Current Data on and Clinical Insights into the Treatment of First Episode Nonaffective Psychosis: A Comprehensive Review

Abstract

Implementing the most suitable treatment strategies and making appropriate clinical decisions about individuals with a first episode of psychosis (FEP) is a complex and crucial task, with relevant impact in illness outcome. Treatment approaches in the early stages should go beyond choosing the right antipsychotic drug and should also address tractable factors influencing the risk of relapse. Effectiveness and likely metabolic and endocrine disturbances differ among second-generation antipsychotics (SGAs) and should guide the choice of the first-line treatment. Clinicians should be aware of the high risk of cardiovascular morbidity and mortality in schizophrenia patients, and therefore monitoring weight and metabolic changes across time is mandatory. Behavioral and counseling interventions might be partly effective in reducing weight gain and metabolic disturbances. Ziprasidone and aripiprazole have been described to be least commonly associated with weight gain or metabolic changes. In addition, some of the SGAs (risperidone, amisulpride, and paliperidone) have been associated with a significant increase of plasma prolactin levels. Overall, in cases of FEP, there should be a clear recommendation of using lower doses of the antipsychotic medication. If no or minimal clinical improvement is found after 2 weeks of treatment, such patients may benefit from a change or augmentation of treatment. Clinicians should provide accurate information to patients and relatives about the high risk of relapse if antipsychotics are discontinued, even if patients have been symptom free and functionally recovered on antipsychotic treatment for a lengthy period of time.

Feasibility, acceptability, and preliminary effectiveness of mindfulness‐based interventions for people with recent‐onset psychosis: A systematic review

“…Early detection and interventions have been strongly proposed because the first 5 years after onset is considered the critical period when the biological and psychological changes are most extensive, and the brain shows the maximum plasticity (McGorry, Killackey, & Yung, 2008). Recent‐onset psychosis is defined as the first 5 years after diagnosis (Crespo‐Facorro, Pelayo‐Teran, & Mayoral‐van Son, 2016) which is the period of high risk for relapse and suicide, and the critical time to build stable social identity and relationships (McGorry et al, 2008). There is evidence that early intervention during this period is most effective, resulting in fewer symptoms, better outcomes and good recovery (Bird et al, 2010; Iyer et al, 2015; Skalli & Nicole, 2011; Srihari, Shah, & Keshavan, 2012).…”

Personalized medicine begins with the phenotype: identifying antipsychotic response phenotypes in a first‐episode psychosis cohort

“…We also demonstrated that baseline clinical characteristics could be useful in the field of personalized medicine to predict the response phenotype from these four and to apply individualized treatment. Our results are especially relevant if we take into account that they were obtained with FEP patients and FEP recovery has come into focus as the main goal of any treatment strategy .…”

Medication adherence in first-episode psychosis and its association with psychopathology

“…The first line of management is low-dose antipsychotics; treatment with atypical antipsychotics in low doses have exhibited high remission rates. [23] Here, it must be stressed that medication adherence is one of the most important factors independently affecting the remission in FEP. [4] Medication adherence improves the outcome through reducing the risk of relapse and fewer hospitalizations.…”