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First-episode psychosis — MCCQE Part 1 MCQ

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ModeratePsychosisFirst-episode psychosisMCCQE Part 1

19-year-old student presents with paranoia and auditory hallucinations for 1 month. Urine toxicology is negative and family reports functional decline. Which of the following is the most appropriate next step?

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Correct answer: C — Urgently refer to early psychosis intervention and assess safety/substances/medical causes

Urgently refer to early psychosis intervention and assess safety/substances/medical causes is best because first-episode psychosis needs early coordinated care. Provide reassurance only and arrange no follow-up is suboptimal because mental health risk often requires structured follow-up or urgent escalation; Use long-term benzodiazepine monotherapy as default treatment is suboptimal because benzodiazepine monotherapy is rarely an appropriate long-term strategy; Avoid direct risk assessment to preserve rapport is suboptimal because direct assessment of suicide, violence, capacity and substance use is clinically appropriate; Attribute symptoms to personality or culture without assessing illness is suboptimal because diagnostic overshadowing risks missing treatable mental illness. Early treatment improves functional outcomes.

Reference: Canadian schizophrenia guidelines