Overview Copy

A combination of both pharmacological, psychological and social treatments are required for the best possible treatment outcomes. Antipsychotic medications are essential for the control of both positive and negative psychotic symptoms. Numerous factors can influence medication response. For example, those who use street drugs such as marijuana, methamphetamine or cocaine may not respond to antipsychotic medications in the same way that individuals who are not using these substances would. In addition, the age of onset of psychotic symptoms also predicts the extent of responsiveness with the youngest individuals often having a poorer response. Clearly there are genetic contributions to disease expression and the extent to which these factors contribute to treatment response is less clear.

Some people with a first episode of psychosis may require other medications in addition to an antipsychotic -mood stabilizers and/or antidepressants – as depression and anxiety are common comorbid symptoms. The newer class of antipsychotics (atypicals) have fewer motor side effects and are less likely to have a detrimental effect on mood or cognition relative to the older class of antipsychotics (typicals). Therefore these agents are preferred as first line treatment. Timely introduction of antipsychotic medication is critical in managing symptoms. The person should be allowed to make decisions about their treatment including medication. Clinicians need to be conversant with, treatment guidelines medications and their side effects.

Activities

Outcomes/Objectives

1. Understand why atypical antipsychotics are preferred over typical antipsychotics in first episode psychosis
2. Be familiar with the more common side effects associated with atypical antipsychotics including metabolic sydrome
3. List several strategies that may be useful in ensuring medication adherence
4. Understand the use of clozapine in those people who have persistent positive symptoms despite optimal use of at least two other agents