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.