Brooke Harbor Health System
PMHNP Clinical Learning Environment
Condition Guide
Psychosis is a syndrome, not a single diagnosis. Assessment must address safety, medical and substance causes, mood episodes, trauma, development, culture, cognition, function, and the time course of hallucinations, delusions, disorganization, negative symptoms, and behavioral change.
Clinical application
Apply these prompts within the simulated clinical context. They support—but do not replace—clinical judgment, supervision, consultation, current guidance, local policy, law, or emergency procedures.
Diagnostic Features
DSM-5-TR criteria require syndromic assessment and exclusion of substance, medical, developmental and mood explanations.
At least two core symptoms are present for a significant time during one month, and at least one is delusions, hallucinations or disorganized speech. Continuous disturbance lasts at least six months, with functional decline and required exclusions.
The schizophrenia symptom criteria are met, but the total illness duration is at least one month and less than six months; functional decline is not required.
One or more psychotic symptoms include at least delusions, hallucinations or disorganized speech, last at least one day but less than one month, and are followed by full return to premorbid functioning.
A major mood episode occurs with schizophrenia criteria, with at least two weeks of delusions or hallucinations in the absence of a major mood episode, while mood symptoms occupy most of the illness duration.
One or more delusions persist at least one month without full schizophrenia criterion A; functioning is not markedly impaired apart from the delusion’s impact, and behavior is not obviously bizarre or odd.
Substance/medication-induced psychosis or psychosis due to another medical condition requires evidence that the exposure or illness directly produced the symptoms, and that they are not better explained by delirium or by a primary psychotic disorder.
Rating Scales & Screening
Use trained clinical assessment for severity tools and interpret early-psychosis screens as referral signals only.
Clinician-rated positive, negative and general psychopathology scale used in specialty care and trials; training and licensing conditions may apply.
Open PANSS resources ↗Clinician-rated measure of broad psychiatric symptoms useful for baseline severity and longitudinal change.
Open BPRS information ↗Self-report early-psychosis risk screen intended to identify people who may need a specialized interview—not to diagnose psychosis.
Open PQ-B PDF ↗Structured examination for abnormal involuntary movements during antipsychotic treatment; it monitors adverse effects rather than diagnosing psychosis.
Open AIMS in the Toolbox →Assessment & Differential
Begin with medical stability and a timeline, then integrate examination, collateral, records, substances, medications, and functional change.
Characterize hallucinations, delusions, disorganized thought or behavior, negative symptoms, catatonia, cognition, insight, affect, function, and distress without arguing about beliefs.
Clarify duration of untreated symptoms, decline from baseline, developmental history, substance exposure, medical red flags, trauma, mood symptoms, family history, and need for coordinated specialty care.
Consider delirium, neurologic or endocrine illness, infection, autoimmune disease, seizures, medications, intoxication, withdrawal, and other causes when the presentation or examination suggests them.
Establish whether psychosis occurs exclusively during mood episodes, whether experiences are trauma-linked, and whether cultural or spiritual context better explains the report.
Treatment
A person-centered plan should address symptoms, adverse effects, housing, relationships, education or work, substance use, physical health, and access.
Use shared decision-making around prior response, metabolic and neurologic risk, sedation, prolactin effects, QT risk, formulation, interactions, access, and patient preference.
Discuss when preferred by the patient or when adherence, recurrent relapse, or continuity problems make a long-acting formulation clinically useful.
Confirm diagnosis, adherence, dose, duration, substance use, and medical contributors. Clozapine is recommended for treatment-resistant schizophrenia and requires structured monitoring.
Include psychoeducation, family intervention, CBT for psychosis, supported employment or education, skills support, cognitive remediation when available, and coordinated specialty care.
Movement Disorders
Establish a movement baseline and assess symptoms directly rather than waiting for spontaneous reports.
Painful sustained contractions can involve the neck, jaw, eyes, or airway and may require urgent treatment. Review timing after medication initiation or dose change.
Inner restlessness may resemble anxiety or agitation and can worsen distress and suicide risk. Ask directly and observe the patient at rest and in motion.
Assess bradykinesia, rigidity, tremor, gait, facial expression, function, and competing neurologic causes; balance symptom treatment with psychiatric stability.
Use structured TD monitoring. Fever, rigidity, mental-status change, and autonomic instability raise concern for neuroleptic malignant syndrome and require emergency medical response.
Longitudinal Care
Follow physical health, function, goals, treatment burden, and the person’s experience of care.
Monitor weight, waist when used, blood pressure, glucose or A1c, lipids, activity, nutrition, smoking, and access to primary care.
Assess directly and formulate dynamically. Most people with psychosis are not violent; focus on patient-specific symptoms, history, access to means, substance use, victimization, and supports.
Explore benefit, adverse effects, stigma, beliefs, cost, transportation, cognition, routines, and prior coercive experiences without reducing nonadherence to a character judgment.
Clarify medication ownership, follow-up, laboratory monitoring, crisis contacts, housing, transportation, family communication, and what should trigger earlier reassessment.
Clinical Sources
These sources support clinical reasoning but do not replace a complete assessment, current prescribing information, local policy, consultation, or individualized shared decision-making.
American Psychiatric Association evidence-based treatment recommendations.
Open source ↗Implementation guidance, including clozapine, long-acting injectables, and movement-disorder monitoring.
Open source ↗Current FDA antipsychotic labeling and medication-specific warnings.
Open source ↗