Use of medication algorithms in first episode psychosis: a naturalistic observational study

Yeisen, Rafal A.H.; Joa, Inge; Johannessen, Jan Olav; Opjordsmoen, Stein

doi:10.1111/eip.12203

Cited by 7 publications

(5 citation statements)

References 25 publications

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“…The applicability of clinical practice guidelines in psychiatry has been studied during recent years, including trying to identify barriers to guideline adherence. 31 – 34 Some proposed barriers are physician related, such as lack of awareness or familiarity, lack of agreement and concerns about control over professional practice. There are also patient-related barriers such as nonadherence and reluctance, clarity and complexity of guidelines, and environmentally related barriers such as resources and facilities.…”

Section: Discussionmentioning

confidence: 99%

One-Year Outcome and Adherence to Pharmacological Guidelines in First-Episode Schizophrenia

Drosos

Brønnick

Joa

et al. 2020

J Clin Psychopharmacol

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Background Remission in schizophrenia is difficult to achieve. Antipsychotic drugs are critical in the treatment of schizophrenia. International guidelines for the pharmacological treatment of schizophrenia recommend a 3-step algorithm with clozapine being the third-line antipsychotic agent. This study investigated the 1-year outcome and the application of the guidelines for the pharmacological treatment of nonremitted first-episode schizophrenia (FES) patients during the first year of follow-up. Methods A sample of 78 FES patients from the Norwegian TIPS (Early Treatment and Intervention in Psychosis) 2 study was assessed at the end of the first year of follow-up. The symptom remission criteria were those defined by the Remission in Schizophrenia Working Group. The adherence to the pharmacological guidelines was assessed by reading the medical files and by a digital search of the words “clozapine,” “klozapin,” and “Leponex” in the hospital electronic data system. Results The majority (n = 53, 67.9%) of the patients included were nonremitted at the 1-year follow-up. The majority of the nonremitted patients received either none (7.5%), one (56.6%), or 2 types (15.1%) of antipsychotic drugs during the first year of follow-up. Only 2 (3.8%) received treatment with clozapine, and 3 (5.7%) in total were offered it. Conclusions For our FES sample, there was a low 1-year remission rate and a poor adherence to the pharmacological guidelines. Higher adherence to treatment guidelines with a more intensified antipsychotic treatment, which in some cases will include clozapine, will enhance the quality of treatment and may enhance the rates of remission for schizophrenia.

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Section: Discussionmentioning

confidence: 99%

One-Year Outcome and Adherence to Pharmacological Guidelines in First-Episode Schizophrenia

Drosos

Brønnick

Joa

et al. 2020

J Clin Psychopharmacol

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“…In this context, we should note that adherence to prescribed medication is a major challenge for first episode patients (47, 48). In addition, previous studies have found that physicians’ adherence to guidelines is adequate in the initial phase of treatment but reduces over time (49). The recommendation of low dosages for first-treatment phases also pertains to the acute phases of illness, and previous studies indicate that lower acute phase dosages is an achievable goal (50).…”

Section: Discussionmentioning

confidence: 99%

Predictors for Antipsychotic Dosage Change in the First Year of Treatment in Schizophrenia Spectrum and Bipolar Disorders

et al. 2019

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Background: Use of antipsychotic medication is central in the treatment of psychotic disorders. However, there is limited knowledge about prescription practice of antipsychotics in the critical early phase of these disorders. Clinical guidelines recommend low dosages, but no discontinuation of antipsychotic medication during the first year of treatment in first episode patients. The main aim of this study was to identify clinical predictors for dosage change or discontinuation of antipsychotics during this period. Methods: A total of 426 antipsychotic-using patients with schizophrenia spectrum or bipolar disorder, including both a first treatment sample and a sample of patients with previous treated episodes (“multi-episode” sample) from the same diagnostic groups, underwent thorough clinical and sociodemographic assessment at study baseline and after 1 year. Prescribed dosage levels at baseline and follow-up and change in dosage or discontinuation of antipsychotics from baseline to follow-up were compared between groups, controlling for possible confounders. Results: We found reduced dosages over the first year in both first treatment groups across diagnoses, but not in multi-episode groups. Weight increase predicted dosage reduction in the schizophrenia group, while the level of psychotic symptoms at baseline predicted dosage reduction in the bipolar group. We found higher baseline levels of antipsychotic use in the schizophrenia group than in the bipolar group. Conclusion: We found indications of a trans-diagnostic reduction of prescribed dosages of antipsychotics over the first year in treatment, but with different predictors for this reduction in the two diagnostic groups. The findings increase the understanding of drivers of early medication change in psychotic disorder.

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“…The acute treatment algorithm recommends only aripiprazole as a first-line antipsychotic agent, which is different from other treatment algorithms for first-episode schizophrenia/psychosis (Agid et al, 2011;Drosos et al, 2020;Yeisen et al, 2016;Yoshimura et al, 2019). We prioritized minimizing adverse effects over maximizing efficacy for the first place, because long-term treatment with antipsychotics is needed to prevent relapse and exacerbation in patients with schizophrenia (Leucht et al, 2012;Takeuchi et al, 2017).…”

Section: Pharmacological Treatment Algorithm For the Maintenance Phase Of First-episode Schizophreniamentioning

confidence: 99%

“…A systematic review identified only a few treatment algorithms for schizophrenia in general, although a substantial number of treatment guidelines are available. To our knowledge, there have been only three and one treatment algorithms designed specifically for first-episode schizophrenia (Agid et al, 2011;Drosos et al, 2020;Yoshimura et al, 2019) and psychosis (Yeisen et al, 2016), respectively. Moreover, all the algorithms were used for acute treatment, but not for maintenance treatment.…”

Section: Introductionmentioning

confidence: 99%

Pharmacological treatment algorithms for the acute phase, agitation, and maintenance phase of first‐episode schizophrenia: Japanese Society of Clinical Neuropsychopharmacology treatment algorithms

Takeuchi

Takekita

Hori

et al. 2021

Human Psychopharmacology

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Objective: There are only a few treatment algorithms for first-episode schizophrenia. Moreover, all the algorithms apply to acute treatment, but not maintenance treatment. Therefore, we aimed to develop acute and maintenance treatment algorithms for first-episode schizophrenia. Methods:The algorithm committee of the Japanese Society of Clinical Neuropsychopharmacology developed pharmacological treatment algorithms for the acute phase, agitation, and maintenance phase of first-episode schizophrenia. Results:The acute treatment algorithm focuses on drug-naïve patients with firstepisode schizophrenia who are not old or very agitated and recommends first-line treatment with aripiprazole, second-or third-line treatment with risperidone/paliperidone or olanzapine, and fourth-line treatment with clozapine. Long-acting injection of the current antipsychotic agent can be used for poor medication adherence or based on patient preference. The agitation treatment algorithm recommends first-line treatment with lorazepam and second-or third-line treatment with quetiapine or levomepromazine and clearly instructs that the medication used for agitation should be reduced and then discontinued after remission of agitation.The maintenance treatment algorithm recommends the gradual reduction of antipsychotics to the minimum effective dose after remission of positive symptoms. Conclusions:We hope that our unique algorithms will be used broadly and will contribute to minimizing patients' burden related to antipsychotic treatment.

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Use of medication algorithms in first episode psychosis: a naturalistic observational study

Abstract: Initial medical intervention followed international standards, but the physicians failed to adhere to algorithms in their follow-up of medication regimes. Adherence was associated with outcome.

Cited by 7 publications

References 25 publications

One-Year Outcome and Adherence to Pharmacological Guidelines in First-Episode Schizophrenia

One-Year Outcome and Adherence to Pharmacological Guidelines in First-Episode Schizophrenia

Predictors for Antipsychotic Dosage Change in the First Year of Treatment in Schizophrenia Spectrum and Bipolar Disorders

Pharmacological treatment algorithms for the acute phase, agitation, and maintenance phase of first‐episode schizophrenia: Japanese Society of Clinical Neuropsychopharmacology treatment algorithms

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