Long-term follow-up program combining medication, therapy, and family support for individuals experiencing hallucinations, delusions, and loss of contact with reality.
Indication
- Schizophrenia and schizoaffective disorder
- Assessment and treatment of first-episode psychosis
- Major depression and bipolar disorder with psychotic features
- Substance-induced psychotic conditions (symptoms persisting after substance cessation)
- Delusional disorder and brief psychotic disorder
- Clozapine evaluation in treatment-resistant psychosis cases
Preparation
- Detailed psychiatric assessment and risk analysis (harm to self/others)
- Substance use screening; medical (thyroid, B12, autoimmune, imaging) differential diagnostic tests
- Measurement of weight, blood pressure, lipids, and blood glucose before starting treatment
- ECG and QT interval assessment (for medication safety)
- Treatment plan and follow-up strategy together with family or caregiver
How it's performed
- First-episode psychosis is treated as early as possible; delay negatively affects prognosis
- Atypical antipsychotics such as risperidone, olanzapine, and aripiprazole are started at low doses based on indication
- Agitation management and short-term inpatient treatment are planned during acute periods if needed
- In first-episode psychosis, medication treatment is generally continued for 1-2 years after symptom resolution
- Long-acting injectable (depot) antipsychotics are considered for patients with poor treatment adherence
- Cognitive behavioral therapy, psychoeducation, and family-focused interventions are added to medication treatment
Post-procedure
- Weekly in the first weeks, then every 2-4 weeks, then regular follow-up
- Monitoring of metabolic/cardiac side effects with weight, blood glucose, lipid profile, prolactin, and ECG
- Symptom severity can be monitored with standardized scales (e.g., PANSS)
- Psychosocial rehabilitation for social functioning, work/school, and family life
- Initiation of clozapine in treatment-resistant cases with physician evaluation
Risks
- Antipsychotic-related weight gain, metabolic syndrome, elevated lipids and blood glucose
- Sedation, extrapyramidal symptoms (tremor, muscle stiffness), akathisia
- Tardive dyskinesia (movement disorders with long-term use)
- QT prolongation and rarely serious cardiac side effects
- High risk of relapse upon treatment discontinuation; do not stop medication without physician approval
- Suicidal thoughts — call 112 in an emergency or go to the nearest emergency department
FAQ
Does psychosis end with a single episode, or does it last a lifetime?
Some patients experience long periods of wellness after the first episode, while conditions such as schizophrenia generally require long-term follow-up. In first-episode psychosis, treatment is usually continued for 1-2 years after symptom resolution and then planned individually.
Do the medications 'sedate' a person or change their personality?
Antipsychotic medications aim to reduce symptoms (hallucinations, delusions); they do not change personality. Side effects such as sedation can usually be managed with dose adjustment. Side effects should be discussed openly with the physician.
Is family support really important?
Yes. Family psychoeducation and a home environment with low 'expressed emotion' significantly reduce relapse rates. Family is an important part of the treatment process.
Can it be treated without medication?
In schizophrenia and other psychotic disorders, medication is the cornerstone of treatment; psychotherapy alone is not sufficient in most cases. The treatment plan is always shaped together with the physician and informed consent.
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