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First-time patients with psychosis often get wrong drugs, study finds

Nearly 40 percent of patients diagnosed with psychosis for the first time receive the wrong medications, which may worsen their symptoms, local scientists found in a wide-ranging national analysis.

Psychosis, also called schizophrenia, is a major mental disorder marked by impaired emotions, thoughts and diminished contact with reality. The condition usually strikes in young adulthood. When doctors treat patients for a first episode of psychosis, guidelines call for therapies that differ from those prescribed to people who've had multiple ones.

But in a study of more than 400 mental health patients ages 15 to 40 who experienced their first episode and sought treatment at 34 community-based clinics in 21 states, the chosen therapies did not follow accepted guidelines, said Dr. John Kane of Hofstra North Shore-Long Island Jewish School of Medicine and The Zucker Hillside Hospital in Glen Oaks, Queens.

The new research is aimed at helping doctors be less aggressive in treating the condition. The study grows out of an earlier government-funded research project that found wide differences in prescriptions given at community mental health centers where many people with schizophrenia often seek treatment. The study's results were released Thursday by the National Institute of Mental Health, a division of the National Institutes of Health in Bethesda, Maryland.

Kane and his North Shore-LIJ colleague, Dr. Delbert Robinson of the Feinstein Institute for Medical Research in Manhasset, found that 159 of the study participants -- nearly 40 percent -- would benefit enormously when first diagnosed if they had been prescribed different medications. Current guidelines, the doctors said, emphasize low doses of antipsychotic drugs and strategies to minimize side effects. "The challenge for the field is to develop ways to transmit the specialized knowledge about first-episode treatment to busy community clinicians," Robinson said.

Of the 159 patients studied by Kane and Robinson, many fell into multiple categories of medication mismanagement. For example, more than 8 percent were prescribed higher-than-recommended doses of antipsychotic drugs; 23 percent were prescribed more than one antipsychotic drug; nearly 37 percent were prescribed an antipsychotic and an antidepressant without a clear need for the antidepressant, and 1.2 percent were inappropriately prescribed stimulants, according to the study's findings.

Worse, the researchers found that more than a third of the patients were prescribed olanzapine, a medication not recommended for patients with first-episode psychosis.

All of the patients were enrolled in the RAISE-Early Treatment Program, or Recovery After Initial Schizophrenia Episode. The National Institute of Mental Health organized RAISE in an effort to change the prognosis for schizophrenia through intensive, coordinated treatment in the earliest stages.

"Our data were for prescriptions individuals received before they started the RAISE-Early Treatment Program study," Robinson said.

He noted that community mental health clinicians usually have extensive experience treating individuals with multiepisode psychosis, which explains the more potent drug cocktail prescribed to people with a first-episode diagnosis.