New research from Australia suggests that some young people with early stage first-episode psychosis (FEP) can reduce symptoms and improve functioning with non-pharmaceutical intervention.
Investigators from Orygen, a youth mental health center in Parkville near Melbourne, found that often young people respond well to psychological interventions and comprehensive case management.
Psychosis is a symptom, not an illness, and it is more common than many believe. In the U.S., approximately 100,000 young people experience psychosis each year. As many as 3 in 100 people will have an episode at some point in their lives.
Early or first-episode psychosis (FEP) refers to when a person first shows signs of beginning to lose contact with reality. Acting quickly to connect a person with the right treatment during early psychosis or FEP can be life-changing and radically alter that person’s future.
The research compared two groups of young people, aged 15 to 25 years, presenting with FEP to a specialist early psychosis service. Both groups received intensive psychosocial intervention, with one group also receiving low dose antipsychotic medication and the other receiving a placebo.
Investigators found that the addition of antipsychotic medication to intensive psychosocial intervention did not lead to superior outcomes in symptoms and functioning within the first six months. This suggests antipsychotic medication may not be needed early in the course of illness for all people within the spectrum of psychosis.
Orygen researcher Dr. Shona Francey, who led the study, said the team wanted to investigate whether medication was an essential part of treatment for young people with early stage FEP.
“For a significant number of young people, it is. But, I think some young people can recover, at least initially, from their psychosis without medication,” she said.
Current practice recommends anti-psychotic medication be taken from the outset of psychotic illness in order to achieve rapid recovery and improvement of psychotic symptoms.
However, Francey said that in reality, a lot of people vote with their feet and don’t take their medication for a variety of reasons.
“Medications can have heavy-duty side effects for young people, including weight gain which is a significant issue that young people are concerned about. There are also various sexual and other physical side effects that young people on medication have to contend with.”
Francey said that not all young people could delay their antipsychotic medication. “For many young people with early stage FEP, medication is an essential part of their treatment plan.
But, for those young people who do not want medication, psychological interventions and comprehensive case management could be a feasible model of treatment.
“What the findings of this research tell us is that if a young person is reluctant to take medication for FEP, a period of intensive psychosocial treatments could be offered as an alternative,” Francey said.
She said a larger trial would be required to investigate whether antipsychotic-free treatment could be recommended for particular groups of young people with FEP.
“Young people currently using medication as part of their supervised treatment should continue to do so under the direction of their doctor,” Francey said.
The findings appear in Schizophrenia Bulletin Open.