Study Finds Targeted Medical Testing May Be More Useful for Young People With First Psychotic Symptoms

Psychosis can involve changes in how a person experiences reality, such as hallucinations, delusions, or severely disorganized thinking. When these symptoms first appear in a child or teenager, clinicians may look for medical conditions or exposures that could be contributing. But there is not one agreed approach to how extensive that testing should be.

Researchers at Soroka University Medical Center in Israel reviewed electronic medical records for young people ages 5 to 18 who came to the pediatric emergency department or were admitted with a first-time diagnosis of psychosis. The review covered cases from 2008 through 2023 and included 235 patients.

This was a retrospective cohort study, meaning the team looked back at care that had already taken place rather than assigning patients to different testing plans. They reviewed clinical information, lab tests, urine toxicology, neuroimaging, and electroencephalography, or EEG. An EEG measures electrical activity in the brain.

The group had a high prevalence of pre-existing neurodevelopmental and medical conditions. The abstract does not give a detailed breakdown of those conditions, so it is not possible from the supplied information to say how they affected the testing results.

Urine toxicology testing found substance-related results in 19 patients, representing 8.1% of the cohort. The findings were predominantly related to cannabinoids. The researchers also identified two cases of psychosis linked to corticosteroids, a type of medicine used for a range of health conditions.

Beyond those findings, routine laboratory investigations did not identify an underlying medical cause of psychosis. This does not mean laboratory testing can never be useful. It means that, in this particular group of patients and based on the tests recorded, routine lab work did not otherwise uncover a medical explanation.

Neuroimaging was performed in 77% of patients. It found clinically explanatory findings in three patients, or 1.3% of the full cohort. Each of those three patients had neurological abnormalities or atypical clinical features. The study does not provide further details about the imaging findings in the supplied abstract.

EEG was performed in 48% of the cohort. It did not identify the cause of psychosis in any case. The authors concluded that imaging and EEG rarely found an underlying medical cause when neurological abnormalities or atypical features were absent.

The findings point toward a clinically guided evaluation: paying close attention to a young person’s symptoms and examination, while including toxicology screening, rather than routinely ordering extensive testing for every patient. That is a conclusion about diagnostic yield, or how often a test provided an explanation, not proof that one testing strategy leads to better health outcomes than another.

There are important limits. This was not a randomized or prospective comparison of broad testing with selective testing. It took place at a single tertiary medical center, which may see patients with different needs than community hospitals or clinics. The results may not apply to adults, other health systems, or every setting where young people receive urgent mental health care.

The supplied abstract also does not report follow-up after the initial evaluation. Further research would need to compare testing approaches prospectively and examine whether they affect missed diagnoses, care experiences, safety, or longer-term outcomes.