Young people with early psychosis may not require antipsychotic medications to recover

Researchers at Orygen have found that some young people with early stage first episode psychosis (FEP) can experience reduced symptoms and improve functioning without antipsychotic medication when they are provided with psychological interventions and comprehensive case management.

The Staged Treatment and Acceptability Guidelines in Early Psychosis (STAGES) study compared two groups of young people, aged 15 – 25 years, presenting with FEP to a specialist early psychosis service.

Both groups received intensive psychosocial intervention, with one group also receiving low dose antipsychotic medication and the other receiving a placebo. The results have been published in Schizophrenia Bulletin Open.

The study found that the addition of antipsychotic medication to intensive psychosocial intervention did not lead to superior outcomes in symptoms and functioning within the first six months, suggesting that antipsychotic medication may not be needed early in the course of illness for all people within the spectrum of psychosis.

Orygen researcher Dr Shona Francey, who led the study, said the team wanted to investigate whether medication was an essential part of treatment for young people with early stage FEP.

“For a significant number of young people, it is. But, I think some young people can recover, at least initially, from their psychosis without medication,” she said.

Current practice recommends anti-psychotic medication be taken from the outset of psychotic illness in order to achieve rapid recovery and improvement of psychotic symptoms.

However, Dr Francey said, in reality, a lot of people vote with their feet and don’t take their medication for a variety of reasons.

“Medications can have heavy-duty side effects for young people, including weight gain which is a significant issue that young people are concerned about. There are also various sexual and other physical side effects that young people on medication have to contend with.”

Dr Francey said that not all young people could delay their antipsychotic medication. “For many young people with early stage FEP, medication is an essential part of their treatment plan. But, for those young people who do not want medication, psychological interventions and comprehensive case management could be a feasible model of treatment.

“What the findings of this research tell us is that if a young person is reluctant to take medication for FEP, a period of intensive psychosocial treatments could be offered as an alternative,” Dr Francey said.

She said a larger trial would be required to investigate whether antipsychotic-free treatment could be recommended for particular groups of young people with FEP.

“Young people currently using medication as part of their supervised treatment should continue to do so under the direction of their doctor,” Dr Francey said.

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This research was supported by funding from the National Health and Medical Research Council and Janssen-Cilag.