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Psychiatry"],"abstract":"<jats:p>The impact of timing of antipsychotics and benzodiazepine treatment during a first episode of psychosis on clinical outcomes is unknown. We present a RECORD-compliant electronic health record cohort study including patients (<jats:italic>n<\/jats:italic> = 4,483, aged 14\u201335) with a primary diagnosis of any non-organic ICD-10 first episode of psychosis at SLAM-NHS between 2007 and 2017. The impact of antipsychotic timing (prescription &amp;gt; 1 week after a first episode of psychosis) was assessed on the primary outcome (risk of any psychiatric inpatient admission over 6 years), and secondary outcomes (cumulative duration of any psychiatric\/medical\/accident\/emergency [A&amp;amp;E] admission over 6 years). The impact of prescribing benzodiazepine before antipsychotic at any point and of treatment patterns (antipsychotic alone, benzodiazepine alone, combination of antipsychotic with benzodiazepine) within the first week after a first episode of psychosis were also assessed. Survival analyses and zero-inflated negative binomial regressions, adjusted for core covariates, and complementary analyses were employed. Antipsychotic prescribed &amp;gt;1 week after a first episode of psychosis did not affect the risk of any psychiatric admission (HR = 1.04, 95% CI = 0.92\u20131.17, <jats:italic>p<\/jats:italic> = 0.557), but increased the duration of any psychiatric (22\u201328%), medical (78\u201335%) and A&amp;amp;E (30\u201334%) admission (months 12\u201372). Prescribing benzodiazepine before antipsychotic at any point did not affect the risk of any psychiatric admission (HR = 1.03, 95% CI = 0.94\u20131.13, <jats:italic>p<\/jats:italic> = 0.535), but reduced the duration of any psychiatric admission (17\u201324%, months 12\u201372), and increased the duration of medical (71\u201345%, months 12\u201372) and A&amp;amp;E (26\u201318%, months 12\u201336) admission. Prescribing antipsychotic combined with benzodiazepine within the first week after a first episode of psychosis showed better overall clinical outcomes than antipsychotic or benzodiazepine alone. Overall, delaying antipsychotic 1 week after a first episode of psychosis may worsen some clinical outcomes. Early benzodiazepine treatment can be considered with concomitant antipsychotic but not as standalone intervention.<\/jats:p>","DOI":"10.3389\/fpsyt.2022.976035","type":"journal-article","created":{"date-parts":[[2022,9,23]],"date-time":"2022-09-23T12:34:12Z","timestamp":1663936452000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Timing of antipsychotics and benzodiazepine initiation during a first episode of psychosis impacts clinical outcomes: Electronic health record cohort 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