Evaluating the Efficacy of Medication-Assisted Treatment for First Episode Psychosis: A Scoping Review
Tracy McClinton, DNP, APRN, AGACNP-BC, EBP-C
Health and Medical Administration | Investigative Techniques | Medicine and Health Sciences | Mental and Social Health | Nursing | Nursing Administration | Psychiatric and Mental Health | Psychiatric and Mental Health Nursing | Public Health and Community Nursing | Quality Improvement | Substance Abuse and Addiction
The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends that individuals with substance use disorder (SUD) receive medicated-assisted treatment (MAT), as a complete approach to substance use treatment (SAMHSA, 2019). However, treatment measures using combination treatment for SUD in individuals experiencing first episode psychosis (FEP) are seldom used. This scoping review assesses the efficacy of MAT in conjunction with antipsychotics compared to the use of antipsychotic monotherapy for FEP individuals on hospital readmission rates.
The authors conducted a literature review utilizing PubMed, EBSCO, Elsevier, Google Scholar, PsychINFO, and Medline from August 2020 to November 2022. Key phrases in the database search included: first-episode psychosis, comorbid substance use, alcohol use disorder, cannabis use disorder, medication-assisted treatment, buprenorphine, methadone, and antipsychotics. Eligibility criteria included individuals experiencing psychosis defined by hallucination, delusion, or paranoia symptoms with co-occurring substance use. Inclusion criteria include publication within the past five years, English or available English translation, full text, institutional review board-approved, and peer-reviewed. Ultimately, we selected ten articles for this scoping review.
The ten articles demonstrated improvement of psychotic symptoms but showed mixed results in hospital readmission rates after combination therapy. The most notable restriction for this review was the paucity of published literature on MAT for FEP and comorbid substance use. Of the literature reviewed, patients experiencing comorbid FEP and SUDs were vulnerable to poor outcomes due to the illnesses, limited treatment options targeting both symptoms, and poor retention rates in MAT programs.
Implications for Nursing Practice
This scoping review highlights the treatment of comorbid SUD and FEP with the use of MAT to potentially reduce hospital readmission rates. There was insufficient evidence to outline targeted treatment regimens for our patient population; therefore, more research is needed in this area.
Thomas, Chanel MSN, APRN, FNP-BC, RN-BC; Wittenberg, Alexandra BSN, RN-BC; Anderson, Anttrenika BSN, RN; and McClinton, Tracy DNP, APRN, AGACNP-BC, EBP-C , "Evaluating the Efficacy of Medication-Assisted Treatment for First Episode Psychosis: A Scoping Review" (2023). Doctor of Nursing Practice Projects. Paper 71. http://dx.doi.org/10.21007/con.dnp.2023.0071.
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