Quality prescribing in early psychosis: key pharmacotherapy principles

Author:

Scott James G123ORCID,McKeon Gemma12ORCID,Malacova Eva1,Curtis Jackie45,Burgher Bjorn12,Macmillan Iain678ORCID,Thompson Andrew910,Parker Stephen D2ORCID

Affiliation:

1. QIMR Berghofer Medical Research Institute, Herston, QLD, Australia

2. Metro North Mental Health Service, Herston, QLD, Australia

3. Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia

4. School of Psychiatry, University of New South Wales, Randwick, NSW, Australia

5. The Bondi Centre, South Eastern Sydney Local Health District, Sydney, NSW, Australia

6. Alfred Hospital, Melbourne, VIC, Australia

7. Headspace Early Psychosis, Frankston, VIC, Australia

8. Monash University, Melbourne, VIC, Australia

9. Orygen, Youth Early Psychosis, Melbourne, VIC, Australia

10. Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia

Abstract

Objective: To present a practical, easy-to-implement clinical framework designed to support evidence-based quality prescribing for people with early psychosis. Method: Identification and explanation of key principles relating to evidence-based pharmacotherapy for people with early psychosis. These were derived from the literature, practice guidelines and clinical experience. Results: Key principles include (1) medication choice informed by adverse effects; (2) metabolic monitoring at baseline and at regular intervals; (3) comprehensive and regular medication risk–benefit assessment and psychoeducation; (4) early consideration of long-acting injectable formulations (preferably driven by informed patient choice); (5) identification and treatment of comorbid mood disorders and (6) early consideration of clozapine when treatment refractory criteria are met. Conclusions: Current prescribing practices do not align with the well-established evidence for quality pharmacotherapy in early psychosis. Adopting evidence-based prescribing practices for people with early psychosis will improve outcomes.

Publisher

SAGE Publications

Subject

Psychiatry and Mental health

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