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Treatments for first-episode psychosis

What is first-episode psychosis?
People with a first episode of psychosis experience distressing symptoms such as unusual beliefs or abnormal behaviour (positive symptoms) and/or withdrawal or loss of interest in work or school (negative symptoms). Early intervention programs for schizophrenia and psychosis often combine many elements comprising both pharmaceutical and psychosocial therapies, and may involve enriched therapies that are tailored to an individual’s needs. The conclusions presented here are based on group data, and as such individual treatment programs need to be tailored by trained clinicians. Individual response to treatment can vary in terms of both symptoms and adverse effects.

What is the evidence for treatments for first-episode psychosis?

High quality evidence suggests multi-element first-episode psychosis programs involving both antipsychotic medication and psychosocial treatments may provide a small reduction in the risk of relapse and symptoms after a first episode of psychosis compared to treatment as usual. Moderate quality evidence suggests these programs may also improve social function, quality of life, treatment adherence, and treatment satisfaction. The addition of Cognitive Behavioural Therapy or Relapse Prevention Therapy to these programs does not further reduce the rate of relapse or suicide, but may further improve negative symptoms, social function, and quality of life.

High quality evidence shows second generation antipsychotics may be associated with fewer side effects than first generation antipsychotics in first-episode patients, with no differences in symptoms. Moderate quality evidence suggests olanzapine may result in better clinical improvement and treatment adherence than haloperidol, and olanzapine and risperidone may result in fewer side effects. Chlorpromazine, haloperidol, risperidone, and olanzapine may be more effective than placebo from the first week of treatment, and are most effective in the first two weeks of treatment.

Moderate quality evidence suggests no differences in long-term outcomes when medication is delayed for a short period of time and psychosocial treatments are provided in a research setting when compared to immediate commencement of medication without psychosocial treatment. Moderate to low quality evidence suggests no significant benefit of group therapy over individual therapy for negative symptoms, functioning and quality of life, but some benefit for improving psychotic symptoms, treatment adherence and treatment satisfaction.

Also see the Course and Outcomes topic for first-episode and high risk groups, and the pharmaceutical treatment topic for first-episode psychosis.

April 2016

Page last updated: 2:09  7 September 2017

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