Treatment Principles of First-Episode Psychosis

Treatment of first-episode psychosis, which has unique advantages and challenges, has an impact on the course of the illness. On one hand, clinician has to understand triggering factors of psychosis and make differential diagnosis, and on other hand he has to choose a rationale psychopharmacological treatment. Although there is no difference between first generation antipsychotics and second generation antipsychotics in terms of effectiveness, the latter group has advantages in terms of side effects and tolerability. Tolerability issues and particularly metabolic side effects should be taken into account when choosing antipsychotic to treat first episode and beyond. Additionally, psychosocial approaches like family psychoeducation should be combined with pharmacological approaches in early phase of psychosis. Clinicians should monitor the medication adherence in every outpatient visit, and minimum duration of treatment is recommended as three years after remission.