whether you have any other symptoms

Referral

The evidence supporting the early treatment of psychosis means that you are likely to be referred to a specialist urgently. This will either be during or after your first episode of psychosis. Who you are referred to will depend on what services are available in your local primary care trust (PCT). However, 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 who are 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 diagnose any underlying mental health condition that could be causing your symptoms. This will help them when planning your treatment (see Psychosis – Treatment).

Helping others

The lack of self-awareness that is associated with psychosis means that people who are experiencing psychosis will not be able to recognise that they are behaving strangely. They may be reluctant to visit their GP if they believe that there is 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 social worker (someone who works in social services), so try to contact them to express your concerns.

If someone is having a psychotic episode for the first time, it may be necessary for a friend, relative or someone else who is close to them to persuade them to visit their GP. If someone is having a rapidly worsening psychotic episode, contact the duty psychiatrist at their nearest A&E department.

If a person who is having a psychotic episode refuses to seek help, and it is believed that they present a risk to themselves or others, their nearest relative can request that a psychological assessment is carried out. The social services department of your local authority will be able to advise you about how to go about this.

In severe cases of psychosis, people can be compulsorily detained at hospital for assessment and treatment under the Mental Health Act (1983).

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 terms of the Act, a person can only be compulsorily admitted to hospital or other mental health facility if:

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

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 that a person can be compulsorily detained for under the Mental Health Act (1983) is:

• 72 hours
• 28 days
• six months

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

If you are being held under the Mental Health Act (1983), you can be treated against your will because it is felt you do not have sufficient capacity to make an informed decision about your treatment. However, certain treatments, such as brain surgery, cannot be carried out unless you provide your consent.

Any person who is 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.

The Directgov website contains more information about mental health and the Mental Health Act (1983).