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.