Principles Of Medication In The Acute Phase Antipsychotics

The efficacy of antipsychotics as a first-line treatment for psychosis has been well established, and earlier treatment is associated with an improved prognosis [34,51]. In young people with early psychosis, relatively low doses of antipsychotics are usually effective in controlling hallucinations, delusions, thought disorder and bizarre behaviour. Low doses minimize the risk of distressing side effects, particularly extrapyramidal symptoms

However, it takes at least 10-14 days for antipsychotic medication to have a significant effect on symptoms, and 6 weeks or longer for a maximum response to be obtained. ''Impatient'' prescribing, with rapid increases in dosage or changes of medication, will not shorten the treatment course or the length of the acute phase, but will increase the risk of poor compliance in the future and of relapse. McEvoy et al. [52] demonstrated that there is a threshold effect for antipsychotic action. In their study, the mean threshold dose was 2mg/day of haloperidol for first-episode cases and 4mg/day for multi-episode cases. Once this dose, located just on the brink of precipitation of extrapyramidal side effects, or an equivalent dose of other antipsychotics, is achieved, there is probably no additional benefit from further increases. This strategy is quite feasible in routine clinical practice, as shown by Power et al. [46]. These doses have been confirmed by more recent studies with atypical and typical antipsychotic medications [53,54] and landmark positron emission tomography (PET) studies, which have clarified the biological basis for appropriate dosing strategies [55]. There is a general consensus, though challenged still by some, that atypical antipsychotics should be used as first-line therapy, largely on the basis of better safety and tolerability [1,14,41,56].

As discussed above, it is ideal to avoid prescribing antipsychotics for the first 24-48 hours in a young person with a first episode of psychosis, in order to allow a more accurate assessment of the symptoms.

BiPolar Explained

BiPolar Explained

Bipolar is a condition that wreaks havoc on those that it affects. If you suffer from Bipolar, chances are that your family suffers right with you. No matter if you are that family member trying to learn to cope or you are the person that has been diagnosed, there is hope out there.

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