Table 2.
Treatment preferences for the six described cases
| Case A | Case B | Case C | Case D | Case E | Case E1 | Case F | |
|---|---|---|---|---|---|---|---|
| First-episode psychosis |
Prodrome/ultra-high risk | Negative and cognitive symptoms | Pregnancy | Treatment resistance | Treatment resistance, second trial | Metabolic syndrome | |
| Number of similar patients during the last 6 months, median (iqi) | 4 (2; 10) | 5 (3; 10) | 5 (3; 10) | 1 (0; 2) | 4 (2; 10) | 4 (2; 8) | |
| Antipsychotics | |||||||
| I would not use any | 13 (2.9) | 146 (32.2) | 28 (6.2) | 143 (31.5) | 4 (0.9) | 27 (5.9) | 7 (1.5) |
| Did not mark any | 11 (2.4) | 188 (41.4) | 86 (18.9) | 210 (46.3) | 96 (21.2) | 0 (0) | 105 (23.1) |
| Monotherapy | 184 (40.5) | 149 (32.8) | 223 (49.1) | 217 (47.8) | 225 (49.6) | 0 (0) | 215 (47.4) |
| Two antipsychotics | 105 (23.1) | 46 (10.1) | 64 (14.1) | 20 (4.4) | 79 (17.4) | 155 (25.3) | 75 (16.54) |
| Three or more | 154 (33.5) | 71 (15.6) | 81 (17.8) | 7 (1.54) | 54 (11.9) | 339 (74.7) | 59 (13) |
| Amisulpiride | 34 (7.5) | 24 (5.3) | 41 (9.0) | 0 (.) | 17 (3.7) | 24 (5.3) | 15 (3.3) |
| Aripiprazole | 190 (41.9) | 143 (31.5) | 179 (39.4) | 200 (44.1) | 40 (8.8) | 26 (5.7) | 264 (58.1) |
| Aripiprazole – LAI | 24 (5.3) | 7 (1.5) | 12 (2.6) | 5 (1.1) | 64(14.1) | 15 (3.3) | 24 (5.3) |
| Asenapine | 1 (0.2) | 1 (0.2) | 0 (.) | 0 (.) | 1 (0.2) | 1 (0.2) | 2 (0.4) |
| Brexpiprazole | 23 (5.1) | 10 (2.2) | 29 (6.4) | 0 (.) | 2 (0.4) | 2 (0.4) | 22 (4.8) |
| Cariprazine | 46 (10.1) | 43 (9.5) | 129(28.4) | 2 (0.4) | 18 (4.0) | 24 (5.3) | 73 (16.1) |
| Chlorpromazine | 6 (1.3) | 3 (0.7) | 1 (0.2) | 0 (.) | 0 (.) | 1 (0.2) | 0 (.) |
| Clozapine | 15 (3.3) | 4 (0.9) | 5 (1.1) | 6 (1.3) | 160(35.2) | 211 (46.5) | 1 (0.2) |
| Flupentixol | 4 (0.9) | 8 (1.8) | 1 (0.2) | 2 (0.4) | 2 (0.4) | 2 (0.4) | 2 (0.4) |
| Flupentixol depot | 1 (0.2) | 0 (.) | 2 (0.4) | 0 (.) | 4 (0.9) | 1 (0.2) | 0 (.) |
| Fluphenazine | 8 (1.8) | 1 (0.2) | 3 (0.7) | 0 (.) | 3 (0.7) | 4 (0.9) | 1 (0.2) |
| Depot fluphenazine decanoate | 1 (0.2) | 0 (.) | 0 (.) | 0 (.) | 6 (1.3) | 1 (0.2) | 0 (.) |
| Haloperidol | 44 (9.7) | 3 (0.7) | 5 (1.1) | 17 (3.7) | 25 (5.5) | 35 (7.7) | 7 (1.5) |
| Haloperidol depot | 5 (1.1) | 0 (.) | 1 (0.2) | 0 (.) | 10 (2.2) | 11 (2.4) | 0 (.) |
| Levomepromazine | 3 (0.7) | 2 (0.4) | 1 (0.2) | 0 (.) | 0 (.) | 2 (0.4) | 0 (.) |
| Loxapine | 0 (.) | 0 (.) | 0 (.) | 0 (.) | 0 (.) | 0 (.) | 0 (.) |
| Lurasidone | 23 (5.1) | 19 (4.2) | 38 (8.4) | 2 (0.4) | 5 (1.1) | 10 (2.2) | 49 (10.8) |
| Olanzapine | 222 (48.9) | 80 (17.6) | 31 (6.8) | 17 (3.7) | 34 (7.5) | 27 (5.9) | 16 (3.5) |
| Olanzapine – LAI | 7 (1.5) | 1 (0.2) | 1 (0.2) | 0 (.) | 15 (3.3) | 2 (0.4) | 0 (.) |
| Paliperidone | 42 (9.3) | 10 (2.2) | 17 (3.7) | 1 (0.2) | 18 (4.0) | 11 (2.4) | 15 (3.3) |
| Paliperidone – LAI | 20 (4.4) | 3 (0.7) | 13 (2.9) | 0 (.) | 50 (11.0) | 24 (5.3) | 5 (1.1) |
| Perphenazine | 1 (0.2) | 0 (.) | 0 (.) | 0 (.) | 0 (.) | 0 (0.0) | 0 (.) |
| Promazine | 5 (1.1) | 0 (.) | 1 (0.2) | 0 (.) | 0 (.) | 0 (0.0) | 1 (0.2) |
| Quetiapine | 54 (11.9) | 97 (21.4) | 30 (6.6) | 22 (4.8) | 11 (2.4) | 15 (3.3) | 17 (3.7) |
| Risperidone | 222 (48.9) | 56 (12.3) | 107(23.6) | 5 (1.1) | 65 (14.3) | 50 (11.0) | 41 (9.0) |
| Risperidone – LAI | 17 (3.7) | 4 (0.9) | 7 (1.5) | 0 (.) | 32 (7.0) | 16 (3.5) | 3 (0.7) |
| Sertindole | 0 (.) | 0 (.) | 0 (.) | 0 (.) | 0 (.) | 0 (.) | 0 (.) |
| Sulpiride | 1 (0.2) | 6 (1.3) | 4 (0.9) | 0 (.) | 1 (0.2) | 2 (0.4) | 0 (.) |
| Ziprasidone | 9 (2.0) | 6 (1.3) | 4 (0.9) | 0 (.) | 2 (0.4) | 3 (0.7) | 24 (5.3) |
| Zuclopenthixol | 9 (2.0) | 3 (0.7) | 1 (0.2) | 0 (.) | 6 (1.3) | 9 (2.0) | 2 (0.4) |
| Zuclopenthixol depot | 2 (0.4) | 1 (0.2) | 0 (.) | 0 (.) | 7 (1.5) | 7 (1.5) | 0 (.) |
| Other pharmacotherapy | |||||||
| I would not apply any | 165 (36.3) | 44 (9.7) | 124 (27.3) | 329 (72.5) | 217(47.8) | 208 (45.8) | 216 (47.6) |
| Agomelatine | 1 (0.2) | 9 (2.0) | 10 (2.2) | 0 (.) | 0 (.) | 454 (100.0) | 0 (.) |
| Bupropion | 1 (0.2) | 17 (3.7) | 11 (2.4) | 1 (0.2) | 0 (.) | 1 (0.2) | 3 (0.7) |
| Citalopram | 3 (0.7) | 31 (6.8) | 24 (5.3) | 0 (.) | 1 (0.2) | 2 (0.4) | 1 (0.2) |
| Duloxetine | 5 (1.1) | 20 (4.4) | 26 (5.7) | 1 (0.2) | 3 (0.7) | 2 (0.4) | 3 (0.7) |
| Escitalopram | 11 (2.4) | 131(28.9) | 99 (21.8) | 4 (0.9) | 4 (0.9) | 8 (1.8) | 2 (0.4) |
| Fluvoxamine | 2 (0.4) | 24 (5.3) | 9 (2.0) | 1 (0.2) | 3 (0.7) | 1 (0.2) | 2 (0.4) |
| Mianserin | 2 (0.4) | 5 (1.1) | 3 (0.7) | 0 (.) | 1 (0.2) | 3 (0.7) | 0 (.) |
| Mirtazapine | 13 (2.9) | 43 (9.5) | 27 (5.9) | 1 (0.2) | 4 (0.9) | 5 (1.1) | 0 (.) |
| Nefazodone | 0 (.) | 0 (.) | 1 (0.2) | 0 (.) | 0 (.) | 0 (0.0) | 0 (.) |
| Paroxetine | 4 (0.9) | 36 (7.9) | 13 (2.9) | 0 (.) | 1 (0.2) | 1 (0.2) | 0 (.) |
| Sertraline | 15 (3.3) | 123 (27.1) | 99 (21.8) | 2 (0.4) | 4 (0.9) | 9 (2.0) | 1 (0.2) |
| Trazadone | 20 (4.4) | 32 (7.0) | 15 (3.3) | 1 (0.2) | 4 (0.9) | 4 (0.9) | 2 (0.4) |
| Venlafaxine | 7 (1.5) | 48 (10.6) | 38 (8.4) | 1 (0.2) | 2 (0.4) | 4 (0.9) | 1 (0.2) |
| Vortioxetine | 2 (0.4) | 31 (6.8) | 44 (9.7) | 1 (0.2) | 1 (0.2) | 3 (0.7) | 2 (0.4) |
| Alprazolam | 25 (5.5) | 44 (9.7) | 13 (2.9) | 2 (0.4) | 12 (2.6) | 8 (1.8) | 4 (0.9) |
| Diazepam | 79 (17.4) | 43 (9.5) | 9 (2.0) | 12 (2.6) | 34 (7.5) | 25 (5.5) | 14 (3.1) |
| Flurazepam | 3 (0.7) | 7 (1.5) | 0 (.) | 0 (.) | 0 (.) | 3 (0.7) | 0 (.) |
| Lorazepam | 127 (28.0) | 38 (8.4) | 16 (3.5) | 5 (1.1) | 38 (8.4) | 30 (6.6) | 10 (2.2) |
| Nitrazepam | 2 (0.4) | 2 (0.4) | 0 (.) | 0 (.) | 0 (.) | 1 (0.2) | 1 (0.2) |
| Oxazepam | 10 (2.2) | 10 (2.2) | 3 (0.7) | 2 (0.4) | 3 (0.7) | 2 (0.4) | 2 (0.4) |
| Zolpidem | 26 (5.7) | 18 (4.0) | 2 (0.4) | 1 (0.2) | 4 (0.9) | 4 (0.9) | 4 (0.9) |
| Zopiclone | 19 (4.2) | 18 (4.0) | 4 (0.9) | 2 (0.4) | 10 (2.2) | 6 (1.3) | 3 (0.7) |
| Carbamazepine | 8 (1.8) | 5 (1.1) | 1 (0.2) | 0 (.) | 6 (1.3) | 8 (1.8) | 1 (0.2) |
| Clonazepam | 29 (6.4) | 10 (2.2) | 6 (1.3) | 0 (.) | 13 (2.9) | 13 (2.9) | 2 (0.4) |
| Gabapentin | 1 (0.2) | 1 (0.2) | 1 (0.2) | 0 (.) | 0 (.) | 3 (0.7) | 1 (0.2) |
| Lamotrigine | 10 (2.2) | 43 (9.5) | 16 (3.5) | 3 (0.7) | 12 (2.6) | 21 (4.6) | 1 (0.2) |
| Lithium | 5 (1.1) | 20 (4.4) | 4 (0.9) | 0 (.) | 7 (1.5) | 24 (5.3) | 1 (0.2) |
| Oxcarbamazepine | 1 (0.2) | 3 (0.7) | 0 (.) | 0 (.) | 2 (0.4) | 3 (0.7) | 0 (.) |
| Pregabalin | 3 (0.7) | 10 (2.2) | 1 (0.2) | 0 (.) | 5 (1.1) | 5 (1.1) | 3 (0.7) |
| Sodium valproate | 9 (2.0) | 18 (4.0) | 4 (0.9) | 0 (.) | 18 (4.0) | 35 (7.7) | 0 (.) |
| Topiramate | 1 (0.2) | 1 (0.2) | 0 (.) | 0 (.) | 1 (0.2) | 1 (0.2) | 11 (2.4) |
| Metformin | 0 (.) | 0 (.) | 0 (.) | 0 (.) | 5 (1.1) | 5 (1.1) | 72 (15.9) |
| Other (Omega–3, vitamin D, supplements) | 32 (7.0) | 35 (7.7) | 28 (6.2) | 23 (5.1) | 25 (5.5) | 21 (4.6) | 35 (7.7) |
| Other | 18 (4.0) | 20 (4.4) | 7 (1.5) | 5 (1.1) | 12 (2.6) | 15 (3.3) | 7 (1.5) |
| Socio and psychotherapy | |||||||
| Cognitive behavioural therapy | 135 (29.7) | 273(60.1) | 181(39.9) | 110 (24.2) | 118(26.0) | 89 (19.6) | |
| Integrative psychotherapy | 25 (5.5) | 25 (5.5) | 25 (5.5) | 25 (5.5) | 25 (5.5) | 25 (5.5) | |
| Psychodynamic psychotherapy | 14 (3.1) | 34 (7.5) | 23 (5.1) | 13 (2.9) | 13 (2.9) | 8 (1.8) | |
| Systemic therapy | 10 (2.2) | 14 (3.1) | 13 (2.9) | 17 (3.7) | 13 (2.9) | 9 (2.0) | |
| Family therapy | 106 (23.3) | 74 (16.3) | 76 (16.7) | 100 (22.0) | 76 (16.7) | 38 (8.4) | |
| Trauma-focused therapy | 5 (1.1) | 4 (0.9) | 2 (0.4) | 1 (0.2) | 2 (0.4) | 454 (100.0) | |
| Acceptance and commitment therapy | 41 (9.0) | 23 (5.1) | 38 (8.4) | 24 (5.3) | 34 (7.5) | 19 (4.2) | |
| Client-centred therapy and supportive therapy | 85 (18.7) | 89 (19.6) | 83 (18.3) | 103 (22.7) | 88 (19.4) | 58 (12.8) | |
| Other psychotherapy | 25 (5.5) | 29 (6.4) | 34 (7.5) | 34 (7.5) | 28 (6.2) | 15 (3.3) | |
| Psychoeducation | 332 (73.1) | 272(59.9) | 287(63.2) | 246 (54.2) | 263(57.9) | 230 (50.7) | |
| Cognitive remediation therapy | 34 (7.5) | 34 (7.5) | 61 (13.4) | 14 (3.1) | 41 (9.0) | 13 (2.9) | |
| Metacognitive training | 46 (10.1) | 45 (9.9) | 54 (11.9) | 12 (2.6) | 48 (10.6) | 17 (3.7) | |
| Social skills training | 125 (27.5) | 87 (19.2) | 119(26.2) | 32 (7.0) | 115(25.3) | 48 (10.6) | |
| Occupational therapy | 119 (26.2) | 75 (16.5) | 124(27.3) | 31 (6.8) | 107(23.6) | 39 (8.6) | |
| Creative therapies (art therapy, music therapy) | 103 (22.7) | 97 (21.4) | 118(26.0) | 53 (11.7) | 90 (19.8) | 37 (8.1) | |
| Body and movement therapy | 35 (7.7) | 53 (11.7) | 44 (9.7) | 26 (5.7) | 25 (5.5) | 75 (16.5) | |
| Lifestyle recommendations (diet, sleep, smoking, alcohol, drugs, and physical activity) | 251 (55.3) | 209 (46.0) | 240 (52.9) | 231 (50.9) | 209 (46.0) | 268 (59.0) | |
| Structured physical health training programme (exercise) | 71 (15.6) | 81 (17.8) | 106 (23.3) | 41 (9.0) | 75 (16.5) | 143 (31.5) | |
| I would not apply any | 18 (4.0) | 5 (1.1) | 8 (1.8) | 16 (3.5) | 17 (3.7) | 7 (1.5) | |
| Other therapies (will probably or certainly use) | |||||||
| Electro-convulsive therapy | 94 (20.7) | 13 (3.2) | 9 (2.3) | 8 (2.1) | 89 (24.6) | 1 (0.3) | |
| Transcranial magnetic stimulation | 17 (3.7) | 45 (11.1) | 37 (9.4) | 12 (3.2) | 28 (7.7) | 7 (2.0) | |
| Long-acting injectable antipsychotics/depot | 238 (52.4) | 50 (12.3) | 96 (24.4) | 9 (2.4) | 263 (72.7) | 67 (18.9) | |
| Hospital treatment | 348 (76.7) | 97 (23.8) | 55 (14.0) | 15 (3.9) | 21 (5.9) | ||
| Community mental health service as the only setting | 147 (32.4) | 178 (43.7) | 197 (50.1) | 186 (48.9) | 181 (51.0) | ||
| Peer groups | 168 (37.0) | 160 (39.3) | 194 (49.4) | ||||
| Employment service (individual placement and support) | 183 (40.3) | 110 (27.0) | 170 (43.3) | ||||
| Professional rehabilitation service | 215 (47.4) | 137 (33.7) | 193 (49.1) | ||||
| Therapeutic drug monitoring | 269 (59.3) | 188 (46.2) | 200 (50.9) | 181 (47.6) | 272 (75.1) | 181 (51.0) | |
| Screening for illegal drugs | 296 (65.4) | 265 (65.1) | 182 (46.3) | 239 (66.0) | 110 (31.0) |
Abbreviations: LAI - long-acting injectable.