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First-Episode Psychosis: A Window of Opportunity for Best Practices

Published online by Cambridge University Press:  07 November 2014

Peter F. Buckley ,
Christoph U. Correll  and
Alexander L. Miller
Peter F. Buckley
Affiliation:
Dr. Buckley is professor and chairman in the Department of Psychiatry and Health Behavior at, the Medical College of Georgia, in Augusta. Dr. Buckley is a consultant to Abbott, Alamo, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Janssen, Merck, Pfizer, Roche Diagnostics, Solvay, and Wyeth; is on the speaker's bureaus of Abbott, Alamo, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Janssen, and Pfizer; and has received grant/research support from AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Janssen, Pfizer, Solvay, and Wyeth.
Christoph U. Correll
Affiliation:
Dr. Correll is medical director of the Recognition and Prevention Program at, the Zucker Hillside Hospital in Queens, New York. He is also assistant professor of psychiatry and behavioral sciences at Albert Einstein College of Medicine in Bronx, New York. Dr. Correll is a consultant to AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Intra-Cellular Therapeuties, Otsuka America, Pfizer, Solvay, Supernus, and Wyeth; is on the advisory boards of Bristol-Myers Squibb, Eli Lilly, Otsuka America, and Vanda; and is on the speaker's bureaus of AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Janssen, and Otsuka America.
Alexander L. Miller
Affiliation:
Dr. Miller is Hugo Auler Professor of Psychiatry and chief of the Division of Schizophrenia and Related Disorders at, the University of Texas Health Science Center at San Antonio. Dr. Miller is a consultant to Centene; is on advisory boards of AstraZeneca, Bristol-Myers Squibb, and Solvay; is on the speaker's bureaus of AstraZeneca, Bristol-Myers Squibb, and Janssen; and has received grant/research support from Alexza, AstraZeneca, Bristol-Myers Squibb, Forest, Eli Lilly, GlaxoSmithKline, Janssen, Pfizer, and Organon.
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Abstract

Patients experiencing a first psychotic episode or early stages of psychosis present with key diagnostic issues for clinicians. At the time of first-episode psychosis presentation, it is crucial that clinicians select the most effective treatment option as immediate intervention offers the best chance for containing the illness. Functional impairment occurs most rapidly at the early stage of illness, and such impairment can influence the patient's future prognosis, alter the level of necessary treatment, and affect morbidity. Although research has shown a decrease in brain gray matter as well as signs of functional impairment in those who develop psychosis, many of these patients remain untreated for extended periods of time and do not visit a clinician due to fear of stigma, a failure to recognize the problem, or complexities of their care system. Prior studies have shown that untreated psychosis results in worse outcome for patients compared to psychosis that is treated earlier in the course of illness. There is a range of treatment options for psychosis, including use of first-generation or second-generation antipsychotic medication. Clinicians should note that both medication types are associated with certain side effects, such as tardive dyskinesia and weight gain, respectively. For all antipsychotics, doses should be lower for patients with a first psychotic episode than for patients with chronic psychosis. Finally, clinicians must consider that patients may present with various comorbidities, such as substance abuse, that also may affect treatment.

This expert roundtable supplement will address the diagnosis and treatment selection for first-episode psychosis as well as comorbidities related to the condition. The use of first- or second-generation antipsychotics for psychosis treatment, dosing guidelines, and the antipsychotic side-effect profile will also be addressed.

Type
Research Article
Information
CNS Spectrums , Volume 12 , Issue S15 , 2007 , pp. 1 - 16
Copyright
Copyright © Cambridge University Press 2007

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