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Achieving recovery in psychotic disorders with comprehensive clinical guidelines 

Only a minority of individuals with a first episode of psychosis achieve a full functional recovery. This proposal consists of six work packages, each will address a key neglected area in psychotic disorders and will culminate into revised, holistic and comprehensive clinical guidelines. Work-package:1 will develop a co-designed supported decision-making application for the choice of first antipsychotic medication. It is hypothesised that this increase in autonomy of clinical decision-making for a service user will result in greater satisfaction and improved outcomes. Work-package:2 aims to prevent the weight gain and metabolic complications associated with antipsychotic medications by proactively using medications such as metformin and Glucagon-like-peptide1-receptor agonists. If effective, training packages and guidelines on their use will be co-developed. Work-package:3 will address the delays and barriers to the commencement of clozapine for treatment-resistant psychosis by co-developing guidelines and a pilot service for the community initiation of clozapine and point-of-care testing for blood tests. The prescribing needs differ for females before and after the menopause, as oestrogen can increase the effectiveness of certain antipsychotic medications. Therefore, lower doses are required prior to the peri-menopause and higher doses afterwards, yet this is not reflected in current guidelines, leading to high rates of relapse for females. Work-package:4 will determine the optimal prescribing for females across the lifespan and whether hormone-replacement therapy can reduce relapse. Some nutritional supplements are effective in reducing negative symptoms and cognitive deficits, which are highly prevalent and underpin the poor functional outcomes. Yet they are rarely prescribed. Work-package:5 will develop a screening protocol and evaluate a personalised medicine approach for adjunctive nutritional supplementation. Finally, there is no clear guidance on when and how to have a trial of discontinuation. Work-package:6 will co-develop and evaluate a clinical decision support system to identify individuals more likely to have a successful discontinuation.