Question: In patients experiencing a first episode of psychosis who misuse substances, what is the most effective intervention for improving patient outcomes?


No definite clinical implications may be made from the available evidence. Generally, there is a consensus that more randomised controlled trials (RCTs) of psychological interventions for patients with early psychosis and concurrent substance abuse or dependence are required. Some of the included studies also highlighted the difficulties in delivering interventions to this group of participants, so that this needs consideration in the study design.

Regarding pharmaceutical interventions, no RCTs were included in this BEST summary that exclusively included participants with first-episode psychosis and substance use disorder. The authors consistently noted that more RCTs, and new strategies, are needed to treat first-episode participants with substance use disorder. One author suggested that if clinicians are choosing between olanzapine and respiridone, the decision should be based upon factors other than symptom response and short-term substance misuse, as both medications appear to have equal efficacy.

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