The Navigate First Psychosis Program: A balance between the medical and recovery models in the debate about long term prophylactic antipsychotics. Mission Impossible?

Abstract

Introduction First psychosis programs have been developed during the past 30 years to influence the prognosis of a first psychotic episode by early integrative biopsychosocial interventions, with a focus on the processes that contribute to relapse. In the process of recovery, Navigate program emphasis on enabling a connection to what is important to the person (work, studies, relationships, intimacy), thus strengthening resiliency and quality of life and reducing self-stigma. Medication is part of any intervention program, however, there is a lot of ambivalence amongst the young person and family about its continuation and many will stop the medication altogether. Moreover, although evidence for the benefits of antipsychotic medication in short-term treatment is well established, there is an ongoing debate in the professional medical literature about the need and benefit of routine prophylactic long-term antipsychotics after first psychotic episode. There is also a significant uncertainty concerning the proportion of patients that will maintain remission without antipsychotics. Objectives In this lecture, we will present some of the lessons that we have learned and are still learning from our clients, together with case examples. Methods In our Navigate Program, we have developed strategies based on literature and experience that enables the person/family to be part of the decision-making process, which at times presents dilemmas and risks but also promotes the potential for growth and transformation. Results How do we talk about the medication issue? Who can continue without medication or with very low dosage? How can we taper antipsychotic treatment? Conclusions Are we willing to take the risk? Disclosure No significant relationships.

Keywords

• Navigate
• long term antipsychotic treatment
• shared decision making
• first psychosis