Hostname: page-component-76fb5796d-skm99 Total loading time: 0 Render date: 2024-04-26T16:15:52.663Z Has data issue: false hasContentIssue false
  • English
  • Français

The first-episode of schizophrenia: a challenge for treatment

Published online by Cambridge University Press:  16 April 2020

W.W. Fleischhacker
Get access

Summary

For young people experiencing a first-episode of schizophrenia, the first and most important matter to be attended to, once the diagnosis of schizophrenia has been made and patients have entered the care system, is to establish a treatment alliance. The next step is to conceive an individually tailored treatment programme (non-pharmacological as well as pharmacological). The use of antipsychotic drugs needs to be carefully discussed with both patients and families, as medication tends to have a poor public perception. Maintaining treatment is vitally important in terms of relapse prevention, but people who suffer a first-episode tend to terminate treatment early. Patients often discontinue their medication because of side-effects, although a number of other factors can also exert a negative influence on the continuous intake of medication. Among others, these include insufficient information provided to patients and significant others as well as lack of insight and problems in the doctor-patient-relationship. The published data indicate that the outcome of treatment is better for younger patients in a first-episode of schizophrenia than it is for patients who are more chronically ill. However, young patients are much more sensitive to compliance problems than older patients. The main challenge in this phase of the illness is therefore to convince patients that maintenance treatment is necessary in order to assure the best possible outcome.

Keywords

First-episode schizophreniaTreatmentComplianceSide-effectsAntipsychotic medication
Type
Research Article
Information
European Psychiatry , Volume 17 , Issue S4: Mind Matters - International Schizophrenia Forum , August 2002 , pp. 371s - 375s
Copyright
Copyright Éditions scientifiques et médicales Elsevier SAS 2002

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Crow, TJMacMillan, JFJohnson, ALJohnstone, EC.A randomised controlled trial of prophylactic neuroleptic treatment. Br J Psychiatry 1986;148:120–7.CrossRefGoogle ScholarPubMed
Emsley, RA.Risperidone in the treatment of first-episode psychotic patients: a double-blind multicenter study. Risperidone Working Group. Schizophr Bull 1999;25:721–9.CrossRefGoogle ScholarPubMed
Findling, RLMcNamara, NKBranick, LASchluchter, MDLemon, EBlumer, JL.A double-blind pilot study of risperidone in the treatment of conduct disorder. J AmAcad Child Adolesc Psychiatry 2000;39:509–16.CrossRefGoogle ScholarPubMed
Fleischhacker, WW.Methodological challenges in the clinical development of antipsychotic drugs. Curr Opin Psychiatry 2000;13:1–2.CrossRefGoogle Scholar
Hummer, MKemmler, GKurz, MKurzthaler, IOberbauer, HFleischhacker, WW.Sexual disturbances during clozapine and haloperidol treatment for schizophrenia. Am J Psychiatry 1999;156:631–3.Google Scholar
Hummer, MKurz, MBarnas, CSaria, AFleischhacker, WW.Clozapine-induced transient white blood count disorders. J Clin Psychiatry 1994;55:429–32.Google ScholarPubMed
Hummer, MKurz, MKurzthaler, IOberbauer, HMiller, CFleischhacker, WW.Hepatotoxicity of clozapine. J Clin Psychopharmacol 1997;17:314–7.CrossRefGoogle ScholarPubMed
Hofer, AHummer, MKemmler, GKurz, MKurzthaler, IFleischhacker, WW.Clozapine in the treatment of first- and multiple-episode patients with schizophrenia. Schizophr Res 2000;41:183.CrossRefGoogle Scholar
Kopala, LCGood, KPHoner, WG.Extrapyramidal signs and clinical symptoms in first-episode schizophrenia: response to low-dose risperidone. J Clin Psychopharmacol 1997;17:308–13.CrossRefGoogle ScholarPubMed
Kumra, SFrazier, JAJacobsen, LKMcKenna, KGordon, CTLenane, MC et al. Childhood-onset schizophrenia. A doubleblind clozapine-haloperidol comparison. Arch Gen Psychiatry 1996;53:1090–7.CrossRefGoogle Scholar
Kumra, SJacobsen, LKLenane, MKarp, BIFrazier, JASmith, AK et al. Childhood on-set schizophrenia: an openlabel study of olanzapine in adolescents. J Am Acad Child Adolesc Psychiatry 1998;37:377–85.CrossRefGoogle Scholar
Kurz, MHummer, MOberbauer, HFleischhacker, WW.Extrapyramidal side effects of clozapine and haloperidol. Psychopharmacology 1995;118:52–6.CrossRefGoogle ScholarPubMed
Loebel, ALieberman, JAlvir, JGeisler, JKoreen, AChakos, M.Time to treatment response in successive episodes of early onset schizophrenia (Abstract). Schizophr Res 1995;15:158.Google Scholar
Martin, ALandau, JLeebens, PUlizio, KCicchetti, DScahill, L et al. Risperidone-associated weight gain in children and adolescents: a retrospective chart review. J Child Adolesc Psychopharmacol 2000;10:259–68.CrossRefGoogle ScholarPubMed
Potenza, MNHolmes, JPKanes, SJMcDougle, CJ.Olanzapine treatment of children, adolescents, and adults with pervasive developmental disorders: an open-label pilot study. J Clin Psychopharmacol 1999;19:37–44.CrossRefGoogle ScholarPubMed
Sanger, TMLieberman, JATohen, MGrundy, SBeasley, C Jr, Tollefson, GD.Olanzapine versus haloperidol treatment in first-episode psychosis. Am J Psychiatry 1999;156:79–87.CrossRefGoogle ScholarPubMed
Sholevar, EHBaron, DAHardie, TL.Treatment of childhood -onset schizophrenia with olanzapine. J Child Adolesc Psychopharmacol 2000;10:69–78.CrossRefGoogle ScholarPubMed
Szigethy, EWiznitzer, MBranicky, LAMaxwell, KFindling, RL.Risperidone-induced hepatotoxicity in children and adolescents? A chart review study. J Child Adolesc Psychopharmacol 1999;9:93–8.CrossRefGoogle ScholarPubMed
Szymanski, SMasiar, SMayerhoff, DLoebel, AGeisler, SPollack, S et al. Clozapine response in treatment-refractory first-episode schizophrenia. Biol Psychiatry 1994;35:278–80.CrossRefGoogle ScholarPubMed
Tollefson, GDBeasley, CMTran, PVStreet, JSKrueger, JATamura, RN et al. Olanzapine versus haloperidol in the treatment of schizophrenia and schizoaffective and schizophreniform disorders: results of an international collaborative trial. Am J Psychiatry 1997;154:457–65Google ScholarPubMed
Van Bellinghen, MDe Troch, C.Risperidone in the treatment of behavioral disturbances in children and adolescents with borderline intellectual functioning: a double-blind, placebocontrolled pilot trial. J Child Adolesc Psychopharmacol 2001;11:5–13.CrossRefGoogle Scholar
Wudarsky, MNicolson, RHamburger, SDSpechler, LGochman, PBedwell, J et al. Elevated prolactin in pediatric patients on typical and atypical antipsychotics. J Child Adolesc Psychopharmacol 1999;9:239–45.CrossRefGoogle ScholarPubMed
Wyatt, RJGreen, MFTuma, AH.Long-term morbidity associated with delayed treatment of first admission schizophrenic patients: a re-analysis of the Camarillo State Hospital data. Psychol Med 1997;27:261–8.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.