From the Guidelines
The recommended duration of treatment after a first episode of psychosis is typically 1-2 years of antipsychotic medication following symptom remission. This recommendation is based on the principle of doing the least harm while aiming for the maximum benefit, as outlined in the international clinical practice guidelines for early psychosis 1. The use of antipsychotic agents requires careful consideration, including adequate informed consent, documentation of target symptoms, and monitoring for side effects, as noted in the practice parameter for the assessment and treatment of children and adolescents with schizophrenia 1.
Medications commonly prescribed for first-episode psychosis include second-generation antipsychotics such as risperidone, olanzapine, quetiapine, or aripiprazole. After the initial 1-2 year treatment period, if the person has remained stable, a gradual, carefully monitored medication reduction may be considered under close supervision from a psychiatrist. However, discontinuation carries a significant risk of relapse.
Key considerations in the treatment approach include:
- Comprehensive treatment, including psychosocial interventions like cognitive behavioral therapy, family support, and vocational rehabilitation alongside medication
- Regular monitoring for side effects and metabolic changes
- Early intervention and consistent treatment to improve long-term outcomes by potentially limiting progressive brain changes and functional decline that may occur with untreated psychosis or multiple relapses.
The decision to continue or adjust treatment should be made on a case-by-case basis, taking into account the individual's response to treatment, risk of relapse, and potential side effects, as guided by the most recent and highest quality evidence 1.
From the Research
Recommended Duration of Treatment
The recommended duration of treatment after a first episode of psychosis (FEP) is not explicitly stated in the provided studies. However, some studies provide guidance on the duration of treatment for specific conditions:
- For delirium, the recommended duration of treatment is 1 week 2
- For agitated dementia, the treatment should be tapered within 3-6 months to determine the lowest effective maintenance dose 2
- For schizophrenia, the treatment should be continued indefinitely at the lowest effective dose 2
- For delusional disorder, the treatment should be continued for 6 months to indefinitely at the lowest effective dose 2
- For psychotic major depression, the treatment should be continued for 6 months 2
- For mania with psychosis, the treatment should be continued for 3 months 2
Factors Influencing Treatment Duration
The duration of treatment may be influenced by several factors, including:
- The specific condition being treated
- The severity of symptoms
- The patient's response to treatment
- The presence of comorbid conditions
- The risk of relapse
Treatment Guidelines
The provided studies offer guidance on the treatment of FEP, including: