Almost everywhere in the world, programs set up to do early intervention in psychosis rush to start people on antipsychotics. This is widely seen to be an evidence based practice: in fact, it is thought that the evidence is so strong, it would be unethical to withhold the drugs.
Many of us are aware that from a longer term perspective, the use of antipsychotics is likely making things worse instead of better. But we probably at least assume that evidence does exist that in short term studies, measured against placebo, people just recently diagnosed with psychosis will appear to do better on antipsychotics. However, a new review by John Bola, Dennis Kao, and Haluk Soydan, “Antipsychotic medication for early episode schizophrenia” shows that very few studies have even been done focusing specifically on early episode schizophrenia, and the evidence from those studies is inconclusive.
So the notion that everyone in an early episode needs antipsychotics is not evidence based, even for the short term.
The problem is that researchers have just been assuming that studies done with groups of people who mostly were not in an early episode could be generalized to apply to early episode groups. There is much reason however to think that early episode groups may be different in how they respond to medications on average.
So in this case, the emperor clearly has no clothes (well evidence in this case) and we can can start to ask the question, why have so many overlooked this lack of evidence for so long? What will it take to get more studies going that weigh medication use in early episodes versus competent psychosocial interventions?