Last update:
03-Aug-2018

Psychotic disorders are not uncommon. They are characterized by a constellation of symptoms which affect the patients significantly, and are associated with moderate outcome and high rates of disability. For many patients with psychosis the primary health care system may be their only pathway to care, because of their symptomatology and various other adversities. This paper addresses some of the challenges that primary health care physicians face in the management of patients with psychotic disorders. The issues of physical morbidity and the high mortality of these patients are highlighted, as well as the diagnostic challenges, the phenomenon of poor compliance with treatment and the stigmatization and discrimination against them in the health care setting. Specific medical emergencies involving patients with psychotic disorders that primary care physicians may have to treat, such as hyponatremia and the neuroleptic malignant syndrome, are briefly presented. Finally, the paper contains practical suggestions for primary care physicians and other professionals with regard to the early suspicion and recognition of a psychotic episode, evaluation of relapses in patients with chronic psychotic illness, and co-operation with mental health professionals. Primary care staff can contribute significantly to the management of psychotic disorders in the community, but for them to be more effective, further training in mental health is needed, along with supervision by specialized mental health services.

Key words: Physical morbidity, Primary health care, Psychoses, Schizophrenia.