Antipsychoticfree Period

Ideally, assessment of a first episode of psychosis should be completed before any antipsychotic medications are administered. Whether managed at home or in hospital, an antipsychotic-free period of at least 24 hours allows clinicians to make repeated assessment of the evolving mental state, gather further clinical information and conduct some routine biological investigations. It also reduces the potential for premature and inappropriate diagnostic interventions or treatment. An antipsychotic-free period allows time for psychoeducation on the nature of the problem and the need for treatment, emphasizing that decisions about treatment are thoughtful and considered. An antipsychotic-free period is particularly valuable when:

• time is needed for symptoms of a drug intoxication or withdrawal to lessen;

• symptoms of psychosis are vague or transient;

• symptoms are subtle or denied by the patient.

In these circumstances, premature prescription of antipsychotics may mask the correct diagnosis.

An ''antipsychotic-free'' period does not mean that all other medications or interventions should be withheld. For example, benzodiazepines can be used to restore normal sleep and to reduce anxiety or agitation. Psychological and social treatments can be implemented, and the patient and family should receive intensive support and education.

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Anxiety and Depression 101

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