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Acute Psychosis & Mania

Also known as: acute psychotic episode · manic episode · acute agitation

An acute disturbance with loss of contact with reality (delusions, hallucinations, disorganisation) and/or an elevated or irritable mood with overactivity. First priorities: keep everyone safe and exclude an organic (medical or drug) cause.

Source · Reviewed 2026-08-15 · v1.0— AI-assisted draft — verify against the cited guideline before clinical use.

⚕️ Education only — not medical advice. Verify against the latest official guideline and your local protocol; confirm every drug dose against the cited source before clinical use.

Who gets it

Schizophrenia and bipolar disorder/mania, but also delirium, substance intoxication or withdrawal, and medical/neurological illness — especially with a first episode or in older patients.

Red flags — escalate / refer

Risk to self or others, delirium features (fluctuating consciousness, disorientation), fever/neurological signs, or catatonia → treat as a medical emergency and exclude an organic cause.

Work-up / diagnosis

1Risk assessment and a mental-state examination.
2EXCLUDE organic causes — glucose, an infection/sepsis screen, electrolytes, a drug and alcohol history/screen, and imaging where indicated; a first episode always needs a medical work-up.

Management — overview

Provide a safe, calm environment and de-escalate verbally first.
Treat any underlying medical cause.
Give an antipsychotic for psychosis or mania (add a mood stabiliser such as lithium or valproate for bipolar mania); a short-term benzodiazepine helps severe agitation.
Involve mental-health services; use capacity/mental-health law for admission when needed.

In-depthFull dosing & advanced protocol

Drug dosing

Antipsychotic (± mood stabiliser)

Psychosis / mania

Adult dose: Per protocol; add lithium or valproate for bipolar mania
Route: Oral / IM

Caution: Avoid valproate in women of childbearing potential unless the criteria are met; monitor for extrapyramidal and metabolic effects.

WHOWHO mhGAP Intervention Guide (mental health in non-specialist settings) ↗

Benzodiazepine (short-term)

Severe agitation

Adult dose: Short-term, per protocol
Route: Oral / IM / IV

WHOWHO Model List of Essential Medicines (electronic EML) (2025 (24th)) ↗

Exclude organic causes; de-escalate before you medicate

Always rule out delirium, substance and medical causes first — especially in a first episode or at older age.
Verbal de-escalation and a safe environment come before rapid tranquillisation.
Watch for antipsychotic side-effects (extrapyramidal, metabolic, and rarely neuroleptic malignant syndrome).

WHOWHO mhGAP Intervention Guide (mental health in non-specialist settings) ↗

References

Guidelines change. If something here is out of date, tell us — we keep these current.

🚩 Report outdated / suggest update

More protocols

DepressionA common mental disorder — persistent low mood and/or loss of interest for ≥2 weeks with cognitive and physical symptoms and functional impairment. It is very treatable.Alcohol WithdrawalA spectrum from tremor/anxiety to seizures and delirium tremens after stopping or cutting down alcohol in dependence. Benzodiazepines and thiamine are the mainstays; delirium tremens can be fatal.Generalised Anxiety Disorder (GAD)Excessive, hard-to-control worry on most days for at least six months, with physical symptoms — restlessness, fatigue, poor concentration, irritability, muscle tension and disturbed sleep — causing distress or impairment.

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👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Antipsychotic (± mood stabiliser)

Benzodiazepine (short-term)

📈 Exclude organic causes; de-escalate before you medicate

📚 References

More protocols

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Antipsychotic (± mood stabiliser)

Benzodiazepine (short-term)

📈 Exclude organic causes; de-escalate before you medicate

📚 References

More protocols

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Exclude organic causes; de-escalate before you medicate

References

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Exclude organic causes; de-escalate before you medicate

References