Table 3.

Treatment Recommendations

Full diagnostic assessment, including differential diagnosis, by a doctoral-level clinician.	Presenting symptoms could be an emerging anxiety, affective, or substance abuse disorder. Other metabolic, endocrine, or neurological causes need to be ruled out.
Psychoeducation regarding the presenting symptoms and risk of ongoing substance abuse.	Education for the patient and family regarding the potential risks and symptoms to watch out for should be presented in a reassuring and nonstigmatizing manner. The use of substances can cloud the clinical picture and may provide a second “hit,” triggering a vulnerable person to become psychotic.
Psychosocial treatment, including crisis intervention, reduction of stress and ongoing support related to family, peer, or school/work problems. Also consider Cognitive Behavioral Therapy (CBT) to target specific symptoms.	Observed symptoms may be transient and in part related to developmental challenges in adolescence and young adulthood. Supportive approaches that include ongoing assessment of symptoms and stressors will help to reduce the intensity of symptoms.
Pharmacologic intervention should target the presenting symptoms.	Keep in mind the differential diagnosis when considering the addition of medication. Consider the use of mood stabilizers (ie, lithium or valproic acid), antidepressants, or short-term use of benzodiazepines prior to the use of antipsychotic agents if mood or anxiety disorders are prominent. Consider a brief trial with antipsychotics to target worsening subsyndromal psychotic symptoms if the above intervention is not effective. Long-term use of antipsychotics should be reserved for established diagnoses of DSM-IV psychotic disorders.