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I've been wondering of late about first episode patients. The diagnosis of schizophrenia is a lot easier after several relapses, which is exactly what you want to prevent. It's a lot harder to make the diagnosis based on the first episode of psychosis. It could be from substance abuse. It could be psychosis of extreme mania from bipolar disorder or it could be schizophrenia, A diagnosis usually isn't very clear especially if it is an insidious onset and not a complete psychosis. I know one psychiatrist specializing in treating first psychosis episode patients who doesn't mention schizophreia or bipolar to his patients. He focuses on the psychosis and the need to prevent another episode.
Substance abuse unfortunately is a common cause of psychosis, and whether the patient denies it or the drug test comes out negative, you can't rule it out. The question is "What do you do if the patient has a full recovery?" After a year or two many psychiatrists will reduce the dose of medication, maybe even take the patient off medication. A percentage of first episode patients never have another psychosis, or so they say. I have seen two adolescents here in Guelph who stopped taking their medication after a year or two and neither have relapsed three years later. The ones who were in psychosis because of substance abuse should do alright. Remove the substance abuse and it is very unlikely they will have another psychosis. Trouble is about 30% of first episode patients developing schizophrenia or bipolar are also engaged in significant substance abuse. So are their friends. Do you tell them to make new friends? Several years ago I was surprised to hear at a conference that reducing or eliminating medication after a year or two if the patient has a good recovery is a recommended practice. When you look at the consequences of relapse you wonder if the risk is worth it. I hope that psychiatrists are just reducing the dose to see if any symptoms return. As long as someone is taking some medication it will slow down a relapse, making it possible to prevent a full psychosis by quickly increasing the dose of medication again. From what I know it would be very irresponsible to take a psychosis patient completely off medication, even after a year of solid recovery. I don't know anyone who is very thrilled at the idea of taking medication for the rest of his or her life, unless it is a recreational drug. You have to wonder if people who engage in substance abuse really want to do that for the rest of their life. Like "get a life!" Typically an adolescent is pretty shook up by a psychosis. People don't recover overnight. Assuming they take their medication faithfully, they will usually recover after a first episode. So they feel like themselves again, they're back at school, they're getting along with their parents who are very glad to see the son or daughter they once knew again, and what would you do if you were in their shoes. You'd stop taking the medication because you don't need it anymore.
The copyright of the article First Psychosis - What's Right? in Schizophrenia is owned by . Permission to republish First Psychosis - What's Right? in print or online must be granted by the author in writing.
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