Acute psychotic episode

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    Last updated: July 2022


    An acute psychotic episode can be a one-time occurrence, usually of sudden onset, or can occur repeatedly, or it may be the early phase of chronic psychosis. It can occur following an adverse life event (e.g. loss, acute stress or trauma). In postpartum psychosis, delusions are frequently related to the mother-child relationship.


    Before prescribing antipsychotic medication, consider the possibility of an underlying organic cause (see Acute confusional state (delirium)) or substance use; check and record blood pressure, heart rate, weight.


    Antipsychotic treatment is the same as for chronic psychoses (haloperidol or risperidone) and should last at least 3 months. After 3 months, if the patient is stable, stop the treatment gradually over 4 weeks, monitoring for potential relapse. If the acute episode lasted more than 3 months, continue antipsychotic treatment for at least 2 years.  


    For severe anxiety or agitation, a short-course anxiolytic or sedative treatment may be added to the antipsychotic treatment, at the beginning of treatment.