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.