What are the key diagnostic criteria for identifying psychosis in a primary care setting?

Key diagnostic criteria for identifying psychosis in a primary care setting include:

• Presence of sustained psychotic symptoms such as hallucinations, delusions, or disorganized thinking lasting 4 weeks or more.
• Distress and decline in social functioning associated with transient or attenuated psychotic symptoms or other experiences suggestive of possible psychosis.
• Consideration of family history, especially a first-degree relative with psychosis or schizophrenia, which increases risk.
• Assessment of risk of harm to self or others, including suicidal ideation, history of self-harm, command hallucinations, substance misuse, and potential for violence or neglect.
• Exclusion of other medical or substance-related causes through history and examination.
• Referral without delay to specialist mental health or early intervention in psychosis services for assessment if psychosis is suspected.
• Do not initiate antipsychotic medication in primary care without specialist consultation.

These criteria focus on clinical features, risk assessment, and prompt referral rather than definitive diagnosis in primary care, which requires specialist assessment for confirmation and management planning ¹,²,³.