1.2 Initiation of Treatment (First Episode) [61]

1.2.1 Early Referral

It is most likely that the first point of contact for people who may be developing schizophrenia for the first time will be a primary care professional. Rapid identification, early referral and good liaison with secondary services are a priority.

1.2.1.1 In primary care, all people with suspected or newly diagnosed schizophrenia should be referred urgently to secondary mental health services for assessment and development of a care plan. If there is a presumed diagnosis of schizophrenia then part of the urgent assessment should include an early assessment by a consultant psychiatrist. (GPP)

1.2.2 Early Intervention Services

1.2.2.1 Because many people with actual or possible schizophrenia have difficulty in getting help, treatment and care at an early stage, it is recommended that Early Intervention Services are developed to provide the correct mix of specialist pharmacological, psychological, social, occupational and educational interventions at the earliest opportunity. (GPP)

1.2.2.2 Where the needs of the service user and/or carer exceed the capacity of Early Intervention Services, referral to Crisis Resolution and Home Treatment Teams, Acute Day Hospitals or inpatient services should be considered. (GPP)

1.2.3 Early Treatment

1.2.3.1 Where there are acute symptoms of schizophrenia, the GP should consider starting atypical antipsychotic drugs at the earliest opportunity – before the individual is seen by a psychiatrist, if necessary. Wherever possible, this should be following discussion with a psychiatrist and referral should be a matter of urgency. (GPP)

1.2.4 Pharmacological Intervention

1.2.4.1 It is recommended that the oral atypical antipsychotic drugs amisulpride, olanzapine, quetiapine, risperidone and zotepine are considered in the choice of first-line treatments for individuals with newly diagnosed schizophrenia. (NICE 2002)

1.2.4.2 Atypical antipsychotics at the lower end of the standard dose range are the preferred treatments for a person experiencing a first episode of schizophrenia. (C)

1.2.5 Second Opinion

After the first episode, many people are unsure about their diagnosis and may need help with this.

1.2.5.1 A decision by the service user, and carer where appropriate, to seek a second opinion on the diagnosis should be supported, particularly in view of the considerable personal and social consequences of being diagnosed with schizophrenia. (GPP)