Moving towards evidence-based screening and investigations in first episode psychosis: A commentary on the ANZJP GRADE Schizophrenia Guidelines

Physical health assessment and investigations are important considerations during the first episode of psychosis. These activities support diagnostic clarification, monitoring for iatrogenic harms and opportunistic screening to limit the multimorbidity that is often associated with psychotic disorders in the longer term. The recent 'Australian and New Zealand Journal of Psychiatry Grading of Recommendations, Assessment, Development and Evaluations (GRADE) guidelines for the management of schizophrenia' and the associated systematic review by Warren et al. fill a critical gap by providing evidence-based guidance on which investigations should be routine and when more targeted investigations are warranted. However, the guidance provided has a limited focus on affective psychosis, and its focus on targeted screening for sexually transmitted infections may underestimate the extent to which people experiencing the first episode of psychosis reflect an at-risk group. This commentary explores the relevance of further consideration of sexual health issues and affective psychosis in developing evidence-based guidance for physical health assessment and investigations at the first episode of psychosis.