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Am Fam Physician. 2024;109(5):482-483

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Key Points for Practice

• Early intervention, family therapy, and supported employment services are important elements of care for first-episode psychosis.

• Schizophrenia is best managed in assertive community care models and can include aerobic activity, yoga, psychotherapy, and supported housing in addition to medication.

• Second-generation antipsychotic medications are the recommended medical therapy. Adverse effects vary, and changing medications can improve tolerability. 

• Clozapine is more effective for positive symptoms but should be reserved for treatment-resistant psychosis due to serious adverse effects, including agranulocytosis.

From the AFP Editors

First-episode psychosis commonly presents in males in their early to mid-20s and females in their late 20s and is often triggered by stress. First-episode psychosis can appear as a prodrome to schizophrenia, and management can improve the severity of psychiatric illness later in life. Schizophrenia is a neurodevelopmental disorder that impacts approximately 1% of the U.S. population. Schizophrenia presents with positive symptoms including perceptual distortions, such as hallucinations and delusions, and motor deficits and negative symptoms including diminished emotional expression and significant reduction in goal-directed activities. Negative symptoms are the most important predictor of poor long-term functioning. People with schizophrenia die an average of 15 years earlier than unaffected individuals. The U.S. Department of Veterans Affairs and U.S. Department of Defense (VA/DoD) published new recommendations for diagnosing and managing schizophrenia and first-episode psychosis.

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Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Michael J. Arnold, MD, Assistant Medical Editor.

A collection of Practice Guidelines published in AFP is available at

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