Medication Copy

Antipsychotic medication is essential in the treatment of a first episode of psychosis and treatment usually begins with a low-dose of an atypical antipsychotic.

Atypical antipsychotics are recommended as first line agents in early psychosis since, compared to typical antipsychotics, they have:

  • Fewer motor side effects
  • Equal or better efficacy against positive and negative symptoms
  • Beneficial effects on mood and cognition (*evidence no longer supports “improvements” in cognition, though Atypicals are less likely to have negative impact on cognition, whereas typicals are more prone to cognitive side effects).

Other medications, such as benzodiazepines, may also be used at the start of treatment in order to reduce distress and promote sleep.

The dose of the atypical antipsychotic may be increased very gradually over time until a treatment response is evident. Many clients in the early phases of a psychotic illness respond to low dose strategies, which is ideal as this will minimize side effects and improve adherence. Others require higher doses of the first medication offered or may not respond to the compound. Each person will have a unique response to any given medication so close monitoring is warranted especially at the start of treatment.

It usually takes several weeks to see the initial medication response and it may take a few months before the medications exert their full effects. If the client is still demonstrating symptoms at this point, another medication may be tried. Once symptoms have remitted, the client is asked to continue with medication in order to prevent relapse. The length of time the client is asked to remain on medication will vary depending on the diagnosis and other factors, but usually it is recommended that the client stay on the medication for at least 1-2 years after the first-episode.

The treatment required by one person may vary from that of another depending on a number of factors including age of illness onset, genetic factors, use of street drugs and alcohol and treatment compliance. In addition to medication, education for clients and their families about symptoms, medication, stress, and a broad range of other topics are all crucial to recovery.

Atypical Antipsychotics CLICK HERE

*CLOZAPINE*Clozaril
OLANZAPINEZyprexa
RISPERIDONERisperdal
QUETIAPINESeroquel
ZIPRASIDONEZeldox

*Clozapine/Clozaril is classified as an atypical antipsychotic but is not to be used “first-line”. The use of clozapine is limited to individuals demonstrating treatment resistance or prolonged recovery.

Medications other than antipsychotics, such as antidepressants or mood stabilizers, may also be used depending on the client’s symptom profile. However, the number of medications and complexity of treatment regimen should always be kept as straight forward as possible and follow treatment guideline recommendations.

The Selective Serotonin Reuptake Inhibitors (SSRIs) and Selective Noradrenaline Re-uptake Inhibitors (SNRIs) are the newest forms of antidepressants and are commonly prescribed treatment for depression, obsessive-compulsive disorder and some of the other anxiety disorders. There have been a growing number of reports which show that some of these drugs may be associated with an increased risk of suicidality in individuals under 18 years of age. “It is important to note that Health Canada has not approved these drugs for use in patients under 18 years. The prescribing of drugs is a physician’s responsibility. Although SSRI/SNRIs are not approved for use with children, doctors rely on their knowledge of patients to determine whether to prescribe them at their discretion in a practice called off-label use.” from Health Canada’s website http://www.hc-sc.gc.ca/

Mood stabilizers, such as lithium or valproate, may also be prescribed depending on the diagnosis and the need for better mood regulation.

Youth and their families need to understand medication side effects, impact of use of medication in combination with other drugs (street and over the counter) and the implications of not taking medications on a regular basis. Doubling up medication or skipping dosages, as well as the need to determine therapeutic levels, are topics that need to be discussed repeatedly.

All clients and families should be provided with both verbal and written information on the medication prescribed.

VIEW 2020 PHARMACOTHERAPY WEBINAR HERE. VIEW POWERPOINT SLIDES HERE.

Review the medication handouts located in the care pathway page.

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