What is the recommended treatment for psychosis?

From the Guidelines

The recommended treatment for psychosis typically involves a combination of antipsychotic medications and psychosocial interventions, with a focus on reducing morbidity, mortality, and improving quality of life. According to the American Psychiatric Association practice guideline for the treatment of patients with schizophrenia 1, first-line medications include second-generation (atypical) antipsychotics such as risperidone, olanzapine, quetiapine, or aripiprazole. Treatment usually begins with a low dose that is gradually increased until symptoms improve or side effects become problematic. Medication should continue for at least 1-2 years after the first psychotic episode, and potentially longer for recurrent episodes.

Some key points to consider in the treatment of psychosis include:

• The use of antipsychotic medications, with clozapine recommended for treatment-resistant schizophrenia 1
• The importance of psychosocial interventions, including cognitive behavioral therapy for psychosis (CBTp), family therapy, supported employment, and case management 1
• The need for regular monitoring for side effects, such as weight gain, metabolic changes, and movement disorders, with medication adjustments made accordingly 1
• The importance of early intervention, as untreated psychosis can lead to more difficult-to-treat symptoms and functional decline 1
• The need for a comprehensive and person-centered treatment plan that includes evidence-based nonpharmacological and pharmacological treatments 1

In terms of specific medications, the American Psychiatric Association recommends that patients with schizophrenia be treated with an antipsychotic medication and monitored for effectiveness and side effects 1. The recommended medications include:

• Risperidone (2-6 mg/day)
• Olanzapine (10-20 mg/day)
• Quetiapine (300-800 mg/day)
• Aripiprazole (10-30 mg/day)

It's also important to note that treatment should address the underlying cause when possible, such as stopping substance use in drug-induced psychosis or treating medical conditions that may cause psychotic symptoms 1. Regular monitoring for side effects like weight gain, metabolic changes, and movement disorders is necessary, with medication adjustments made accordingly.

Overall, the goal of treatment is to reduce morbidity, mortality, and improve quality of life for individuals with psychosis, and a comprehensive and person-centered treatment plan that includes evidence-based nonpharmacological and pharmacological treatments is essential to achieving this goal 1.

From the FDA Drug Label

BOXED WARNING SECTION WARNING: INCREASED MORTALITY IN ELDERLY PATIENTS WITH DEMENTIARELATED PSYCHOSIS Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. RISPERIDONE (risperidone) is not approved for the treatment of patients with dementia-related psychosis. [see Warnings and Precautions ( 5.1)]

The recommended treatment for psychosis is not explicitly stated in the provided drug labels. However, antipsychotic drugs such as olanzapine and risperidone are mentioned as being associated with an increased risk of death in elderly patients with dementia-related psychosis.

• Olanzapine is not approved for elderly patients with dementia-related psychosis 2.
• Risperidone is not approved for the treatment of patients with dementia-related psychosis 3. It is essential to consult a healthcare professional for proper diagnosis and treatment of psychosis.

From the Research

Psychosis Treatment Overview

• The recommended treatment for psychosis typically involves the use of antipsychotic medications, which can help alleviate symptoms such as hallucinations and delusions 4, 5, 6, 7.
• The choice of antipsychotic medication can depend on various factors, including the severity of symptoms, the presence of any side effects, and the patient's medical history 6, 7.

First-Generation vs. Second-Generation Antipsychotics

• First-generation antipsychotics, such as haloperidol, can be effective in treating psychosis but may have more side effects, such as extrapyramidal symptoms (EPS) 4, 5.
• Second-generation antipsychotics, such as risperidone, olanzapine, and aripiprazole, may have fewer side effects and be more effective in treating certain symptoms, such as negative symptoms 5, 6, 7.

Specific Antipsychotic Medications

• Risperidone has been shown to be effective in treating first-episode psychosis and may have a more favorable side effect profile compared to haloperidol 4, 5, 7.
• Olanzapine and aripiprazole may also be effective in treating first-episode psychosis and may have advantages in terms of effectiveness and tolerability 6.
• Clozapine may be an option for patients who are at risk for tardive dyskinesia or have treatment-resistant schizophrenia 8.

Treatment Considerations

• The dosage and duration of antipsychotic treatment can vary depending on the individual patient and the severity of their symptoms 4, 5, 6, 7.
• Regular monitoring of symptoms and side effects is important to ensure that the treatment is effective and well-tolerated 5, 6, 7.