Patients occasionally present having become acutely psychotic 'out of the blue', with no previous history. Delusions and hallucinations, with disturbed behaviour, may be prominent for a few days or so, and then completely resolve. Sometimes there are obvious precipitants, such as emotional distress, overwork, or physical illness. Some patients are never heard from again. Others go on to have further episodes. However, most UK psychiatrists would have reservations about accepting that stress, in the absence of predisposition, illicit drugs, or some other definite causative factor, can cause true psychosis.
Because of the difficulty in assessing and predicting further episodes, most psychiatrists would record a diagnosis of 'psychotic episode' after a first such psychotic episode, as the diagnosis of schizophrenia can be very upsetting for the patient, and can have worse consequences; for example, it may adversely affect insurance cover and work.
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