Pharmacologic Treatment of First-Episode Schizophrenia: Early Intervention Is Key to Outcome

The early recognition and management of a first episode of schizophrenic illness is a difficult task,with identification complicated by a broad differential diagnosis, lack of definitive data on the prognosticimplications of premorbid/prodromal symptoms, and, until recently, treatment limited to pharmacologicagents with severe adverse effects. The first psychotic episode in patients with schizophreniais the most responsive to treatment in terms of both rate and degree. However, first-episodepatients are also more likely to develop motor side effects, even at lower medication doses, thanmultiepisode patients. Considerable evidence supports the assertion that early treatment can improveoutcome and possibly prevent the development of full-blown illness in high-risk individuals. There isevidence that atypical antipsychotic medications are effective in the treatment of first-episode schizophreniaand are well tolerated. The improved tolerability associated with the newer antipsychoticmedications, including a lower risk for motor side effects and possible lower risk for development oftardive dyskinesia, has swung the risk-benefit balance in favor of early and aggressive treatment. Byintervening early and providing long-term maintenance treatment, the course of schizophrenic illnessmay be altered in the coming years with overall decreased deterioration and chronicity and overallimproved functioning resulting in lower societal costs.