Usually, but not always, initial treatment for an acute psychotic episode is provided in the hospital, where antipsychotics are initiated with the expectation of response. Ancillary medications (e.g., benzodiazepine or valproate acid) are often prescribed to reduce the severity of the patient’s
psychopathology. This acute illness phase often provides a window of opportunity for engaging the family.

“Response” merely signifies a reduction in symptoms severity, usually quantified as a percent decrease on a rating scale of psychopathology. While some response (e.g., a 20% reduction in psychopathology) is achieved by the majority of first-episode patients, even such small reductions in symptom severity can take several weeks in some patients (Emsley et al., 2006). Patience is required, and “pushing the dose” of the antipsychotic is unnecessary: You cannot accelerate the resolution of psychosis once dopamine receptors are sufficiently blocked; it takes time for a complex delusional system to resolve. Yet, in multiepisode patients, the greatest reduction in symptoms occurs in the first few weeks of treatment (Agid et al., 2003), and many patients show signs of response almost immediately after treatment is initiated (such as a reduction in excitability). A modern view of antipsychotic response rejects the idea of a delayed response. Instead, it posits an immediate action of antipsychotics with accrued benefits over time (Kapur et al., 2005).

During this illness phase, the main focus remains on symptoms. When patients are discharged, they are still rather symptomatic. However, given time (and assuming an antipsychotic-responsive form of schizophrenia), positive symptoms are expected to remit completely while other problems, particularly side effects, negative symptoms, and depression (postpsychotic depression), become the focus of treatment. For many first-episode patients, this early adjustment period following a psychiatric hospitalization will last anywhere from 3 months to 1 year.