S-51-01
Outcome in first episode patients under naturalistic conditions
R. Bottlender. Psychiatrisehe Klinik der Ludw, München, Germany
Schizophrenia is one of the most serious mental disorders and often affects quite young people. Although more than two third of patients experiencing their first episode of schizophrenia will recover under modem psychopharmacological treatment strategies, most of these patients will experience a further episode during the following few years, and after a longer course of the illness two thirds will sustain lasting impairment. About one third of patients will be so severely impaired that they will be classified as suffering from a residual or deficit type of schizophrenia. On that background it is of major interest to identify prognostic factors that can be modified by therapeutic/preventive interventions. In the past decade, studies of first-episode schizophrenia noted that the periods between the onset of the patients" psychotic symptoms and their first treatment (=duration of untreated psychosis, DUP) are alarmingly long. Moreover these studies indicate that these extended periods of DUP are important because it may be during this period that the chronicity of schizophrenia happens. Further findings concerning these evidences that were obtained by the project April 2, 1 (“basic study”) of the German schizophrenia research network are presented. The project April 2, 1 is a prospective multicenter study on the short and mid-term course and outcome of schizophrenic patients under naturalistic treatment conditions. Major aim of the study is a multidimensional description of the acute and 2-years course and outcome in patients with schizophrenia under naturalistic treatment conditions.
S-51-02
Treatment of first episode schizophrenia
W. Gaebel. Heinrieh-Heine University Dues, Duesseldorf Germany
Bringing together schizophrenia research projects in Europe has been initiated by the German Research Network on Schizophrenia. While the last cooperating symposia of five mostly transnational and network-based studies at the AEP congress in Geneva 2004 focused on the presentation of transnational and network-based studies dealing with the prevention and treatment of first episodes, this symposium will deal with the further development of new treatment strategies. In particular the implementation of new treatment strategies into routine care facilities will he carried out with special regard to the role of research networks within the process of research transfer.
S-51-03
Side effects and compliance in first episode schizophrenia
W. Fleischhacker. Psychiatrische Univers.-Klinik Innsbruck, Innsbruck, Austria
The first episode of schizophrenia is generally the most responsive to treatment. However, although first-episode patients are the most responsive to treatment, they are also among the most susceptible to antipsychotic-induced adverse events, which is known to have profound implications on compliance. The first contact with antipsychotics will shape the future acceptance of drug treatment. Compliance may be jeopardized by attitude issues (“I don't want to take drugs that change my character”) and tolerability problems (“this medication makes me feels stiff, impotent, fat ...”). As a consequence, it is critical that those patients experiencing their first episode of psychosis are treated with an effective drug that produces minimal side effects. Several studies have reported the improved efficacy and tolerability of second generation antipsychotics compared with conventional agents in first-episode patients. Aside from the issue of side effects, one has to be aware of the fact that compliance problems have a multifaceted etiology. It is influenced by factors related to the patients themselves, to their illness, to the treatments employed and to the patients environment, including most importantly, the relationship between the patients and their care team. All of these factors have to be taken into account when trying to tackle compliance problems. Given the tremendous impact of compliance on the outcome of schizophrenia, successful management of compliance problems has highly relevant consequences both for the welfare of our patients and the economics of our healthcare system. Fleischhacker WW, Hofer A, Hunwner M (2003) Managing schizophrenia: the compliance challenge. Science Press.
S-51-04
Neuropsychological correlates of prodromal symptoms in first episode schizophrenia
W. Wflwer, W. Gaebel. H.-H.-Universität /RKD, Düsseldorf Germany
The differential impact of the components of the Vulnerability- Stress-Coping (VSC) model of schizophrenia on relapse and the relationship to prodromal symptoms preceding a relapse are unclear yet. As part of an ongoing comprehensive study on acute and long-term treatment strategies in first episode schizophrenia patients within the German Research Network on Schizophrenia (GRNS), the present subproject aims at (1) a longitudinal assessment ofneuropsycbological vulnerability indicators and (2) an investigation of the relationship of these indicators with prodromal symptoms and relapses. This subproject focuses on the predictive power of neuropsychological impairments for the risk of relapse and on a comparison of risk indicators of the first manifestation with risk indicators of relapses (in cooperation with a parallel project in high risk individuals by Wagner et al). Assessments take place at inclusion into the long-term treatment study (TO), after 1 year of controlled medication and psychological treatment (T1) and after 1 year of discontinued treatment (T2). A total of 140 patients entered the ongoing study until now. First preliminary analyses revealed the expected neuropsychological impairments at TO. These impairments are more pronounced than - but qualitatively comparable to - the impairments found in prodromal subjects before their first episode. Neuropsychological impairments prove to be unrelated to prodromal symptoms allowing to use both in combination to improve the prediction of poor clinical course. From the latter result a further improvement of relapse prediction can be expected by additional inclusion of stress and coping indicators.
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