Medical Workup for
First Episode Psychosis
A systematic approach to rule out medical and neurological mimics before diagnosing primary psychiatric conditions.
Primary Psychosis
Psychiatric conditions such as Schizophrenia, Schizoaffective Disorder, or Bipolar Disorder. Diagnosed only by exclusion.
Secondary Psychosis
Psychotic symptoms caused by an underlying medical condition, toxin, autoimmune disease, or medication.
Tier 1: Standard Baseline Workup
Required for almost all patients presenting with new-onset psychotic symptoms to establish a baseline and rule out common mimics.
Toxicology Screen
Urine & blood tests to rule out substance-induced psychosis (cannabis, amphetamines, hallucinogens).
CMP
Comprehensive Metabolic Panel checks for severe electrolyte imbalances, kidney, or liver failure.
Thyroid Function
TSH & Free T4. Severe hyper/hypothyroidism can profoundly alter mental status.
Nutritional Panels
Vitamin B12 and Folate. Severe deficiencies cause neuro-psychiatric symptoms.
Infectious Disease
Syphilis (RPR) and HIV testing to rule out neuro-cognitive associated disorders.
Pre-Treatment Baseline
EKG, Fasting Lipids, and HbA1c to establish health status before starting antipsychotics.
Clinical "Red Flags"
The presence of any of these indicators suggests a high probability of a neurological, structural, or autoimmune origin, necessitating immediate escalation to Tier 2 testing.
- Atypical age (< 13 or > 35)
- Visual, tactile, or olfactory hallucinations
- Unusually rapid symptom progression
- Confusion, delirium, or memory deficits
- Motor abnormalities (tremors, catatonia)
Tier 2: Targeted Investigations
Brain MRI (with/without contrast)
Rules out tumors, cysts, strokes, or demyelinating diseases (e.g., Multiple Sclerosis).
Preferred over CT for white matter detailElectroencephalogram (EEG)
Rules out seizure disorders, particularly Temporal Lobe Epilepsy, which can manifest purely as brief episodes of confusion or strange olfactory/gustatory hallucinations without full-body convulsions.
Autoimmune Encephalitis Panel
Tests for Anti-NMDA receptor encephalitis and Hashimoto's encephalopathy. Often requires a Lumbar Puncture (CSF analysis) to avoid false negatives from blood tests alone.
Critical in young adults with rapid onsetInflammatory & Specialty Screens
Checks for systemic inflammation attacking the CNS (ANA, ESR, CRP for CNS Lupus/Vasculitis) or heavy metal toxicities (Wilson's disease).