Principles of treating psychosis Aims • • Facilitate recovery Prevent relapse - More relapse -> poorer short- and long-term outcomes - Improve function, quality of life and physical health - Prevent suicide To achieve aims • • • • • • • • • • • • Patient factors Psychotic disorder being treated Stage of illness - First episode - Recovery - Relapse Speed at which symptoms and signs resolve with treatment Mutiifaced treatment – patient factors - Over the first 5 years -> maximises recovery - Instill optimism in the patient - Ensure continuity and quality of care Psychological interventions - More effective at treating cognitive and negative symptoms Antipsychotic treatment - Positive and negative symptoms ➔ Oral regimes for first time psychosis ➔ Approach for recovery and relapse prevention ➔ Long acting injectable regimes ➔ Approach to therapy for treatment relapse ➔ Approach to clozapine therapy Strategies to monitor, prevent and address antipsychotic effects Strategies to maintain physical health Identification and treatment of comorbidities Support families, cares or significant others A relapse prevention strategy Schizophrenia Key Information • • • Most common psychotic disorder in Australia Usually arises between late teens and 30 years of age More common in males Management • • • • • See first episode of psychosis treatment Recovery and relapse prevention - Most people return to a productive life Managing negative symptoms - Responf poorly to most antipsychotics Relapse management Treatment resistant schizophrenia Treatment resistant schizophrenia Criteria • • • • • • Moderate or severe positive, negative or conigitve physosis for at least 12 weeks Modrate or severe functional impairment Monotherapy with at least two antipsyhcitcs given at adequate doses for at least 6 weeks Adherent to antipsytic therapy - Taken at least 80% of time - Check by ➔ Pill counts ➔ Blood concentration Ideally long acting injectables should be used for at least 4 months to confirm adherence and a achieve a steady state oncentration Rarely appropriate to increase above maximum dose to try to overcome treatment resistance Clozapine for shcizophernia • • At least one third of patients improve moderatetly after taking for 6 to 12 months For it to be offered, criteir amust be met and there is no contradications Using a clozapine • • Only a psychiatrist can perscrpe after a comprehensive assesmsnrt for suitability Check for: - Cardiovascular disease - Epilepsy - Hematoloeitc disorders ➔ Especially drug induced neutropenia - Other comobidies that contradicate use: ➔ Smoking ➔ Caffeine intake