Pharmacologic treatment of first-episode schizophrenia: Early interventionis key to outcome

The early recognition and management of a first episode of schizophrenic il lness is a difficult task, with identification complicated by a broad diffe rential diagnosis, lack of definitive data on the prognostic implications o f premorbid/prodromal symptoms, and, until recently, treatment limited to p harmacologic agents with severe adverse effects. The first psychotic episod e in patients with schizophrenia is the most responsive to treatment in ter ms of both rate and degree. However, first-episode patients are also more l ikely to develop motor side effects, even at lower medication doses, than m ultiepisode patients. Considerable evidence supports the assertion that ear ly treatment can improve outcome and possibly prevent the development of fu ll-blown illness in high-risk individuals. There is evidence that atypical antipsychotic medications are effective in the treatment of first-episode s chizophrenia and are well tolerated. The improved tolerability associated w ith the newer antipsychotic medications, including a lower risk for motor s ide effects and possible lower risk for development of tardive dyskinesia, has swung the risk-benefit balance in favor of early and aggressive treatme nt. By intervening early and providing long-term maintenance treatment, the course of schizophrenic illness may be altered in the coming years with ov erall decreased deterioration and chronicity and overall improved functioni ng resulting in lower societal costs.