Hostname: page-component-76fb5796d-22dnz Total loading time: 0 Render date: 2024-04-28T00:55:33.122Z Has data issue: false hasContentIssue false

First-episode schizophrenia

Early intervention and medication discontinuation in the context of course and treatment

Published online by Cambridge University Press:  06 August 2018

Richard Jed Wyatt*
Affiliation:
NIMH Neuroscience Center alt St Elizabeths, Washington, DC, USA
L. Michelle Damiani
Affiliation:
Department of Psychiatry, University of Virginia, Charlottesville, USA
Ioline D. Henter
Affiliation:
NIMH Neuroscience Center alt St Elizabeths, Washington, DC, USA
*
Correspondence: Richard J. Wyatt, NIMH Neuroscience Center at St Elizabeths, Washington, DC 20032, USA

Abstract

Background The concept that early intervention with antipsychotic medications improves the long-term course of schizophrenia is discussed.

Method This report reviews the literature concerning early intervention with antipsychotic medications for people with firstepisodes, and how it affects long-term morbidity. It also studies the effects of discontinuing antipsychotic medications on relapse for people with first episodes.

Results Early intervention with antipsychotic medications appears to decrease the long-term morbidity of schizophrenia.

Conclusions Early intervention with antipsychotic medications should be encouraged for people experiencing their first episode of schizophrenia. This report proposes that studying the various phases of subject response to treatment can be helpful in elucidating when antipsychotic medications should be tapered or withdrawn.

Type
Research Article
Copyright
Copyright © 1998 The Royal College of Psychiatrists 

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

Achté, K. A. (1961) Der Verlauf der Schizophrenien und der schizophreniformen Psychosen. Acta Psychiatrica Scandinavica, Suppl. 55.Google Scholar
Angrist, B. & Schulz, S. C. (1990) The neuroleptic-nonresponsive patient: characterisation and treatment. In Progress in Psychiatry (ed. Spiegel, D.), pp. xviixxviii. Washington, DC: APA.Google Scholar
Astrup, C., Fossum, A. & Holmboe, R. (1962) Progress in Functional Psychoses. Springfield, IL: Charles C. Thomas.Google Scholar
Astrup, C. & Noriek, K. (1966) Functional Psychoses: Diagnostic and Prognostic Models. Springfield, IL: Charles C. Thomas.Google Scholar
Bamrah, J. S., Freeman, H. L. & Goldberg, D. P. (1991) Epidemiology of schizophrenia in Salford, 1974–84. Changes in an urban community over ten years. British Journal of Psychiatry, 159, 802810.Google Scholar
Barrelet, L., Ferrero, F., Szigethy, L., et al (1990) Expressed emotion and first-admission schizophrenia. Nine-month follow-up in a French cultural environment. British Journal of Psychiatry 156, 357362.CrossRefGoogle Scholar
Bleuler, M. (1978) The Schizophrenic Disorders: Long-Term Patient and Family Studies (trans. S. M. Clemens). New Haven, CT: Yale University Press.Google Scholar
Breier, A., Schreiber, J., Dyer, J., et al (1991) National Institute of Mental Health longitudinal study of chronic schizophrenia. Archives of General Psychiatry 48, 239246.Google Scholar
Brown, G. W., Birley, J.T. & Wing, J. K. (1972) Influence of family life on the course of schizophrenic disorders: A replication. British Journal of Psychiatry 121, 241258.Google Scholar
Cameron, D. E. (1938) Early schizophrenia. American Journal of Psychiatry 95, 567578.Google Scholar
Carpenter, W.J. (1997) The risk of medication-free research. Schizophrenia Bulletin, 23, 1118.Google Scholar
Carpenter, W.J., Heinrichs, D. & Wagman, A. (1988) Deficit and nondeficit forms of schizophrenia: the concept. American Journal of Psychiatry, 145, 578583.Google Scholar
Castle, D., Wessely, S. & Der, G. (1991) The incidence of operationally defined schizophrenia in Camberwell, 1965–84. British Journal of Psychiatry, 159, 790794.Google Scholar
Ciompi, L. (1980) The natural history of schizophrenia in the long term. British Journal of Psychiatry 136, 413420.CrossRefGoogle ScholarPubMed
Crow, T. J., MacMillan, J. F., Johnson, A. L., et al (1986) II. A randomised controlled trial of prophylactic neuroleptic treatment. British Journal of Psychiatry 148, 120127.Google Scholar
Davis, J. M., Kane, J. M., Marder, S. R., et al (1993) Dose response of prophylactic antipsychotics. Journal of Clinical Psychiatry, 54, 2430.Google Scholar
de Alarcon, J., Seagroatt, V. & Godacre, M. (1990) Trends in schizophrenia. Lancet, 335, 852853.Google Scholar
Der, G., Gupta, S. & Murray, R. M. (1990) Is schizophrenia disappearing? Lancet, 335, 513516.Google Scholar
Docherty, J., Van Kammen, D., Siris, S., et al (1978) Stages of onset of schizophrenic psychosis. American Journal of Psychiatry, 135, 420426.Google Scholar
Eagles, J. M. & Whalley, L.J. (1985) Decline in the diagnosis of schizophrenia among first admissions to Scottish mental hospitals from 1969–78. British Journal of Psychiatry, 146, 151154.Google Scholar
Eaton, W.W., Bilker, W., Haro, J. M., et al (1992) Long-term course of hospitalisation for schizophrenia: Part II. Change with passage of time. Schizophrenia Bulletin, 18, 229241.CrossRefGoogle ScholarPubMed
Ey, H., Igert, C. & Rappard, P. (1957) Psychoses aigues et evolutions schizophréniques dans un service de 1930 à 1956. Annates Médipsychotogiques, 115, 231240.Google Scholar
Falloon, I. (1984) Relapse: A reappraisal of assessment of outcome in schizophrenia. Schizophrenia Bulletin, 10, 293299.Google Scholar
Frank, E., Prein, R., Jarrett, R., et al (1991) Conceptualisation and rationale for consensus definitions of terms in major depressive disorder: Remission, recovery, relapse, and recurrence. Archives of General Psychiatry, 48, 851855.Google Scholar
Goldstein, M., Rodnick, E., Evans, J., et al (1978) Drug and family therapy in aftercare of acute schizophrenics. Archives of General Psychiatry, 35, 11691177.Google Scholar
Gurland, B. J., Fleiss, J. L., Cooper, J. E., et al (1969) Cross-national study of diagnosis of the mental disorders: some comparisons of diagnostic criteria from the first investigation. American Journal of Psychiatry, 125, 3039.Google Scholar
Häfner, H. & Gattaz, W. (1991) Is schizophrenia disappearing. European Archives of Psychiatry and Clinical Neuroscience, 240, 3374–376.Google Scholar
Hare, E. H. (1983) Was insanity on the increase? The Fifty-six Maudsley Lecture delivered before the Royal College of Psychiatrists. British Journal of Psychiatry, 142, 439455.Google Scholar
Harrison, G., Cooper, J. & Gancarczyk, R. (1991) Changes in the administrative incidence of schizophrenia. British Journal of Psychiatry, 159, 811816.Google Scholar
Hegarty, J. D., Baldessarini, R. J., Tohen, M., et al (1994) One hundred years of schizophrenia: A meta-analysis of the outcome literature. American Journal of Psychiatry, 151, 14091416.Google Scholar
Herz, M., Endicott, J. & Spitzer, R. (1977) Brief hospitalization: A two-year follow-up. American Journal of Psychiatry 134, 502507 Google Scholar
Hogarty, G. E. (1998) The limitations of antipsychotic medications on schizophrenia relapse and adjustment, and the contributions of psychosocial treatment. Journal of Psychiatric Research, in press.Google Scholar
Isaac, R. & Armat, V. (1990) Madness in the Streets: How Psychiatry and the Law Abandoned the Mentally III. New York: The Free Press.Google Scholar
Johnson, D. A.W. (1979) The duration of maintenance therapy in chronic schizophrenia. Acta Psychiatrica Scandinavica, 53, 339352.Google Scholar
Johnson, D. A.W., Pasterski, G., Ludlow, J. M., et al (1983) The discontinuance of maintenance neuroleptic therapy in chronic schizophrenic patients: Drug and social consequences. Acta Psychiatrica Scandinavica, 67, 339352.CrossRefGoogle ScholarPubMed
Johnstone, E. C., Macmillan, J. F., Frith, C. D., et al (1990) Further investigation of the predictors of outcome following first schizophrenic episodes. British Journal of Psychiatry, 157, 182189.Google Scholar
Joyce, P. (1987) Changing trends in first admissions and readmissions for mania and schizophrenia in New Zealand 1974 to 1984. Australian and New Zealand Journal of Psychiatry, 21, 8286.Google Scholar
Kane, J., Rifkin, A., Quitkin, F., et al (1982) Fluphenazine vs. placebo in patients with remitted, acute first-episode schizophrenia. Archives of General Psychiatry, 39, 7073.Google Scholar
Kendell, R. E., Malcolm, D. E. & Adams, W. (1993) The problem of detecting changes in the incidence of schizophrenia. British Journal of Psychiatry, 162, 212218.Google Scholar
Kissling, W. (ed.) (1991) Guidelines for Neuroleptic Relapse Prevention in Schizophrenia. New York: Springer-Verlag.Google Scholar
Kraepelin, E. (1913) Psychiatrie. Leipzig: Aufl.Google Scholar
Lieberman, J. A., Jody, D., Geisler, S., et al (1993) Time course and biological correlates of treatment response in first-episode schizophrenia. Archives of General Psychiatry, 50, 369376.Google Scholar
Loebel, A. D., Lieberman, J. A., Alvir, J. M., et al (1992) Duration of psychosis and outcome in first episode schizophrenia. American Journal of Psychiatry, 149, 11831188.Google Scholar
Lukoff, D., Liberman, R. & Neuchterlein, K. (1986) Symptom monitoring in the rehabilitation of schizophrenic patients. Schizophrenia Bulletin, 12, 578593.Google Scholar
MacMillan, J., Gold, A., Crow, T., et al (1986) IV. Expressed emotion and relapse. British Journal of Psychiatry, 148, 133143.Google Scholar
May, P. R. A., Tuma, A. H. & Dixon, W.J. (1976a) Schizophrenia: A follow-up study of results of treatment: I. Design and other problems. Archives of General Psychiatry, 33, 474478.CrossRefGoogle ScholarPubMed
May, P. R. A., Tuma, A. H., Yale, C., et al (1976b) Schizophrenia: A follow-up study of results of treatment: II. Hospital stay over two to five years. Archives of General Psychiatry, 33, 481486.Google Scholar
May, P. R. A., Tuma, A. H. & Dixon, W. J. (1981) Schizophrenia: A follow-up study of results of five forms of treatment. Archives of General Psychiatry, 38, 776784.Google Scholar
McEvoy, J. P., Schooler, N. R. & Wilson, W. H. (1991) Predictors of therapeutic response to haloperidol in acute schizophrenia. Psychopharmacology Bulletin, 27, 97101.Google Scholar
Munk-Jorgensen, P. (1987) Why has the incidence of schizophrenia in Danish psychiatric institutions decreased since 1970? Acta Psychiatrica Scandinavica, 75, 6268.CrossRefGoogle ScholarPubMed
Munk-Jorgensen, P. & Jorgensen, P. (1986) Decreasing rates of first-admission diagnoses of schizophrenia among females in Denmark 1970–84. Acta Psychiatrica Scandinavica, 74, 379383.Google Scholar
Neuchterlein, K. H., Snyder, K. S. & Mintz, J. (1992) Paths to relapse: Possible transactional processes connecting patient illness onset, expressed emotion, and psychotic relapse. British Journal of Psychiatry, 161 (suppl. 18), 8896.Google Scholar
Parker, G., O'Donnell, M. & Walter, S. (1985) Changes in the diagnoses of the function psychoses associated with the introduction of lithium. British Journal of Psychiatry, 146, 377382.Google Scholar
Ram, R., Bromet, E. J., Eaton, W.W., et al (1992) The natural course of schizophrenia: A review of first-admission studies. Schizophrenia Bulletin, 18, 185207 Google Scholar
Scottish Schizophrenia Research Group (1988) The Scottish first episode schizophrenia study: V. One-year follow-up. British Journal of Psychiatry, 152, 470476.Google Scholar
Snezhnevsky, A. (1966) The prognosis of schizophrenia. International Journal of Psychiatry, 2, 635638.Google Scholar
Stephens, J. H. (1970) Long-term course and prognosis in schizophrenia. Seminars in Psychiatry, 2, 464485.Google Scholar
Stirling, J., Tantam, D., Thomas, P., et al (1991) Expressed emotion and early onset schizophrenia: A one year follow-up. Psychological Medicine, 21, 675685.Google Scholar
Szymanski, S., Lieberman, J. A., Alvir, J. M., et al (1995) Gender differences in onset of illness, treatment response, course, and biologic indexes in first-episode schizophrenic patients. American Journal of Psychiatry, 152, 698703.Google Scholar
Teuth, M. & Cheong, J. (1993) Clinical uses of pimozide. Southern Medical Journal, 86, 344349.Google Scholar
Waddington, J. L. & Youssef, H. A. (1994) Evidence for a gender-specific decline in the rate of schizophrenia in rural Ireland over a 50-year period. British Journal of Psychiatry, 164, 171176.Google Scholar
Watt, D. C., Katz, K. & Shepherd, M. (1983) The natural history of schizophrenia: A 5-year prospective follow-up of a representative sample of schizophrenics by means of standardized clinical and social assessment. Psychological Medicine, 13, 663670.Google Scholar
Wyatt, R.J. (1991) Neuroleptics and the natural course of schizophrenia. Schizophrenia Bulletin, 17, 325351.Google Scholar
Wyatt, R.J. (1995a) Antipsychotic medication and the long-term course of schizophrenia: Therapeutic and theoretical implications. In Contemporary Issues in the Treatment of Schizophrenia (eds Shriqui, C. & Nasrallah, H.), pp. 385410. Washington, DC: APA.Google Scholar
Wyatt, R.J. (1995b) Early intervention for schizophrenia: Can the course of the illness be altered? Biological Psychiatry, 38, 13.Google Scholar
Wyatt, R.J. (1997) Research in schizophrenia and the discontinuation of antipsychotic medications. Schizophrenia Bulletin, 23, 39.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.