Pharmacologic Treatment of First-Episode Schizophrenia: A Review of the Literature

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Objective: To review the evidence base for the efficacy and tolerability of antipsychotic medication for the treatment of the first episode of schizophrenia.

Data Source: MEDLINE databases were searched for published articles in English over the last 25 years, from January 1986 to January 2011, on choice of antipsychotic treatment for the first episode of schizophrenia, with an emphasis on efficacy and tolerability of antipsychotic drugs in the acute phase of psychotic illness.

Study Selection: The keywords antipsychotic drugs and schizophrenia were used in combination with drug treatment, pharmacologic treatment, efficacy, and tolerability in addition to atypical antipsychotics, first-generation antipsychotics, second-generation antipsychotics, first-episode psychosis, and acute psychotic episode.

Data Synthesis: At present, there is no convincing evidence to guide clinicians in choosing a single first-line antipsychotic that is effective in treating the positive and negative symptoms of the first episode of schizophrenia. Even though second-generation antipsychotic drugs offer potential benefits in terms of less extrapyramidal side effects and some benefits in treating negative, affective, and cognitive symptoms, these drugs are not without their own side effects.

Conclusions: With the introduction of a number of second-generation antipsychotic drugs there have been significant advances in antipsychotic drug treatment over the last decade. Despite these advances, there are still a number of limitations in continued use of some antipsychotic medications due to their efficacy and tolerability issues in the acute and early maintenance phases of psychosis. Active research in this area would provide more promising results of improved efficacy and tolerability of antipsychotic medication.

Prim Care Companion CNS Disord 2012;14(1):doi:10.4088/PCC.11r01198

Submitted: April 13, 2011; accepted June 22, 2011.

Published online: January 5, 2012.

Corresponding author: Shibu P. Thomas MBBS, DPM, Departments of General Adult Psychiatry and Early Intervention, Ashton House, 15 George St, Leamington Spa, Warwickshire, CV31 1ET, UK (

Prim Care Companion CNS Disord 2012;14(1):doi:10.4088/PCC.11r01198