Evidence mapPaperPMID 41793755Full record

GuidelineSchizophrenia bulletin2026

Clinical Practice Guideline on the Choice of First Antipsychotic Medicine for Females Experiencing a First-Episode of Psychosis.

Caroline Hynes-Ryan, Dolores Keating, Aoife Carolan, Bodyl Brand, Paola Dazzan, Fiona Gaughran, Margaret Hahn, Sean Halstead, Sophie Mae Harrington, Yvonne Hartnett and 8 more

Abstract readPractice Guideline
In one paragraph

Guideline in Schizophrenia bulletin, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it.

  1. Guideline
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors.

Caroline Hynes-RyanPharmacy Department And Research and Innovation Hub, St John of God University Hospital, Dublin A94 FH92, Ireland.
Dolores KeatingPharmacy Department And Research and Innovation Hub, St John of God University Hospital, Dublin A94 FH92, Ireland.
Aoife CarolanPharmacy Department And Research and Innovation Hub, St John of God University Hospital, Dublin A94 FH92, Ireland.ORCID 0000-0003-0821-1489
Bodyl BrandDepartment of Psychiatry, University of Oxford, Oxford OX3 7JX, United Kingdom.
Paola DazzanDepartment of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, SE5 8AB, United Kingdom.
Fiona GaughranNational Psychosis Unit, South London and Maudsley NHS Foundation Trust, London BR3 3BX, United Kingdom.
Margaret HahnInstitute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, M5 S1A8, Canada.
Sean HalsteadMetro South Addiction and Mental Health Service, Brisbane, QLD 4109, Australia.ORCID 0009-0000-4890-3506
Sophie Mae HarringtonSpunout, Dublin D02 T883, Ireland.
Yvonne HartnettSchool of Medicine, University College Dublin, Dublin D04 V1W8, Ireland.
Ian KelleherCentre for Clinical Brain Sciences, Division of Psychiatry; University of Edinburgh, Edinburgh EH16 4SB, United Kingdom.
John LyneRCSI University of Medicine and Health Sciences, Dublin D02 P796, Ireland.
Fiona McNicholasDepartment of Psychiatry, School of Medicine, University College Dublin, Dublin D04 V1W8, Ireland.
Karen O'ConnorRISE Early Intervention in Psychosis Service, South Lee Mental Health Services, Cork T12 YEO2, Ireland.
Benjamin PerryInstitute for Mental Health, University of Birmingham, Birmingham, B15 2TT, United Kingdom.
Ewa SadowskaDepartment of Psychiatry, School of Medicine, University College Dublin, Dublin D04 V1W8, Ireland.
Brian O'DonoghueDepartment of Psychiatry, School of Medicine, University College Dublin, Dublin D04 V1W8, Ireland.ORCID 0000-0001-6240-6952
Iris E SommerCenter for Clinical Neuroscience and Cognition, University Medical Center Groningen, RijksUniversiteit Groningen, Groningen, 9700 RB, The Netherlands.

Funding

Australian Research Training Program scholarship RANZCP Foundation Partners PhD scholarshipHealth Research Board APRO-2023-005
6 · The paper itself

Abstract

backgroundEarly intervention in first-episode psychosis (FEP) is critical for long-term outcomes with antipsychotic medicines among the primary treatment options. However, existing clinical practice guidelines (CPGs) do not provide sex-specific recommendations, despite females experiencing distinct vulnerabilities to antipsychotic side-effects. In particular, hyperprolactinemia and cardiometabolic side-effects are associated with substantial subjective distress and potential long-term physical health risks for females across the reproductive lifespan. We aimed therefore to develop a CPG on the preferred antipsychotic medicines for females experiencing FEP. STUDY

designAn international multidisciplinary panel, including experts-by-experience, used the GRADE-ADOLOPMENT process and AGREE II framework to adapt existing FEP guidelines for adults and adolescents. Key health questions were developed through stakeholder consultation and literature review. Critically important patient outcomes were prioritized, and evidence was synthesized on side-effect profiles, with recommendations agreed by consensus. The guideline algorithm was field-tested and externally reviewed by experts. STUDY

resultsProlactin-elevation and cardiometabolic side-effects were prioritized in antipsychotic medicine selection for females. Medicines with higher risks-first-generation antipsychotics, olanzapine, quetiapine, risperidone, paliperidone, and amisulpride-are not recommended first-line. Aripiprazole is recommended as the preferred first-choice due to its consistently favorable prolactin and cardiometabolic profile. Alternative options with low or low-to-medium risk profiles are recommended for adults and adolescents, supported by shared decision-making tools.

conclusionsThis is the first CPG addressing antipsychotic choice for females with FEP. By prioritizing critically important patient outcomes and lived experience, the guideline supports safer, sex-sensitive prescribing for females that may improve treatment acceptability, adherence, and equity in psychosis care.

Indexed as

Antipsychotic AgentsClinical Decision-MakingEarly Medical InterventionHyperprolactinemiaPractice Guidelines as TopicPsychotic DisordersAdolescentAdultFemaleHumansAntipsychotic Agentsantipsychotic medicinefemalefirst-episode psychosispatient-centered careshared decision-making

Identifiers

PMID41793755
PMCPMC12967135

What Socratic holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.