From the Guidelines
The recommended diagnostic tests for psychosis disorders should include a comprehensive psychiatric evaluation, physical examination, laboratory tests, and brain imaging when organic causes are suspected, and treatment should typically involve antipsychotic medications as the cornerstone therapy, with first-line options including second-generation antipsychotics such as risperidone, olanzapine, quetiapine, or aripiprazole, as recommended by the American Psychiatric Association practice guideline for the treatment of patients with schizophrenia 1.
Diagnostic Tests
The diagnostic tests for psychosis disorders should include:
- A comprehensive psychiatric evaluation
- Physical examination
- Laboratory tests, such as complete blood count, metabolic panel, thyroid function, toxicology screen, and sometimes B12/folate levels
- Brain imaging, such as MRI or CT, when organic causes are suspected
Treatment Recommendations
The treatment recommendations for psychosis disorders should include:
- Antipsychotic medications as the cornerstone therapy
- First-line options, including second-generation antipsychotics, such as:
- Risperidone (2-6 mg/day)
- Olanzapine (10-20 mg/day)
- Quetiapine (300-800 mg/day)
- Aripiprazole (10-30 mg/day)
- Psychosocial interventions, such as:
- Cognitive behavioral therapy for psychosis (CBTp)
- Family education and support
- Social skills training
- Vocational rehabilitation
- Regular monitoring for medication side effects, including:
- Metabolic parameters (weight, glucose, lipids)
- Movement disorders
- Prolactin levels
Treatment Approach
The treatment approach should target dopamine dysregulation in the brain, particularly D2 receptor blockade, which helps reduce hallucinations, delusions, and disorganized thinking that characterize psychotic disorders, as recommended by the American Psychiatric Association practice guideline for the treatment of patients with schizophrenia 1.
Psychosocial Interventions
Psychosocial interventions are essential complements to medication and should include:
- Cognitive behavioral therapy for psychosis (CBTp)
- Family education and support
- Social skills training
- Vocational rehabilitation
- Supported employment services
- Assertive community treatment, as recommended by the American Psychiatric Association practice guideline for the treatment of patients with schizophrenia 1.
Medication Side Effects
Regular monitoring for medication side effects is crucial, including:
- Metabolic parameters (weight, glucose, lipids)
- Movement disorders
- Prolactin levels
- Extrapyramidal side effects, such as akathisia, parkinsonism, and tardive dyskinesia, as recommended by the American Psychiatric Association practice guideline for the treatment of patients with schizophrenia 1.
Treatment Duration
Treatment duration depends on the specific diagnosis, with first-episode psychosis typically requiring 1-2 years of medication, while chronic conditions like schizophrenia often need indefinite treatment, as recommended by the American Psychiatric Association practice guideline for the treatment of patients with schizophrenia 1.
Conclusion is not allowed, so the response will be ended here.
From the FDA Drug Label
- 18 Tardive Dyskinesia Tardive dyskinesia (TD) has occurred in patients treated with antipsychotic drugs, including clozapine.
- 20 Recurrence of Psychosis and Cholinergic Rebound after Abrupt Discontinuation of Clozapine If abrupt discontinuation of clozapine is necessary (because of severe neutropenia or another medical condition, for example) [see Dosage and Administration (2.4), Warnings and Precautions (5. 1)], monitor carefully for the recurrence of psychotic symptoms and adverse reactions related to cholinergic rebound, such as profuse sweating, headache, nausea, vomiting and diarrhea.
The recommended diagnostic tests are not explicitly mentioned in the label. The treatment recommendations for psychosis disorder include:
- Using the lowest effective dose and the shortest duration necessary to control symptoms
- Periodically assessing the need for continued treatment
- Considering discontinuing treatment if tardive dyskinesia occurs
- Monitoring carefully for the recurrence of psychotic symptoms and adverse reactions related to cholinergic rebound after abrupt discontinuation of clozapine 2
From the Research
Diagnostic Tests for Psychosis Disorder
- The diagnosis of psychosis can be made by taking a thorough history, examining the patient's mental state, and obtaining a collateral history 3.
- The history usually enables a distinction to be made between bipolar disorder, schizophrenia, and other causes 3.
- Early symptoms often include low mood, declining educational or occupational functioning, poor motivation, changes in sleep, perceptual changes, suspiciousness, and mistrust 3.
- Patients may describe abnormal thoughts and enquiry into thoughts of suicide should be routine 3.
- Disturbances of thought such as insertion or withdrawal may be present along with perceptual abnormalities, i.e., illusions, hallucinations 3.
Treatment Recommendations for Psychosis Disorder
- All patients presenting with first-episode psychosis for which no organic cause can be found should be referred to the local early intervention service 3.
- In patients with a known diagnosis, consider referral if there is poor response or non-adherence to treatment, intolerable side effects, comorbid substance misuse, or risk to self or others 3.
- Quetiapine appears to be a good starting drug candidate in patients admitted to hospital for symptoms of psychosis 4.
- Olanzapine, risperidone, and aripiprazole presented advantages for the first-line treatment of first-episode psychosis in terms of effectiveness 5.
- The choice of antipsychotic medication should be based on the individual patient's needs and circumstances, taking into account factors such as side effect profiles, efficacy, and patient preference 4, 6, 5.
Antipsychotic Medications
- Second-generation antipsychotics such as olanzapine, quetiapine, risperidone, and ziprasidone are commonly used to treat psychosis 4, 6, 5.
- These medications have different side effect profiles and efficacy, and the choice of medication should be individualized based on the patient's needs and circumstances 4, 6, 5.
- Substance use does not appear to influence the general magnitude of side effects of antipsychotic medication, but may affect the occurrence of specific side effects 6.