Initial medical work-up of first-episode psychosis: a conceptual review

Aim: To help clinicians carry out a comprehensive, medical diagnostic assessment in first-episode patients who are suspected of developing schizophrenia. Methods: Conceptual review of the published work with emphasis on the diagnostic goals of excluding medical causes of psychosis and establishing a medical baseline. Results: There is no agreed-upon standard for the initial medical work-up of first-episode cases. Excluding secondary causes of schizophrenia requires consideration of likelihood of disease; laboratory test performance; and relevance of positive test results. Conclusions: We propose a medical work-up for first-episode psychosis that combines: (i) broad screening; (ii) exclusion of specific diseases informed by treatability and epidemiology; and (iii) medical baseline measures.