First-episode psychosis: a window of opportunity for best practices

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. During this period, selecting the best treatment option is also important because functional impairment occurs most rapidly during this early period, which can alter the patient's future prognosis, level of necessary treatment, and affect morbidity. Although research has shown a decrease in brain gray matter for those who develop psychosis along with signs of functional impairment, many patients with psychosis remain untreated for extended periods of time and do not visit a clinician because of denial, fear of stigma, a failure to recognize the problem, or complexities of their care system. Prior studies have shown that when psychosis is left untreated, the patient outcome is worse than for a patient treated earlier in the course of illness. There is a range of treatment options for psychosis treatment, including use of first-generation or second-generation antipsychotic medication. Clinicians should note that both drug types are associated with certain side effects, such as tardive dyskinesia and weight gain, respectively. For both medication types, doses should be lower for patients with a first psychotic episode than for patients with chronic psychosis. Lastly, 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.