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NIH Study: Medications for Patients With First-Episode Psychosis May Not Meet Guidelines

Researchers call for more prescriber education

Many patients with first-episode psychosis receive medications that do not comply with recommended guidelines for first-episode treatment, researchers have found. Current guidelines emphasize low doses of antipsychotic drugs and strategies for minimizing the adverse effects that might contribute to patients stopping their medication.

A study funded by the National Institute of Mental Health (NIMH), part of the National Institutes of Health, concluded that almost 40% of people with first-episode psychosis in community mental-health clinics across the U.S. might benefit from medication treatment changes. The findings were published December 4 in the American Journal of Psychiatry.

Psychosis is a mental disorder in which thoughts and emotions are impaired and contact with reality is diminished. People experiencing a first episode of psychosis have different treatment requirements than people with multi-episode psychosis. A recent analysis of prescribing patterns for first-episode psychosis suggests that more effort is needed to promote awareness of first episode-specific medication practices at community facilities.

Investigators studied 404 individuals aged 15 to 40 years with first-episode psychosis who presented for treatment at 34 community-based clinics in 21 states. The study participants had been treated with antipsychotic drugs for 6 months or less.

The authors identified 159 patients (39.4% of those enrolled in the study) who might benefit from changes in their medications. Of these patients, 36.5% were prescribed an antipsychotic and an antidepressant without a clear need for the antidepressant; 23.3% were prescribed more than one antipsychotic; 10.1% were prescribed psychotropic medications without an antipsychotic medication; 8.8% were prescribed higher-than-recommended doses of antipsychotics; and 1.2% were prescribed stimulants. In addition, 32.1% were prescribed olanzapine, a medication not recommended for first-episode patients. Some of the 159 patients fell into multiple categories.

Better medication treatment early in the illness, particularly strategies that minimize uncomfortable side effects, may lead to better results for patients. To improve prescription practices, the authors recommend additional education for those prescribing medications for patients with first-episode psychosis.

The study was among the first of several to report results from the Recovery After an Initial Schizophrenia Episode (RAISE) project, which was developed by the NIMH to examine first-episode psychosis before and after specialized treatment was offered in community settings in the U.S. The RAISE project seeks to change the path and prognosis of schizophrenia through coordinated and intensive treatment in the earliest stages of illness, according to the authors. The findings from these studies identify opportunities for improving the lives of people experiencing first-episode psychosis by highlighting ways that existing treatments can be enhanced. For example, the studies make recommendations for improving the coordination of mental-health care and primary care, and for ensuring that medications follow established guidelines.

“Our data were for prescriptions individuals received before they started the RAISE–Early Treatment Program study,” said lead author Delbert Robinson, MD, of the Feinstein Institute for Medical Research in Manhasset, New York. “Community mental-health clinicians usually have extensive experience treating individuals with multi-episode psychosis. The challenge for the field is to develop ways to transmit the specialized knowledge about first-episode treatment to busy community clinicians.”

Source: NIH; December 4, 2014.

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