Psychosocial treatment, antipsychotic postponement, and low-dose medication strategies in first-episode psychosis: A review of the literature

Reconsidering medication-free research in early-episode schizophrenia prompts a review of acute psychosocial treatments using medication postponement protocols. We describe and compare the different psychosocial treatment approaches. Studies were included in the review if initial psychosocial treatment combined with a time-limited postponement of antipsychotics was compared to initial antipsychotic treatment using a quasi-experimental or better research design and reported outcomes of at least one year. Five studies were included (N=261), each reporting modestly better long-term outcomes than initial medication treatment, resulting in a composite small-medium effect-size advantage (r = 0.17). In addition, 27-43% of experimental patients were not receiving antipsychotics at the two-or three-year follow-up. These projects demonstrate the feasibility of a carefully supervised approach to medication-free research and also suggest a strategy for integrating biological, psychological and social treatment components in early-episode psychoses. Initial psychosocial treatment combined with a time-limited postponement of antipsychotic medications for eligible, non-dangerous, early-episode patients may facilitate a reduction in long-term medication dependence and the discrimination of similar but pathophysiologically different diagnostic entities. Rigorous evaluation in a randomized controlled trial designed to identify medication and psychosocial treatment-responsive subgroups of patients may contribute to diagnostic specificity and improved patient outcomes.