Clinical practical guide for the management of an acute psychiatric crisis in primary care: A meta-review of systematic literature

Background

The duration of untreated psychosis is negatively associated with long-term outcomes. General practitioners play a key role in the pathway to care but they have difficulties managing an acute psychiatric crisis such as first-episode psychosis. Therefore, the objective of this meta-review was to provide clinical practical guides on the management of first-episode psychosis, aimed to general practitioners.

Methods

We searched Pubmed, Cochrane and Web of Science for systematic reviews of literature, meta-analyses and guidelines of oral antipsychotics or benzodiazepines treatment for the management of acute psychiatric crisis, published from 2005 to 2021. The reports have been selected and reviewed independently by two researchers.

Results

31 articles were included, with 25 on first-episode psychosis. Second-generation antipsychotics are the mainstay of treatment. The choice of the antipsychotic drugs should be guided mainly by side-effects, to maximize tolerability and acceptability. It must be introduced at a low starting dose with gradual titration until the minimal effective dosage is reached.

Conclusion

We merged our meta-review findings into a comprehensive algorithm for the management of first-episode psychosis in primary care, from assessment to first-line therapies and follow-up.