Background
Antipsychotic medications are the first line treatment in the management of a first episode of psychosis (FEP).
While randomised controlled trials have been essential to determining the effectiveness of these medications,
participants in trials are not reflective of the typical clinical presentation, which can involve substance use,
involuntary treatment and poor adherence to medication. Furthermore, clinical trials have short follow-up periods
and the recommended maintenance treatment for a psychotic disorder is up to five years. Therefore,
representative longitudinal cohort studies can address current gaps in the knowledge in this area.
Aims
This project will address three broad areas on the use of antipsychotic medications. First, the real-world response
rates and predictors of response to each trial of antipsychotic medication will be determined. Second, the rates,
reasons for, predictors and outcomes of discontinuation of antipsychotic medication will be determined. Third, the
potential for pharmacogenetic testing and therapeutic drug monitoring to optimise treatment response and
tolerability will be examined.
Methods
A large, representative cohort dataset consisting of 1220 consecutive cases of treated FEP in young people aged
15 to 24 who attended the Early Psychosis Prevention and Intervention Service in Melbourne will be used to
assess these studies aims. This dataset contains an extensive battery of assessments at baseline; 3 monthly
assessments of symptoms and medication use over two years.
Potential to inform policy and practice
Importantly this dataset covers both Child & Adolescent and General Adult age categories and there is a dearth of
knowledge on the use of antipsychotic medications in those under 18. These research questions will help inform
the delivery and roll out of early intervention for psychosis services across Ireland. The findings will also inform the
Irish Clinical Guidelines for the Management of Psychosis which are currently being developed by our group.
