Psych · General adult psychiatry — early psychosis pathway
First-episode psychosis
Also known as FEP · First episode psychosis · Early psychosis · Early intervention in psychosis · First-episode schizophrenia · Duration of untreated psychosis · DUP · Coordinated specialty care · OPUS · RAISE · NAVIGATE
Exam-exhaustive fellowship reference on the first-episode psychosis pathway — definition and DUP, organic exclusion, early intervention evidence (OPUS, RAISE), low-dose antipsychotic starts, family intervention, substance comorbidity, relapse prevention and maintenance duration after FEP, vocational recovery (IPS). Distinct from the full schizophrenia spectrum monograph. FRANZCP-primary, globally tagged.
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Meet the patient
A 19-year-old engineering student is brought in by his mother. Four months ago he stopped answering texts; then he stopped going to lectures. Six weeks of sleeping through the day and smoking cannabis nightly "to quieten the room." Tonight he told her the lecturers are broadcasting his thoughts on the tram — two voices, commenting on everything he does. He has not eaten today. He is staring at the corner of the room.[19][15]
Every registrar's first instinct: reach for the drug chart. Every examiner's first question: "What is the DUP, and what happens in the first 24 hours?" This topic is the answer to both.[1][5]
You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Psychiatry Fellowship fellowship atlas.
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- [1]Marshall M, Lewis S, Lockwood A, et al. Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review Arch Gen Psychiatry, 2005.PMID 16143729
- [2]Perkins DO, Gu H, Boteva K, et al. Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis Am J Psychiatry, 2005.PMID 16199825
- [3]Petersen L, Nordentoft M, Jeppesen P, et al. Improving 1-year outcome in first-episode psychosis: OPUS trial Br J Psychiatry Suppl, 2005.PMID 16055817
- [4]Bertelsen M, Jeppesen P, Petersen L, et al. Five-year follow-up of a randomized multicenter trial of intensive early intervention vs standard treatment for patients with a first episode of psychotic illness: the OPUS trial Arch Gen Psychiatry, 2008.PMID 18606949
- [5]Kane JM, Robinson DG, Schooler NR, et al. Comprehensive Versus Usual Community Care for First-Episode Psychosis: 2-Year Outcomes From the NIMH RAISE Early Treatment Program Am J Psychiatry, 2016.PMID 26481174
- [6]Correll CU, Galling B, Pawar A, et al. Comparison of Early Intervention Services vs Treatment as Usual for Early-Phase Psychosis: A Systematic Review, Meta-analysis, and Meta-regression JAMA Psychiatry, 2018.PMID 29800949
- [7]Kahn RS, Fleischhacker WW, Boter H, et al. Effectiveness of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: an open randomised clinical trial Lancet, 2008.PMID 18374841
- [8]Gardner DM, Murphy AL, O'Donnell H, et al. International consensus study of antipsychotic dosing Am J Psychiatry, 2010.PMID 20360319
- [9]Howes OD, Kapur S The dopamine hypothesis of schizophrenia: version III--the final common pathway Schizophr Bull, 2009.PMID 19325164
- [10]Robinson D, Woerner MG, Alvir JM, et al. Predictors of relapse following response from a first episode of schizophrenia or schizoaffective disorder Arch Gen Psychiatry, 1999.PMID 10078501
- [11]Zipursky RB, Menezes NM, Streiner DL Risk of symptom recurrence with medication discontinuation in first-episode psychosis: a systematic review Schizophr Res, 2014.PMID 23972821
- [12]Pharoah F, Mari J, Rathbone J, et al. Family intervention for schizophrenia Cochrane Database Syst Rev, 2010.PMID 21154340
- [13]Leucht S, Tardy M, Komossa K, et al. Antipsychotic drugs versus placebo for relapse prevention in schizophrenia: a systematic review and meta-analysis Lancet, 2012.PMID 22560607
- [14]Di Forti M, Quattrone D, Freeman TP, et al. The contribution of cannabis use to variation in the incidence of psychotic disorder across Europe (EU-GEI): a multicentre case-control study Lancet Psychiatry, 2019.PMID 30902669
- [15]Schoeler T, Petros N, Di Forti M, et al. Effects of continuation, frequency, and type of cannabis use on relapse in the first 2 years after onset of psychosis: an observational study Lancet Psychiatry, 2016.PMID 27567467
- [16]Wunderink L, Nieboer RM, Wiersma D, et al. Recovery in remitted first-episode psychosis at 7 years of follow-up of an early dose reduction/discontinuation or maintenance treatment strategy: long-term follow-up of a 2-year randomized clinical trial JAMA Psychiatry, 2013.PMID 23824214
- [17]Alvarez-Jimenez M, Priede A, Hetrick SE, et al. Risk factors for relapse following treatment for first episode psychosis: a systematic review and meta-analysis of longitudinal studies Schizophr Res, 2012.PMID 22658527
- [18]Killackey E, Allott K, Jackson HJ, et al. Individual placement and support for vocational recovery in first-episode psychosis: randomised controlled trial Br J Psychiatry, 2019.PMID 30251616
- [19]Galletly C, Castle D, Dark F, et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders Aust N Z J Psychiatry, 2016.PMID 27106681
- [20]Melle I, Larsen TK, Haahr U, et al. Reducing the duration of untreated first-episode psychosis: effects on clinical presentation Arch Gen Psychiatry, 2004.PMID 14757590