International clinical practice guidelines for early psychosis

Abstract

These international clinical practice guidelines were developed with detailed input from 29 invited international consultants, who provided content as well as detailed feedback on draft versions. The final draft of the guidelines was ratified by the Executive of the International Early Psychosis Association and presented and formally endorsed at the Third International Conference on Early Psychosis held in Copenhagen, September 2002. They have been revised slightly to include medications that were not available in 2002, although a fully comprehensive process of update has not yet been conducted. The final version is published in this Supplement with the aim of encouraging further discussion as well as providing practical guidance to clinicians and researchers. A second edition is planned for publication in 2008.

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

“…Table 1 summarizes the advantages and disadvantages of the antipsychotic agents discussed in this review. The initial better tolerability of SGAs based on the diminished emergence of extrapyramidal symptoms and tardive dyskinesia has led to the recommendation of SGAs as the first choice for the treatment of a first episode of schizophrenia in almost all international guidelines for early psychosis [26, 27]. Presently it is widely accepted that there is not an obvious difference between FGAs and SGAs in terms of efficacy in decreasing the severity of positive symptoms in schizophrenia [26].…”

“…Additionally, people with a FEP are more likely to respond to lower doses of antipsychotic medications and treatment should be started at the lower half of the recommended dosage range for multiple episodes (300–500 mg chlorpromazine equivalents per day) [116]. There is a clear recommendation for using lower doses of antipsychotic medications in cases of FEP [27, 116, 117]. Previous studies assessing the efficacy of antipsychotics in FEP have evaluated the efficacy of lower doses.…”

“…Strategies for switching have been previously poorly studied in an attempt to make an accurate recommendation, but the future results of two ongoing trials, SWITCH and OPTiMiSE, should help decision making and provide a basis for clinical guidelines. In a previous finding, Agid et al [128] described only a 20% responsiveness among subjects who did not respond to the first-line antipsychotic drug, whereas the efficacy rate of clozapine in these nonresponsive subjects was 75%; therefore early after a lack of response, a second antipsychotic trial and then the use of clozapine may be indicated when other issues such as adherence or co-morbidity have been addressed [27, 125]. …”

“…Importantly, co-morbid symptoms such as depression, anxiety, suicide risk, and substance misuse must be correctly diagnosed and treated in order to avoid early refractoriness, lack of remission, and relapse [27, 125]. Subjects who not respond to the first antipsychotic trial after a few weeks have a low response rate thereafter.…”

Mismatch Negativity and P3a/Reorienting Complex in Subjects with Schizophrenia or At-Risk Mental State

“…Sixteen out of 19 ARMS subjects were not taking any medication, while three were prescribed a small dose of risperidone (1.5 mg/day), aripiprazole (3 mg/day), and sulpiride (150 mg/day), respectively, for acute psychosis episodes (sometimes with strong agitation), based on the criteria of International Early Psychosis Association Writing Group (2005). MMN recordings for these subjects were conducted immediately after medications were started (9, 15, and 27 days).…”