NICE Guidance Initiation [63]

The first illness (leading up to the first breakdown)

Most people go to see their GP when they are first ill, either because their family want them to or because they are feeling that things aren’t right. If your GP thinks that you are having a breakdown, you can expect to be referred to a psychiatrist quickly. Alternatively, your GP may ask a special team of doctors, nurses and therapists called an ‘early intervention service’ to see you.

If your GP thinks that you are very ill or there are problems with getting help very quickly, he or she may offer you some medicine to help calm you. The type of medicine you should be offered is called an antipsychotic. In your first breakdown you should be offered one of the newest types of these medicines, which are called ‘atypical’ antipsychotics (their individual names are amisulpride, olanzapine, quetiapine, risperidone and zotepine); these tend to have different side effects from the older ‘conventional’ antipsychotics.

Doctors usually prescribe low doses during a first illness, as you may be quite sensitive to them when you first take them. It might be that you always stay on low doses of medication but it could be that later in the illness you need higher doses. In any case, you should be told about the effects and side effects of these medicines and given written information about them. In other ways, your treatment during the first breakdown will be similar to that for the second or subsequent illnesses (see ‘If you have a breakdown’, below). After you have recovered from your first breakdown and the mental health team has discussed the diagnosis with you, and your carer if you wish, you may want to have a second opinion (when you are seen by another consultant psychiatrist). You should have help in getting to talk to another psychiatrist about the diagnosis. You may want to ask the psychiatrists looking after you to make the referral, or perhaps your GP.