Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-10T05:51:21.193Z Has data issue: false hasContentIssue false
  • English
  • Français

Pharmacotherapy of first-episode schizophrenia

Published online by Cambridge University Press:  06 August 2018

Gary Remington ,
Shitij Kapur  and
Robert B. Zipursky
Gary Remington
Affiliation:
Department of Psychiatry, University of Toronto, Canada
Shitij Kapur
Affiliation:
Department of Psychiatry, University of Toronto, Canada
Robert B. Zipursky
Affiliation:
Department of Psychiatry, University of Toronto, Canada
Get access Rights & Permissions [Opens in a new window]

Abstract

Background A growing interest in first-episode schizophrenia reflects the belief that this line of investigation will lead to further developments regarding schizophrenia's aetiology, course and outcome.

Method Evidence from more recent clinical trials involving first-episode schizophrenia is integrated with neuroimaging data, specifically positron emission tomography, to provide direction regarding pharmacotherapy.

Results Individuals with a first episode of schizophrenia appear particularly responsive to pharmacotherapy, as well as quite sensitive to side-effects. At the same time, current clinical and receptor-binding data support the efficacy of low-dose neuroleptic treatment.

Conclusions Early and effective treatment of schizophrenia has been associated with better long-term outcome. Low-dose neuroleptic therapy is an effective treatment strategy and the diminished risk of side-effects with this approach may further enhance compliance and outcome.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 172 , Issue S33: Verging on reality , June 1998 , pp. 66 - 70
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

Aguilar, E. J., Keshavan, M. S., Martinez-Quiles, M. D., et al (1994) Prediction of acute dystonia in first-episode psychotic patients. American Journal of Psychiatry, 151, 1819–1821.Google Scholar
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM–III–R). Washington, DC: APA.Google Scholar
Baldessarini, R. J., Katz, B. & Cotton, P. (1984) Dissimilar dosing with high-potency and low-potency neuroleptics. American Journal of Psychiatry, 141, 748–752.Google ScholarPubMed
Baldessarini, R. J., Cohen, B. M. & Teicher, M. H. (1988) Significance of neuroleptic dose and plasma levels in the pharmacological treatment of psychoses. Archives of General Psychiatry, 45, 79–91.CrossRefGoogle ScholarPubMed
Bollini, P., Pampallona, S., Orza, M. J., et al (1994) Antipsychotic drugs: is more worse? A meta-analysis of the published randomised control trials. Psychological Medicine, 24, 307–316.CrossRefGoogle Scholar
Chakos, M. H., Mayerhoff, D. I., Loebel, A. O., et al (1992) Incidence and correlates of acute extrapyramidal symptoms in first episode of schizophrenia. Psychopharmacology Bulletin, 28, 81–86.Google Scholar
Chouinard, G., Jones, B., Remington, G., et al (1993) A Canadian multicenter placebo-controlled study of fixed doses of risperidone and haloperidol in the treatment of chronic schizophrenic patients. Journal of Clinical Psychopharmacology, 13, 25–40.Google Scholar
Farde, L., Nordstrom, A-L., Wiesel, F-A., et al (1992) Positron emission tomographic analysis of central D1 and D2 dopamine receptor occupancy in patients treated with classical neuroleptics and clozapine. Archives of General Psychiatry, 49, 538–544.Google Scholar
Fennig, S., Kovasznay, B., Rich, C., et al (1994) Six-month stability of psychiatric diagnoses in first-admission patients with psychosis. American Journal of Psychiatry, 151, 1200–1208.Google Scholar
Kapur, S., Remington, G., Zipursky, R. B., et al (1995) The D2 dopamine receptor occupancy and its relationship to extrapyramidal symptoms: a PET study. Life Sciences, 10, 103–107.Google Scholar
Kapur, S. & Remington, G. (1996) Serotonin-dopamine interaction and its relevance to schizophrenia. American Journal of Psychiatry, 153, 466–476.Google Scholar
Kapur, S., Remington, G., Jones, C., et al (1996) High levels of dopamine D2 receptor occupancy with low-dose haloperidol treatment: a PET study. American Journal of Psychiatry, 153, 948–950.Google Scholar
Kapur, S., Zipursky, R., Roy, P., et al (1997) The relationship between D2 receptor occupancy and plasma levels on low dose oral haloperidol: a PET study. Psychopharmacology, 131, 148–152.Google Scholar
Kay, S. R., Fiszbein, A. & Opler, L. A. (1987) The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13, 261–276.Google Scholar
Kopala, L. C., Fredrikson, D., Good, K. P., et al (1996) Symptoms in neuroleptic-naive, first-episode schizophrenia: response to risperidone. Biological Psychiatry, 39, 296–298.Google Scholar
Lieberman, J. A., Jody, D., Geisler, S., et al (1989) Treatment outcome of first episode schizophrenia. Psychopharmacology Bulletin, 25, 92–96.Google Scholar
Loebel, A. D., Lieberman, J. A., Alvir, J. M. J., et al (1992) Duration of psychosis and outcome in first-episode schizophrenia. American Journal of Psychiatry, 149, 1183–1188.Google Scholar
McEvoy, J. P. (1986) The neuroleptic threshold as a marker of minimum effective neuroleptic dose. Comprehensive Psychiatry, 27, 327–335.Google Scholar
McEvoy, J. P., Hogarty, G. E. & Steingard, S. (1991) Optimal dose of neuroleptic in acute schizophrenia. Archives of General Psychiatry, 48, 739–745.Google Scholar
Meltzer, H.Y. (1991) The mechanism of action of novel antipsychotic drugs. Schizophrenia Bulletin, 17, 263–287 CrossRefGoogle ScholarPubMed
Nordstrom, A-L., Farde, L., Wiesel, F-A., et al (1993) Central D2-dopamine receptor occupancy in relation to antipsychotic drug effects: a double-blind PET study of schizophrenic patients. Biological Psychiatry, 33, 227–235.Google Scholar
Scottish Schizophrenia Research Group (1987) The Scottish first episode schizophrenia study II. Treatment: pimozide versus flupenthixol. British Journal of Psychiatry, 150, 334–338.Google Scholar
Seeman, P. (1992) Dopamine receptor sequences: therapeutic levels of neuroleptics occupy D2 receptors, clozapine occupies D4 . Neuropsychopharmacology, 7, 261–284.Google ScholarPubMed
Stone, C. K., Garver, D. L., Griffith, J., et al (1995) Further evidence of a dose–response threshold for haloperidol in psychosis. American Journal of Psychiatry, 152, 1210–1212.Google Scholar
Van Putten, T., Marder, S. R., Wirshing, W. C., et al (1991) Neuroleptic plasma levels. Schizophrenia Bulletin, 17, 197–216.Google Scholar
Werry, J. S., McClennan, J. M. & Chard, L. (1991) Childhood and adolescent schizophrenic, bipolar, and schizoaffective disorders: a clinical and outcome study. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 457–465.Google Scholar
Wolkin, A., Barouche, F., Wolf, A. P., et al (1989) Dopamine blockade and clinical response: evidence for two biological subtypes of schizophrenia. American Journal of Psychiatry, 146, 905–908.Google Scholar
Wong, J., Zipursky, R. B., Beiser, M., et al (1996) Optimal haloperidol dosage for first episode schizophrenia. Biological Psychiatry, 39, 513.Google Scholar
Wyatt, R. J. (1995) Risks of withdrawing antipsychotic medications. Archives of General Psychiatry, 52, 205–208.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.