From first episode to long-term care: The need for sustained clinical commitment

There is considerable evidence to suggest that many patients experience dif ficulties in gaining access to treatment after the onset of significant sym ptoms and social disability. Delay in obtaining appropriate support and tre atment can have profound effects on both the patient and their family and m ay also be associated with a poorer long-term. outcome. As stated in the Pr inciples of Practice, prompt and comprehensive clinical assessment, by a cl inician experienced in the recognition and treatment of severe mental illne ss, is therefore important for achieving the best possible outcome for the patient. The primary objectives of early-stage treatment for schizophrenia are to achieve a full improvement in psychopathological symptoms and a reco very of premorbid levels of function. However, even with optimal treatment, the reality for many patients is that their symptoms and impairment contin ue. Many patients cart therefore be regarded as only partially responsive, or even resistant, to treatment. When assessing the utility of an antipsych otic treatment regimen for such patients, clinicians should not just consid er the objective manifestations of the disorder but also the subjective exp erience of the patient. Relapse of illness is also a common and serious pro blem for many patients with schizophrenia, despite continual treatment. Pre vention and management of relapse are two of the main challenges in the eff ective treatment of schizophrenia. The optimal use of antipsychotic treatme nt and the adherence by patients to that treatment offer valuable protectio n against relapse. Symptoms Of depression or low mood affect a high proport ion of patients with schizophrenia at some point in their illness and ave a lso associated with an increased risk of relapse. Treatment objectives in t he early stages may need to be modified if a pattern of partial response or resistance to treatment, a cycle of relapse of the illness or the presence of depressive symptoms, develops. Clinicians should continue to offer a su stained and positive clinical commitment to all.