Abstract
Objective: Initial presentations of psychosis require a thorough physical health assessment to identify comorbidities, establish treatment safety and exclude organic causes of psychosis. Despite clinical consensus that these assessments are essential, global guidelines are variable and outdated. This work aimed to synthesise current evidence to inform updated recommendations for physical assessments in psychosis, balancing thorough investigation with practical applicability.
Methods: A scoping review of physical health disorders associated with psychosis was conducted using PubMed, Embase and CINAHL. Separately, a systematic review of international guidelines from 2000 to 2025 was performed, extracting physical health assessment recommendations for schizophrenia spectrum disorders. A narrative analysis evaluated the clinical utility of identified investigations.
Results: Eighty-four physical health disorders with potential psychotic presentations were identified, mostly rare and typically associated with other neurological or systemic features. There was significant heterogeneity in investigations advised by the 25 identified guidelines, outside of the common consideration for metabolic screening. The majority of guidelines considered investigations for both the exclusion of organic causes of psychosis and identifying a physical health baseline or comorbidity. There was limited consistency around recommendations for neuroimaging or autoimmune screening. Clinical assessment remains central to determining appropriate investigations.
Conclusion: Global inconsistency in assessment recommendations reflects the complexity of distinguishing organic psychoses from primary psychiatric disorders. Structured yet individualised assessments, informed by symptomatology and risk factors, are essential. A staged, context-sensitive approach is proposed to optimise diagnostic accuracy and avoid unnecessary testing. Updated, evidence-informed guidelines are critical for improving care for people with psychosis.