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Schizophrenia Bulletin Advance Access originally published online on July 8, 2005
Schizophrenia Bulletin 2005 31(3):705-722; doi:10.1093/schbul/sbi032
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© The Author 2005. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oupjournals.org.

Pharmacological Treatments for First-Episode Schizophrenia

Delbert G Robinson
Research Department, The Zucker Hillside Hospital, Glen Oaks, NY 11004
Department of Psychiatry, The Zucker Hillside Hospital of the North Shore–Long Island Jewish Health System, Glen Oaks, New York 11004
Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, New York 10461

Margaret G Woerner
Department of Psychiatry, The Zucker Hillside Hospital of the North Shore–Long Island Jewish Health System, Glen Oaks, New York 11004
Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, New York 10461

Howard M Delman
Department of Psychiatry, The Zucker Hillside Hospital of the North Shore–Long Island Jewish Health System, Glen Oaks, New York 11004

John M Kane
Department of Psychiatry, The Zucker Hillside Hospital of the North Shore–Long Island Jewish Health System, Glen Oaks, New York 11004
Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, New York 10461

To whom correspondence should be addressed; e-mail: robinson{at}lij.edu

Studies with first-episode populations offer the unique opportunity to examine the effectiveness and side effects of medications without the confounding effects of prior medication use. This review focuses upon studies of (1) treatment of the initial episode, (2) maintenance treatment issues, (3) recovery, and (4) side effects. Response rates for the initial episode are high with both conventional and new-generation antipsychotics. However, we lack data directly comparing the new-generation agents with one another for treatment of the initial episode, and data about options for patients with treatment resistance at illness onset are very limited. With the most commonly used pharmacological therapies, the course of early-phase schizophrenia is characterized by repeated relapses and a low rate of recovery. Medication treatment is also associated with a variety of side effects. Of particular concern for treatment of first-episode patients are the metabolic side effects with the new-generation antipsychotics because they occur rapidly, are very distressful to adolescents and young adults, and have long-term medical consequences. Available data support maintenance treatment to prevent relapse, but questions remain about the optimal duration of maintenance treatment, whether there are differences among the new-generation agents for maintenance treatment, and balancing the benefits of maintenance antipsychotics with their long-term side effects.

Keywords: treatment response / maintenance treatment / relapse / recovery / adherence / side effects


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