The use of medication in first episode psychosis
‘The principle underlying the use of neuroleptic medication in the early stages of schizophrenia is simple: it is to ensure that the experience of medication is as positive as possible’ and should occur in the context of building a trusting relationship with the patient and providing information about their illness (Bebbington, 2000) Treatment recommendations for the management of schizophrenia have been developed by a number of expert committees (APA 1997; Working Group for the Canadian Psychiatric Association and the Canadian Alliance For Research on Schizophrenia, 1998; Bethlem and Maudsley NHS Trust, 1999; Expert Consensus Panel, 1999). In general, these guidelines have not drawn a great distinction between the treatment of first and subsequent psychotic episodes. However, since it is being increasingly recognised that first-episode psychosis clients tend to respond to lower doses of antipsychotic medication and to develop more extrapyramidal side effects than do clients with more established illnesses (Cole et. al., 1964), recently, separate medication guidelines for use in this population have been developed. The most developed of these is the Australian National Early Psychosis Project (NEPP, 1998), which provides a detailed algorithm for the drug treatment of first episode psychosis based on expert opinion and a review of the literature. It has drawn heavily from clinical experience gained in the EPPIC Program in Melbourne, a well-established first-episode psychosis programme. The current document has drawn brief guidelines from existing medication protocols as well as from the brooder literature on medication use in first-episode psychosis.
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