Who needs antipsychotic medication in the earliest stages of psychosis? A reconsideration of benefits, risks, neurobiology and ethics in the era of early intervention

摘要: In recent years, early intervention services have attempted to identify people with a first episode of psychosis as possible, reducing the duration untreated and changing timing delivery interventions. The logic is based partly on accessing in more treatment responsive stage illness which psychosocial damage less extensive, remediating putatively active process neuroprogression that leads pathophysiological, symptomatic structural changes, hence improving functional outcomes. However, other areas health care, earlier identification new patients may mean different approaches are indicated. corollary detection sequence complexion strategies for has been revaluated. Examples include minimal effective dosage antipsychotic medication content With substantial reductions DUP now seen many services, clinical staging stepped care principles, it even possible immediate introduction not be necessary all cases, but potentially safer interventions, acceptable patients, such comprehensive intervention, constitute at least subgroup patients. this paper, we review theoretical background describe randomised controlled trial currently underway Early Psychosis Prevention Intervention Centre (EPPIC) Melbourne designed test outcomes response two treatments: intensive plus versus placebo. This theoretically pragmatically novel study will provide evidence whether alone sufficient specialised service, heuristic model. By experimentally manipulating psychosis, also methodologically strong effect delaying medication, well helping disentangle effects medications putative neurobiological processes associated brain changes symptom profiles phase psychotic disorders. carefully crafted satisfy critical ethical demands challenging research domain.