OBJECTIVES To assess aspects of medical examination, diagnosis and side-effect monitoring, and to consider the role of routine investigations in this group as recommended by national guidelines. METHOD A retrospective file audit was performed on young people presenting with first episode psychosis (n = 117) over 12 months of treatment contact. RESULTS Diagnoses were: first episode psychosis (43%), schizophrenia (16%), drug-induced psychosis (12%), affective psychosis (13%) and brief reactive psychosis (2%). Only four of the 52 (8%) subjects undergoing neuroimaging had any abnormality, with only two of these requiring referral. Three of the 33 (9%) electroencephalograms were obviously abnormal, but without epileptiform activity. There was little documentation of the assessment of involuntary movements (4% of sample) or weight (15% of sample). CONCLUSIONS The low rates of clinically important abnormal findings in computed tomography/magnetic resonance imaging and electroencephalogram re-open debate about the need for routine neuroimaging and electrophysiology in this population.