CT brain studies are performed in Nepean Blue Mountains Local Health District as part of the work up for patients that present with first-episode of psychosis without any focal neurology. This study is performed to look for an organic cause of their presentation such as a space occupying lesion. Using imaging studies of the brain in the work up for first-episode of psychosis is a controversial topic with Royal Australia and New Zealand College of Psychiatry guidelines stating that performing MRI brain studies on these...

Local approval gained from ethics committee. CT brain studies were identified from January 1, 2020 to April 6, 2023 using a keyword search of the provided clinical information using the inbuilt search functionality of the PACS system used at Nepean Blue Mountains Local Health District. The keyword used was ‘psychosis’. This identified 185 matching examinations. These examinations were then assessed and those that were not for the work up of first-time psychosis were removed. Those that were performed as part of trauma studies were also...

Of the 143 patients that were analysed 73 were men (51%) and 70 were women (49%). The age range of patients was 16 years to 91 years. All of the studies performed were non contrast studies. 139 CT brain studies were reported as normal studies (97%). A total of four patients had pathology reported on their examinations (2.8%) with no acute pathology identified. Three had prior chronic infarcts (2.1%) and one patient had prior neurocysticercosis infection (0.7%). As the 4 studies with pathology demonstrated on...

Four patients (3.5%) had chronic pathology on their CT brain studies. These pathologies can have a link to psychosis in a small subset of patients, but all these pathologies were known from prior imaging studies with no new pathology identified as part of the CT brain performed for the work up of first-episode psychosis. CT brain study is not included in the latest Royal Australia and New Zealand College of Psychiatry guidelines for the work up of first-episode psychosis published in 2016 with MRI brain...

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