Magazine article Clinical Psychiatry News

Early Treatment Key in First-Episode Psychosis

Magazine article Clinical Psychiatry News

Early Treatment Key in First-Episode Psychosis

Article excerpt


SAN DIEGO -- According to Dr. Joseph P. McEvoy, early recognition and treatment of first-episode psychosis affords the best opportunity for a positive outcome.

"In the United States, we do a very poor job detecting psychosis early," Dr. McEvoy, professor and I. Clark Case Chair in Psychotic Disorders at the Medical College of Georgia, Augusta, said at the annual U.S. Psychiatric and Mental Health Congress.

"The sooner you identify them and get them into treatment the better they do in the long run. Treatment of these folks cannot be done by the smartest, best, most decent, overworked person doing 15-minute medication checks. It just can't happen. You need a team," he said.

Current estimates suggest that only 20%-40% of people who meet clinical high-risk criteria for a first episode of psychosis convert to psychosis within 2-4 years. A challenge for clinicians, he continued, is that the criteria for identifying individuals at risk for FEP have a low predictive value, which raises concern about unnecessary and potentially harmful interventions. "Any interventions we would want to try now for somebody we're worried about should have a very low burden of toxicity: antipsychotic medications at very low doses, cognitive-behavioral therapy to reduce or delay the onset of psychosis, and the use of long-chain polyunsaturated fatty acids," he said.

In a study led by Dr. McEvoy, researchers used a lipidomics platform to measure individual lipid species in 20 drug-naive patients with a first episode of schizophrenia, 20 patients with chronic schizophrenia who had not adhered to prescribed medications, and 29 controls without schizophrenia (PloS One. 2013;8[7]:e68717). They found that, compared with controls, patients with a first episode of schizophrenia demonstrated significant downregulation of several n3 polyunsaturated fatty acids, including 20:5n3, 22:5n3, and 22:6n3 within the phosphatidylcholine and phosphatidylethanolamine lipid classes. …

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