Psychosocial treatment, antipsychotic postponement, and low-dose medication strategies in first-episode psychosis: A review of the literature – Bola, Lehtinen, Cullberg and Ciompi

Reconsidering medication-free research in early-episode schizophrenia prompts a review of acute psychosocial treatments using medication postponement protocols. We describe and compare the different psychosocial treatment approaches. Studies were included in the review if initial psychosocial treatment combined with a time-limited postponement of antipsychotics was compared to initial antipsychotic treatment using a quasi-experimental or better research design and reportcd outcomes of at least one year.

Five studies were included (N=261). each reporting modestly better long-term
outcomes than initial medication treatment. resulting in a composite sma l l –
medium effect-size advantage ( r .= 0.17). In addition, 27-43% of experimental
patients were not receiving anti psychotics at the two- or three-year follow-up.

These projects demonstrate the feasibility of a carefully supervised approach
to medication-free research and also suggest a strategy for integrating biological,
psychological and social treatment components in early-episode psychoses.
Initial psychosocial treatment combined with a time-limited postponement of
antipsychotic medications for eligible, non-dangerous. early-episode patient- may
facilitate a reduction in long-term medication dependence and the discrimination
of similar but pathophysiologically different diagnostic entities. Rigorous
evaluation in a randomized controlled trial designed to identify medication and
psychosocial treatment-responsive subgroups of patients may contribute to
diagnostic specificity and improved patient outcomes.

Psychosis Vol. I, No. I, February 2009, 4 18

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