The Recovery After an Initial Schizophrenia Episode–Early Treatment Program compared NAVIGATE, a comprehensive program for first-episode psychosis, to clinician-choice community care over 2 years. Quality of life and psychotic and depressive symptom outcomes were found to be better with NAVIGATE. Compared with previous comprehensive first-episode psychosis interventions, NAVIGATE medication treatment included unique elements of detailed first-episode-specific psychotropic medication guidelines and a computerized decision support system to facilitate shared decision making regarding prescriptions. In the present study, the authors compared NAVIGATE and community care on the psychotropic medications prescribed, side effects experienced, metabolic outcomes, and scores on the Adherence Estimator scale, which assesses beliefs related to nonadherence.

Prescription data were obtained monthly. At baseline and at 3, 6, 12, 18, and 24 months, participants reported whether they were experiencing any of 21 common antipsychotic side effects, vital signs were obtained, fasting blood samples were collected, and the Adherence Estimator scale was completed.

Over the 2-year study period, compared with the 181 community care participants, the 223 NAVIGATE participants had more medication visits, were more likely to receive a prescription for an antipsychotic and more likely to receive one conforming to NAVIGATE prescribing principles, and were less likely to receive a prescription for an antidepressant. NAVIGATE participants experienced fewer side effects and gained less weight; other vital signs and cardiometabolic laboratory findings did not differ between groups. Adherence Estimator scores improved in the NAVIGATE group but not in the community care group.

As part of comprehensive care services, medication prescription can be optimized for first-episode psychosis, contributing to better outcomes with a lower side effect burden than standard care.

最初的精神分裂症发作-早期治疗计划后的恢复将NAVIGATE（一项针对首发精神病的综合计划）与临床医师选择的社区护理进行了2年的比较。使用NAVIGATE可以改善生活质量以及精神病和抑郁症状的结局。与以前的综合性首发精神病干预措施相比，NAVIGATE药物治疗包括详细的首发特定性精神药物指南的独特元素和计算机化决策支持系统，以促进就处方制定共同的决策。在本研究中，作者比较了NAVIGATE和社区护理在所开的精神药物，所经历的副作用，代谢结果以及依从性估计量表上的得分，该评分评估了与非依从性有关的信念。

处方数据是每月获取的。在基线以及第3、6、12、18和24个月时，参与者报告他们是否正在经历21种常见的抗精神病药物副作用中的任何一种，是否获得生命体征，是否采集空腹血样以及是否完成了粘附力估计量表。

在为期2年的研究期内，与181名社区护理参与者相比，223名NAVIGATE参与者进行了更多的药物就诊，更有可能接受抗精神病药的处方，并且更有可能接受一种符合NAVIGATE处方原则的药物，而且人数较少可能会收到抗抑郁药的处方。NAVIGATE参与者的副作用更少，体重减轻了；两组之间其他生命体征和心脏代谢实验室检查结果无差异。在NAVIGATE组中，依从性评估器得分有所提高，但在社区护理组中则没有。

作为综合护理服务的一部分，可以针对首发性精神病优化药物处方，与标准护理相比，可带来更好的结果，并且副作用负担更低。