“I stopped my antipsychotic months ago — I want to go back on it, can you just prescribe it?”

A patient who recognises early relapse of psychosis and proactively asks to restart their antipsychotic is showing valuable insight that should be strongly supported — the task is to act on his relapse signs both quickly AND safely, holding a supportive response together with the proper process, never meeting it with a bureaucratic refusal. Assess his current mental state and relapse (returning symptoms, insight, function) and crucially the risk to himself (self-harm, self-neglect) and others, plus any command symptoms; if he is acutely unwell or at significant risk this is urgent, warranting contact with the crisis team/CMHT or urgent psychiatric assessment rather than a prescription. Understand who prescribes: NICE CG178 directs a person with established psychosis showing signs of relapse back to secondary care (crisis team or CMHT), and NHS England guidance (2018) makes the clinician who starts or changes a medicine responsible for it — formal shared-care agreements cover only some antipsychotics, such as clozapine — so restarting after a months-long gap with relapse generally needs psychiatric involvement — re-referral to the CMHT or liaison with his mental-health team — rather than a unilateral GP reissue of a higher-risk drug, framed as getting him the right, safe treatment fast rather than a brush-off. Arrange the NICE CG178 baseline monitoring face to face — weight/BMI and waist, blood pressure and pulse, fasting glucose, HbA1c, lipids, prolactin, an assessment of movement disorders, and diet and physical activity, with an ECG only if the product information requires it, there is cardiovascular risk on examination or a personal cardiovascular history, or he is being admitted — and remember clozapine is specialist-only with additional strict neutrophil monitoring. Explore why he stopped (side-effects such as weight gain, sedation, sexual/metabolic effects or akathisia, and his adherence pattern), discuss managing side-effects and the relapse risk of stopping, and consider options like a long-acting depot or a different agent toward sustainable treatment. The hidden agenda is genuine fear of becoming unwell again, alongside fear of hospital, lost control, judgement and the side-effects that drove him off; honour his insight, act swiftly, explain that involving his mental-health team is to help, and neither bluntly refuse (risking disengagement and relapse) nor unsafely reissue, but escalate appropriately and supportively.