Psychiatrists’ Prescriptions for First-time Psychosis Often Don’t Follow Guidelines

Rob Wipond
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“Many patients with first-episode psychosis receive medications that do not comply with recommended guidelines for first-episode treatment,” states a National Institute of Mental Health press release about a new NIMH study published in the American Journal of Psychiatry. The study found that about 40% of patients who’d been diagnosed with having psychotic experiences for the first time in their lives were being too heavily medicated right away.

The study is part of the Recovery After an Initial Schizophrenia Episode (RAISE) project, “which was developed by NIMH to examine first-episode psychosis before and after specialized treatment was offered in community settings in the United States,” states the press release. “RAISE seeks to change the path and prognosis of schizophrenia through coordinated and intensive treatment in the earliest stages of illness… Current guidelines emphasize low doses of antipsychotic drugs and strategies for minimizing the side effects that might contribute to patients stopping their medication.”

The researchers found that, out of 159 people,

  • 8.8 percent were prescribed higher-than-recommended doses of antipsychotics;
  • 23.3 percent were prescribed more than one antipsychotic;
  • 36.5 percent were prescribed an antipsychotic and an antidepressant without a clear need for the antidepressant;
  • 10.1 percent were prescribed psychotropic medications without an antipsychotic medication,
  • and 1.2 percent were prescribed stimulants.
  • In addition, 32.1 percent were prescribed olanzapine, a medication not recommended for first-episode patients.
  • Some of the 159 people fell into multiple categories.

“Despite some regional variations in prescription practices, no region consistently had different practices from the others,” wrote the authors of the study. “Diagnosis had limited and inconsistent effects.”

Medications for patients with first episode psychosis may not meet guidelines (National Institutes of Health Press Release, December 4, 2014)

(Abstract) Prescription Practices in the Treatment of First-Episode Schizophrenia Spectrum Disorders: Data From the National RAISE-ETP Study (Robinson, Delbert G. et al. American Journal of Psychiatry. Published online ahead of print December 4, 2014.)

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Rob Wipond
Rob Wipond is a Victoria, British Columbia-based freelance journalist who has been writing on mental health issues for fifteen years. His research has particularly focused on the interfaces between psychiatry, the justice system, and civil rights. His articles have been nominated for three Canadian National Magazine Awards, six Western Magazine Awards, and four Jack Webster Awards for journalism. He can be contacted through his website.

14 COMMENTS

  1. Prove there is a psychotic molecule first in the blood and brain of the “patient”, before you apply the antipsychotic countermeasure.
    There is no psychotic molecule. The drugs are a chemical lobotomy. If a person is young and healthy enough, the brain can recover from the poison.

    • I survived Zyprexa , it is the most evil sh^t ever. First it robbed my ability to feel any pleasure from life but then 100 times worse the withdrawal reactions , insomnia from hell , nausea vomiting and a scary psychosis I never had BEFORE taking it. Of course when I complained of these withdrawal reactions they were used to confirm I was “sick” and needed even more psychiatric lobotomy pills.

      I will never forget going to the ER sick with Zyprexa withdrawal and the nurse telling me the doctor could write more Zyprexa if “we asked him nicely”.

      Can I please have more of the stuff that made me violently ill and landed me in the emergency room ? Gee thanks.

      Look at what those soulless psychos at Eli Lilly did to sell the stuff.

      Google search results for “the Zyprexa scandal” http://www.google.com/search?q=+the+zyprexa+scandal

      Olanzapine is Zyprexa.

    • Re: I didn’t even have a psychotic episode or any serious mental health problems, and I was prescribed Zyprexa. 🙁

      I was given Zyprexa for a complaint of insomnia and that SOB doctor said to me “don’t worry its safe” after I read the small print scary medical words on the package insert.

      All these quacks should be put on trial for crimes against humanity.

    • I went to a supposedly holistic, Christian, dream specialist psychologist. After two appointments, I was shipped to a psychiatrist and put on Rispedal for questioning the meaning of a dream (my dream was called “psychosis,” according to my medical records).

      When Risperdal caused an actual frightening psychotic episode, actually confessed in my medical records to be a “Foul up,” I was put on lithium, Seroquel, Zantac, Zyprexa, Provigil, Voltaren, Ultram, Geodon, Trileptal, Wellbutrin, Topomax, and Carbitrol. Check out the drugs.com major drug interaction warnings on those drugs.

      Apparently, when a person doesn’t react well to a psychiatric drug, the psychiatrists feel the need to poison their patients, to protect the reputation of their precious “wonder drugs.”

  2. The study found that about 40% of patients who’d been diagnosed with having psychotic experiences for the first time in their lives were being too heavily medicated right away.

    I saw what goes on in these hospitals. I think the worst is endured by people suffering paranoia getting stuck in the hospital with big ugly surveillance cameras in every room to be followed around by the techs with clip boards looking at them and wiring stuff down. No one ever explains they are just doing busy work charting patient locations on paper that’s never looked at by anyone.

    That same logic of those hospitals would treat arachnophobia by locking people in a room full of spiders.

    The reason I think people are being too heavily medicated right away is because the trauma of being a prisoner in one of psychiatry’s hell-holes is labelled ‘symptoms of the illness’ and then the “patient” is drugged into zombie oblivion, a condition they call ‘better’.

  3. Why to survivors even dignify conversations about the “proper” use of antisychotic drugs? Antipsychotics are poison, period. Even to someone who’s wildly irrational, prescribing them is no more civilized than hacking off the hands of a thief or gouging out the eyes of a peeping tom.
    “Psychiatry: Old fashioned 14th Century barbarity, prettied up for the 21st.”

    • Poisons? No!! You can’t be talking about these wildly popular toxins derived originally from parasite killing deworming pesticides??

      I agree with your comments completely. Not sure how their use can ever be justified, but it appears some people seem to advocate for or see a benefit in “selective, short-term use”.

      I have often wondered if there is a natural, plant-based concoction that has ever been used or proven to treat psychoses? I know there have been references to using niacin and vitamin C and fish oil….

  4. “The study found that about 40% of patients who’d been diagnosed with having psychotic experiences for the first time in their lives were being too heavily medicated right away.”
    They needed a study to determine that? And only 40%? I’d say all of them if you look at Open Dialogue outcomes – psychosis patients should not be medicated at all or if so at very low doses and short times.