First-episode psychosis: lessons from 15 years of research

Dedicated research efforts over the last 15 years have produced significant findings on the early course of psychotic illness. We now know that patien ts may experience prodromal symptoms for many years before the onset of ill ness and may, even after the onset of frank psychosis, remain untreated for many months. Negative and cognitive symptoms are often less severe in the first episode. Mood symptoms are more prevalent in this population, whereas brain imaging shows similar, but less severe changes when compared to thos e in chronic schizophrenia. All symptoms respond better to and at lower dos es of medication, with increased sensitivity to side-effects. Second genera tion antipsychotics or low doses of typical antipsychotics, combined with t ailored psychotherapy, are emerging as the treatments of choice. High level s of remission are the role in first-episode psychosis, hut patients often become noncompliant with pharmacotherapy, leading to high levels of relapse in the first five years after diagnosis and initial treatment.