Many patients with first-episode psychosis are given medications that do not comply with the recommended guidelines for first-episode treatment, according to a new analysis published in the American Journal of Psychiatry.
First-episode patients have different treatment needs than those with multi-episode psychosis. Current guidelines strongly recommend low doses of antipsychotic drugs and other strategies that would help minimize any side effects that could contribute to patients stopping their medication.
The analysis, funded by the National Institute of Mental Health, suggests that more effort is needed to promote awareness of first episode-specific medication practices at community facilities. Nearly 40 percent of people with first-episode psychosis might benefit from treatment changes.
The study was led by Dr. John Kane of Hofstra North Shore-Long Island Jewish School of Medicine, who also serves as chairman of psychiatry at the Zucker Hillside Hospital, Glen Oaks, New York.
The research involved 404 individuals between the ages of 15 and 40 with first-episode psychosis who were being treated at 34 community-based clinics across 21 states. The study participants had been treated with antipsychotic drugs for six months or less.
The researchers found that nearly 40 percent of the participants (159 people) would most likely benefit from a change in their medication.
Of these 159 people, the researchers found a number of problematic issues:
- 8.8 percent had been prescribed higher-than-recommended doses of antipsychotics;
- 23.3 percent were prescribed more than one antipsychotic;
- 36.5 percent were prescribed an antipsychotic and an antidepressant without a clear need for the antidepressant;
- 10.1 percent were prescribed psychotropic medications without an antipsychotic medication, and;
- 1.2 percent were prescribed stimulants.
In addition, 32.1 percent were prescribed olanzapine (brand name Zyprexa), a medication not recommended for first-episode patients. Some people fell into multiple categories.
To improve prescription practices, the authors recommend additional education for clinicians prescribing medication for patients with first-episode psychosis.
The study is among the first of several to report results from the Recovery After an Initial Schizophrenia Episode (RAISE) project, which was developed by NIMH to examine first-episode psychosis before and after specialized treatment was offered in community settings in the United States.
RAISE seeks to change the path and prognosis of schizophrenia through coordinated and intensive treatment in the earliest stages of illness.
“Our data were for prescriptions individuals received before they started the RAISE-Early Treatment Program study. Community mental health clinicians usually have extensive experience treating individuals with multi-episode psychosis,” said researcher Delbert Robinson, M.D.
“The challenge for the field is to develop ways to transmit the specialized knowledge about first-episode treatment to busy community clinicians.”