Logo image
Back
The Million Dollar Workup: Evidence for Nonpsychiatric Medical Evaluation in Early Psychosis Care
Abstract   Peer reviewed

The Million Dollar Workup: Evidence for Nonpsychiatric Medical Evaluation in Early Psychosis Care

Megan Good, Jacqueline Alexandra Clauss and Jessica E Becker
Journal of the American Academy of Child and Adolescent Psychiatry, Vol.65(10 Suppl), p.S429
10/10/2026
DOI: 10.1016/j.jaac.2026.07.1134

View Online

Abstract

Objectives As many as 12.5% of children and adolescents who present with first episode psychosis (FEP) have a nonpsychiatric medical comorbidity that contributes to their psychiatric presentation. The treatment of nonpsychiatric causes of psychotic symptoms involves treating the underlying diagnosis, which usually differs from psychiatric standard of care for FEP. However, many child and adolescent psychiatrists may be unfamiliar with or hesitant to undertake a medical evaluation in patients with FEP. Currently there is no standardized protocol for nonpsychiatric contributors to FEP. In this Symposium, we will review the evidence for the development of a standardized, FEP medical workup. Methods We will include 4 presentations that will guide the development of an evidence-based FEP nonpsychiatric medical workup by: 1) presenting a comprehensive literature review of medical contributors, comorbidities, and nonpsychiatric causes of psychotic symptoms; 2) comparing and contrasting current medical workup protocols and practices across multiple academic medical centers in the United States; 3) discussing the results of a systematic review of FEP workup practices ranked by quality of evidence; and 4) examining cost-effective, financially responsible resource utilization of FEP nonpsychiatric medical diagnostic procedures. Results Nonpsychiatric causes of FEP are common in both children and adolescents. Analysis reveals that there is substantial heterogeneity in FEP medical workup clinical practices between both individual practitioners and institutions. Practice spans from no workup to intensive, multidisciplinary interventions. The systematic review identifies high-yield laboratory and neuroimaging studies that support a targeted selection approach. These findings aim to reduce the “million-dollar workup” burden without compromising the efficacy of the nonpsychiatric diagnostic evaluation. Conclusions A standardized, evidence-based, cost-effective FEP medical evaluation protocol is needed to better identify secondary psychosis and to manage the associated physical health needs of child and adolescent patients with FEP. By prioritizing the highest quality evidence, clinicians can ensure responsible stewardship of healthcare resources while improving diagnostic accuracy.
 Adolescents Psychosis Childhood Needs Cost Effectiveness Evidence Based Practice Literature Reviews Medical Evaluation Physical Health Psychological Evaluation Systematic review Teenagers

Details

Metrics

1 Record Views
Logo image