NAMI Montana Mental Health Research Update: First-Episode Psychosis

July 20, 2023

NAMI Montana is committed to raising awareness and providing reliable information on mental health topics to support individuals and their loved ones. In this week’s research update, we are highlighting three peer-reviewed studies that examine different aspects of First-Episode Psychosis (FEP).

These articles are provided for informational purposes only and are not a substitute for professional medical advice. We encourage individuals and families to work closely with qualified clinicians and healthcare providers to determine the most appropriate treatment and support options for their specific situation.

The goal of sharing this research is to support understanding and encourage informed conversations between individuals, families, and care teams.

Study 1

Efficacy and Safety of Second-Generation vs. First-Generation Antipsychotics in First-Episode Psychosis

Citation
Zhang JP, Gallego JA, Robinson DG, Malhotra AK, Kane JM, Correll CU. (2013). Efficacy and safety of individual second-generation vs. first-generation antipsychotics in first-episode psychosis: A systematic review and meta-analysis.
International Journal of Neuropsychopharmacology, 16(6), 1205–1218.

Key Findings (Summary)

• Early treatment choice is critical in first-episode schizophrenia-spectrum disorders.

• Certain second-generation antipsychotics (SGAs), particularly olanzapine and amisulpride, showed stronger efficacy compared to first-generation antipsychotics (FGAs).

• SGAs were associated with:

  • Lower treatment discontinuation

  • Fewer extrapyramidal symptoms (movement-related side effects)

  • Improved outcomes for negative symptoms and cognition

• However, some SGAs were linked to greater weight gain and metabolic side effects, highlighting important trade-offs in medication choice.

Takeaway
Second-generation antipsychotics may offer advantages in early psychosis treatment, but side-effect profiles must be carefully considered on an individual basis.

Study 2

Epigenetics and First-Episode Psychosis: A Systematic Review

Citation
Lockwood L, Miller B, Youssef NA. (2022). Epigenetics and first-episode psychosis: A systematic review.
Psychiatry Research, 307, 114325.

Key Findings (Summary)

• Early intervention in psychosis is associated with better clinical outcomes.

• This review examined epigenetic changes—biological modifications that influence gene expression—in people experiencing first-episode psychosis.

• Studies identified changes in DNA methylation patterns, particularly in genomic regions linked to stress response and brain signaling.

• Findings suggest that trauma history and substance use may influence biological pathways involved in early psychosis.

Takeaway
Although sample sizes were small, this research supports the idea that biological and environmental factors interact early in psychosis, reinforcing the importance of early, holistic intervention.

Study 3

Oxidative Stress and Inflammation in First-Episode Psychosis

Citation
Fraguas D, Díaz-Caneja CM, Ayora M, et al. (2019). Oxidative stress and inflammation in first-episode psychosis: A systematic review and meta-analysis.
Schizophrenia Bulletin, 45(4), 742–751.

Key Findings (Summary)

• Individuals experiencing first-episode psychosis showed:

  • Lower antioxidant levels

  • Higher levels of inflammatory markers

• Elevated markers included interleukin-6, tumor necrosis factor alpha, and homocysteine.

• These findings suggest a pro-inflammatory and pro-oxidative biological state early in psychosis.

Takeaway
Inflammation and oxidative stress may play a role in early psychosis and could represent future targets for treatment and prevention strategies.