Researchers at St John of God University Hospital’s Research & Innovation Hub, UCD Centre for Psychosis Research and University Medical Centre Groningen in the Netherlands have developed the first international clinical practice guideline specifically focused on the choice of first antipsychotic medicine for females experiencing a first episode of psychosis. The recommendations were developed by an international multidisciplinary panel of clinicians, researchers and experts-by- experience from Europe, North America and Australia. These guidelines are developed as part of the PROGRESS research group that has been funded by the Health Research Board.
Published recently in Schizophrenia Bulletin, the guideline responds to long- standing gaps in prescribing guidance, where sex-specific risks and side-effect profiles have not been adequately reflected in clinical recommendations. The recommendations are designed to support clinicians and patients to make safer, more personalised treatment choices at the earliest stage of care. Psychosis most commonly begins in early adulthood, with the median age of onset around 20 years. Symptom onset is often later in females, with a second peak after age 50. Early intervention at first onset is considered the gold standard of care, with antipsychotic medicines forming a key component of treatment alongside psychological, social, occupational and educational supports.
Caroline Hynes-Ryan, lead author and pharmacist at St John of God University Hospital, said: “First-episode prescribing is a crucial window to get treatment right. By prioritising outcomes that matter for females — particularly hormonal and cardiometabolic effects — this guideline helps clinicians
choose options with a lower long-term burden and supports females to stay on treatment that is both effective and acceptable.”
Prof Brian O’Donoghue, Director of the UCD Centre of Psychosis Research at the School of Medicine in UCD and lead of the PROGRESS group, said: “Response rates to antipsychotic medications are high and therefore the choice of first antipsychotic medication needs to be based on the expected side-effects and tolerability. There is a very real difference in side-effect vulnerability for females and therefore, these sex-specific guidelines should result in females being prescribed lower-risk medications from the outset and will have longer-term benefits for physical health. This guideline brings together international evidence and expert consensus to support safer first-choice antipsychotic medicine,
better shared decision-making, and more equitable care from day one.”
The guideline highlights that females can experience distinct vulnerabilities to certain antipsychotic side-effects — particularly hormonal disruption (including prolactin elevation) and cardiometabolic risk — with potential long-term implications for bone health, fertility and overall physical health.
