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Am J Psychiatry. 2018 Feb 1;175(2):169-179. doi: 10.1176/appi.ajp.2017.16080919. Epub 2017 Sep 15.

Psychopharmacological Treatment in the RAISE-ETP Study: Outcomes of a Manual and Computer Decision Support System Based Intervention.

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From the Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, N.Y.; the Departments of Psychiatry and of Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, N.Y.; Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, N.Y.; the Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, N.Y.; the Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, N.Y.; the Department of Mathematics, Hofstra University, Hempstead, N.Y.; University of Texas Southwestern Medical Center, Dallas; and the Department of Psychiatry, University of Texas Health Science Center at San Antonio.



The Recovery After an Initial Schizophrenia Episode-Early Treatment Program compared NAVIGATE, a comprehensive program for first-episode psychosis, to clinician-choice community care over 2 years. Quality of life and psychotic and depressive symptom outcomes were found to be better with NAVIGATE. Compared with previous comprehensive first-episode psychosis interventions, NAVIGATE medication treatment included unique elements of detailed first-episode-specific psychotropic medication guidelines and a computerized decision support system to facilitate shared decision making regarding prescriptions. In the present study, the authors compared NAVIGATE and community care on the psychotropic medications prescribed, side effects experienced, metabolic outcomes, and scores on the Adherence Estimator scale, which assesses beliefs related to nonadherence.


Prescription data were obtained monthly. At baseline and at 3, 6, 12, 18, and 24 months, participants reported whether they were experiencing any of 21 common antipsychotic side effects, vital signs were obtained, fasting blood samples were collected, and the Adherence Estimator scale was completed.


Over the 2-year study period, compared with the 181 community care participants, the 223 NAVIGATE participants had more medication visits, were more likely to receive a prescription for an antipsychotic and more likely to receive one conforming to NAVIGATE prescribing principles, and were less likely to receive a prescription for an antidepressant. NAVIGATE participants experienced fewer side effects and gained less weight; other vital signs and cardiometabolic laboratory findings did not differ between groups. Adherence Estimator scores improved in the NAVIGATE group but not in the community care group.


As part of comprehensive care services, medication prescription can be optimized for first-episode psychosis, contributing to better outcomes with a lower side effect burden than standard care.



Antipsychotics; Medication Adherence; Metabolic Outcomes; Psychosis; Schizophrenia; Side Effects

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