From Clinical guidelines — Diagnosis and treatment manual › Chapter 11: Mental disorders in adults · Médecins Sans Frontières, Current online edition (last updated July 2022)
MSF clinical guidance on managing acute psychotic episodes, chronic psychoses and bipolar disorder in resource-limited settings.
- Issuer
- Médecins Sans Frontières
- Edition
- Current online edition (last updated July 2022)
- Audience
- Clinicians in humanitarian and resource-limited settings
- Evidence
- Expert consensus
- Reviewed
- 22 Oct 2026 · GMJ
What this guideline says
GMJ summary
This MSF clinical guideline section provides practical guidance on recognising and managing psychotic disorders in humanitarian and resource-limited settings. Psychoses are characterised by delusions (the patient is convinced of things that are not real and not accounted for by the person’s cultural background), hallucinations (the patient hears voices that do not exist), and behavioural symptoms such as strange behaviour, agitation, mutism, opposition or fleeing.
Management includes psychosocial support and antipsychotic medication. The guideline emphasises that treatment efficacy and prognosis depend largely on the quality of the therapeutic relationship established with the patient and their family. Keeping the patient at home with outpatient follow-up is preferred if there is no risk of self-harm or harm to others, and if the family is capable of managing the disorder.
The document stresses the critical importance of cultural context in interpreting psychotic symptoms. Psychotic disorders may be attributed to charms or ancestor intervention in some cultures, and therapeutic approaches should take those beliefs into account. Patients are usually already under ‘traditional’ treatments, which should not be seen as an obstacle to conventional medical treatment.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Psychoses are characterised by delusions not accounted for by cultural background, hallucinations (hearing voices that do not exist), and behavioural symptoms (strange behaviour, agitation, mutism, opposition, fleeing)
- Management includes psychosocial support and antipsychotic medication
- Treatment efficacy and prognosis depend largely on the quality of therapeutic relationship with patient and family
- Keep patient at home with outpatient follow-up if no risk of self-harm or harm to others and family can manage the disorder
- Interpretation of psychotic symptoms varies by cultural context; work with cultural informants in unfamiliar contexts
- Therapeutic approach should take cultural beliefs (charms, ancestor intervention) into account
- Traditional treatments should not be seen as obstacle to conventional medical treatment
From the guideline
Verbatim
“Treatment efficacy and prognosis depend largely on the quality of the therapeutic relationship established with the patient and their family.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As Editor-in-Chief of the Georgian Medical Journal and Chair of the Public Health Institute, I find this MSF guidance particularly relevant for Georgia's ongoing mental health reform, which has emphasised integration of mental health services into primary care since 2013. The guideline's emphasis on cultural competence resonates strongly in our multi-ethnic South Caucasus context, where traditional healers and religious explanations for mental illness remain prevalent alongside biomedical approaches. I would stress to Georgian clinicians the recommendation that traditional treatments should not be seen as obstacles—this pragmatic stance can build trust and therapeutic alliances. However, implementation will require training primary care physicians in basic psychopharmacology and ensuring reliable antipsychotic medication supply in rural areas, which remains challenging in our resource-constrained settings.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 22 Oct 2026
Applicability
Georgia and the South Caucasus
For Georgia and the South Caucasus, this guidance addresses a significant mental health burden in a region where cultural interpretations of psychotic symptoms may vary significantly across ethnic groups (Georgian, Armenian, Azerbaijani, Ossetian and others). National mental health programmes would need to consider how traditional healing practices and religious/spiritual explanations for psychosis are integrated with biomedical treatment, and ensure that primary care clinicians can establish therapeutic relationships across diverse cultural contexts. The emphasis on home-based care with family support aligns well with traditional family structures in the region, though availability of antipsychotic medications and trained mental health professionals at primary care level would need assessment.
Questions this guideline answers
Quick answers
When should a patient with psychosis be kept at home rather than hospitalised?
Home-based care with outpatient follow-up is preferred if there is no risk of self-harm or harm to others, and if the family is capable of managing the disorder.
How should cultural beliefs about psychosis be addressed?
Therapeutic approach should take cultural beliefs into account. Psychotic disorders may be attributed to charms or ancestor intervention in some cultures. Working with a cultural informant is important in unfamiliar contexts.
Should traditional treatments be discouraged?
No. Patients are usually already under traditional treatments, and this should not be seen as an obstacle to conventional medical treatment. Both can coexist.
What determines treatment success in psychotic disorders?
Treatment efficacy and prognosis depend largely on the quality of the therapeutic relationship established with the patient and their family, not just medication.
Related on GMJ
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Same guideline
- Depression — MSF Clinical guidelinesChapter 11: Mental disorders in adults
- Post-traumatic stress disorder — MSF Clinical guidelinesChapter 11: Mental disorders in adults
- Acute confusional state (delirium) — MSF Clinical guidelinesChapter 11: Mental disorders in adults
- Agitation — MSF Clinical guidelinesChapter 11: Mental disorders in adults
- Insomnia — MSF Clinical guidelinesChapter 11: Mental disorders in adults
- Anxiety — MSF Clinical guidelinesChapter 11: Mental disorders in adults
- Issuer
- Médecins Sans Frontières
- Guideline
- Clinical guidelines — Diagnosis and treatment manual
- Chapter
- Chapter 11: Mental disorders in adults
- Type
- Clinical guideline (chapter)
- Edition
- Current online edition (last updated July 2022)
- Status
- Current
- Published
- 2026-10-14
- Scope
- Acute psychotic episode, chronic psychoses, bipolar disorder
- Audience
- Clinicians in humanitarian and resource-limited settings
- Evidence
- Expert consensus
- Record history
- Created 22 Oct 2026 · updated 22 Oct 2026 · next check Apr 2027
Médecins Sans Frontières. Psychotic disorders. In: Clinical guidelines — Diagnosis and treatment manual. Paris: MSF; 2022 [cited 2026 Oct 14]. Available from: https://medicalguidelines.msf.org/GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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