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Pharmacological Management of First-Episode Schizophrenia and Related Nonaffective Psychoses

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Abstract

Schizophrenia is a severe mental illness characterised by abnormalities of thought and perception that affects 1–2% of the population. Patients who experience a first episode of schizophrenia should be treated early and optimally with antipsychotic agents to lessen the morbidity of the initial episode and possibly improve the course of the illness. Positive psychotic symptoms remit in the majority of patients who are treated with adequate trials of antipsychotic medications, but most relapse within 1 year. Non-adherence is strongly related to the likelihood of recurrence of symptoms. Innovative programmes that integrate early intervention, psychosocial treatments and atypical antipsychotic pharmacotherapy show promise in improving outcomes.

The available research supports the use of antipsychotic medications early in the first-episode of schizophrenia and for at least 1 year after remission of positive symptoms. Antidepressants, benzodiazepines and mood stabilisers have roles in the acute and maintenance phases of treatment for some patients. Atypical antipsychotics represent a great advance in the treatment of first-episode schizophrenia with strong evidence for greater tolerability with equal or better therapeutic efficacy. Future research will further define their roles in treatment and hopefully identify targets for prevention of first-episode schizophrenia.

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Notes

  1. Integration/Sealing Over, Explanatory Model, Scale for the Assessment of Negative Symptoms, Brief Psychiatric Rating Scale, Quality of Life Scale, Symptom Checklist-90-R and Beck Depression Inventory measures.

References

  1. Bourdon KH, Rae DS, Locke BZ, et al. Estimating the prevalence of mental disorders in US adults from the epidemiologic catchment area survey. Public Health Rep 1992; 107: 663–8

    PubMed  CAS  Google Scholar 

  2. Hare EH. Epidemiology of schizophrenia and affective psychoses. Br Med Bull 1987; 43: 514–30

    PubMed  CAS  Google Scholar 

  3. Jablensky A. Epidemiology of schizophrenia: a European perspective. Schizophr Bull 1986; 12: 52–73

    Article  PubMed  CAS  Google Scholar 

  4. Eaton WW. Epidemiology of schizophrenia. Epidemiol Rev 1985; 7: 105–26

    PubMed  CAS  Google Scholar 

  5. Robins LN, Heizer JE, Weissman MM, et al. Lifetime prevalence of specific psychiatric disorders in three sites. Arch Gen Psychiatry 1984; 41: 949–58

    Article  PubMed  CAS  Google Scholar 

  6. Kramer M. Cross-national study of diagnosis of the mental disorders: origin of the problem. Am J Psychiatry 1969; 10 Suppl.: 1–11

    PubMed  Google Scholar 

  7. Tohen M, Stoll AL, Strakowski SM, et al. The McLean First-Episode Psychosis Project: six-month recovery and recurrence outcome. Schizophr Bull 1992; 18: 273–82

    Article  PubMed  CAS  Google Scholar 

  8. Emsley RA. Risperidone in the treatment of first-episode psychotic patients: a double-blind multicenter study. Risperidone Working Group. Schizophr Bull 1999; 25: 721–9

    Article  CAS  Google Scholar 

  9. Kopala LC, Fredrikson D, Good KP, et al. Symptoms in neuroleptic-naive, first-episode schizophrenia: response to risperidone. Biol Psychiatry 1996; 39: 296–8

    Article  PubMed  CAS  Google Scholar 

  10. Lieberman J, Jody D, Geisler S, et al. Time course and biologic correlates of treatment response in first-episode schizophrenia. Arch Gen Psychiatry 1993; 50: 369–76

    Article  PubMed  CAS  Google Scholar 

  11. May PR, Tuma AH, Yale C, et al. Schizophrenia: a follow-up study of results of treatment. Arch Gen Psychiatry 1976; 33: 481–6

    Article  PubMed  CAS  Google Scholar 

  12. Sanger TM, Lieberman JA, Tohen M, et al. Olanzapine versus haloperidol treatment in first-episode psychosis. Am J Psychiatry 1999; 156: 79–87

    PubMed  CAS  Google Scholar 

  13. Szymanski S, Masiar S, Mayerhoff D, et al. Clozapine response in treatment-refractory first-episode schizophrenia. Biol Psychiatry 1994; 35: 278–80

    Article  PubMed  CAS  Google Scholar 

  14. Group TS. The Scottish First Episode Schizophrenia Study. II. Treatment: pimozide versus flupenthixol. The Scottish Schizophrenia Research Group. Br J Psychiatry 1987; 150: 334–8

    Article  Google Scholar 

  15. Robinson DG, Woerner MG, Alvir JM, et al. Predictors of treatment response from a first episode of schizophrenia or schizoaffective disorder. Am J Psychiatry 1999; 156: 544–9

    PubMed  CAS  Google Scholar 

  16. Yap HL, Mahendran R, Lim D, et al. Risperidone in the treatment of first episode psychosis. Singapore Med J 2001; 42: 170–3

    PubMed  CAS  Google Scholar 

  17. Lieberman JA, Phillips M, Gu H, et al. Atypical and conventional antipsychotic drugs in treatment-naive first-episode schizophrenia: a 52-week randomized trial of clozapine vs chlorpromazine. Neuropsychopharmacology 2003 May; 28(5): 995–1003

    PubMed  CAS  Google Scholar 

  18. Lieberman JA, Tollefson G, Tohen MG, et al. Comparative efficacy and safety of atypical and conventional antipsychotic drugs in first-episode psychosis: a randomized, double-blind trial of olanzapine versus haloperidol. Am J Psychiatry 2003; 160: 1396–404

    Article  PubMed  Google Scholar 

  19. Mohamed S, Paulsen JS, O’Leary D, et al. Generalized cognitive deficits in schizophrenia: a study of first-episode patients. Arch Gen Psychiatry 1999; 56: 749–54

    Article  PubMed  CAS  Google Scholar 

  20. Addington J, Addington D. Cognitive functioning in first-episode schizophrenia. J Psychiatry Neurosci 2002; 27: 188–92

    PubMed  Google Scholar 

  21. Gold S, Arndt S, Nopoulos P, et al. Longitudinal study of cognitive function in first-episode and recent-onset schizophrenia. Am J Psychiatry 1999; 156: 1342–8

    PubMed  CAS  Google Scholar 

  22. Bilder RM, Goldman RS, Robinson D, et al. Neuropsychology of first-episode schizophrenia: initial characterization and clinical correlates. Am J Psychiatry 2000; 157: 549–59

    Article  PubMed  CAS  Google Scholar 

  23. Townsend LA, Malla AK, Norman RM. Cognitive functioning in stabilized first-episode psychosis patients. Psychiatry Res 2001; 104: 119–31

    Article  PubMed  CAS  Google Scholar 

  24. Riley EM, McGovern D, Mockler D, et al. Neuropsychological functioning in first-episode psychosis: evidence of specific deficits. Schizophr Res 2000; 43: 47–55

    Article  PubMed  CAS  Google Scholar 

  25. Chakos MH, Mayerhoff DI, Loebel AD, et al. Incidence and correlates of acute extrapyramidal symptoms in first episode of schizophrenia. Psychopharmacol Bull 1992; 28: 81–6

    PubMed  CAS  Google Scholar 

  26. Cullberg J. Integrating intensive psychosocial therapy and low dose medical treatment in a total material of first episode psychotic patients compared to “treatment as usual” a 3 year follow-up. Medicinski Arhiv 1999; 53: 167–70

    PubMed  CAS  Google Scholar 

  27. Zhang-Wong J, Zipursky RB, Beiser M, et al. Optimal haloperidol dosage in first-episode psychosis. Can J Psychiatry 1999; 44: 164–7

    PubMed  CAS  Google Scholar 

  28. Merlo MC, Hofer H, Gekle W, et al. Risperidone, 2 mg/day vs 4 mg/day, in first-episode, acutely psychotic patients: treatment efficacy and effects on fine motor functioning. J Clin Psychiatry 2002; 63: 885–91

    Article  PubMed  CAS  Google Scholar 

  29. McEvoy JP, Hogarty GE, Steingard S. Optimal dose of neuroleptic in acute schizophrenia: a controlled study of the neuroleptic threshold and higher haloperidol dose. Arch Gen Psychiatry 1991; 48: 739–45

    Article  PubMed  CAS  Google Scholar 

  30. Jackson H, McGorry P, Henry L, et al. Cognitively oriented psychotherapy for early psychosis (COPE): a 1-year followup. Br J Clin Psychol 2001; 40: 57–70

    Article  PubMed  CAS  Google Scholar 

  31. Lehman AF, Steinwachs DM. Translating research into practice: the Schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations. Schizophr Bull 1998; 24: 1–10

    Article  PubMed  CAS  Google Scholar 

  32. Lieberman JA. Atypical antipsychotic drugs as a first-line treatment of schizophrenia: a rationale and hypothesis. J Clin Psychiatry 1996; 57 Suppl. 11: 68–71

    PubMed  CAS  Google Scholar 

  33. Bhana N, Foster RH, Olney R, et al. Olanzapine: an updated review of its use in the management of schizophrenia. Drugs 2001; 61: 111–61

    Article  PubMed  CAS  Google Scholar 

  34. Bustillo JR, Lauriello J, Keith SJ. Schizophrenia: improving outcome. Harv Rev Psychiatry 1999; 6: 229–40

    Article  PubMed  CAS  Google Scholar 

  35. Green AI, Schildkraut JJ. Should clozapine be a first-line treatment for schizophrenia? The rationale for a double-blind clinical trial in first-episode patients. Harv Rev Psychiatry 1995; 3:1–9

    Article  PubMed  CAS  Google Scholar 

  36. Addington J. Draft consensus statement-principles and practice in early psychosis. In: Edwards J, McGorry P, editors. Implementing early intervention in psychosis: a guide to establishing early psychosis services. 1st ed. London: Martin Dunitz, 2002: 145–55

    Google Scholar 

  37. Sartorius N, Fleischhacker WW, Gjerris A, et al. The usefulness and use of second-generation antipsychotic medications. Curr Opin Psychiatry 2002; 15: S1–S51

    Article  Google Scholar 

  38. National Institute for Excellence. Schizophrenia: core interventions in the treatment and management of schizophrenia in primary and secondary care [online]. Available from URL: http://www.nice.org.uk/pdf/CG1NICEguideline.pdf [Accessed 2002 Aug 13]

  39. Conley RR, Kelly DL. Management of treatment resistance in schizophrenia. Biol Psychiatry 2001; 50: 898–911

    Article  PubMed  CAS  Google Scholar 

  40. Chakos M, Lieberman J, Hoffman E, et al. Effectiveness of second-generation antipsychotics in patients with treatmentresistant schizophrenia: a review and meta-analysis of randomized trials. Am J Psychiatry 2001; 158: 518–26

    Article  PubMed  CAS  Google Scholar 

  41. Bradford D, Stroup S, Lieberman J. Pharmacological treatment of schizophrenia. In: Nathan PE, Gorman JM, editors. A guide to treatments that work. 2nd ed. New York: Oxford University Press, 2001

    Google Scholar 

  42. Edwards J, McGorry P. Implementing early intervention in psychosis: a guide to establishing early psychosis services. London: Martin Dunitz, 2002

    Google Scholar 

  43. Cormac I, Jones C, Campbell C, et al. Cognitive behaviour therapy for schizophrenia. Available in The Cochrane Library [database on disk and CD ROM]. Updated quarterly. The Cochrane Collaboration; issue 1. Oxford: Update Software, 2003

    Google Scholar 

  44. Battaglia J, Moss S, Rush J, et al. Haloperidol, lorazepam, or both for psychotic agitation?: a multicenter, prospective, double-blind, emergency department study. Am J Emerg Med 1997; 15: 335–40

    Article  PubMed  CAS  Google Scholar 

  45. Barbee JG, Mancuso DM, Freed CR, et al. Alprazolam as a neuroleptic adjunct in the emergency treatment of schizophrenia. Am J Psychiatry 1992; 149: 506–10

    PubMed  CAS  Google Scholar 

  46. Salzman C, Solomon D, Miyawaki E, et al. Parenteral lorazepam versus parenteral haloperidol for the control of psychotic disruptive behavior. J Clin Psychiatry 1991; 52: 177–80

    PubMed  CAS  Google Scholar 

  47. Kellner R, Wilson RM, Muldawer MD, et al. Anxiety in schizophrenia: the responses to chlordiazepoxide in an intensive design study. Arch Gen Psychiatry 1975; 32: 1246–54

    Article  PubMed  CAS  Google Scholar 

  48. Carpenter Jr WT, Buchanan RW, Kirkpatrick B, et al. Diazepam treatment of early signs of exacerbation in schizophrenia. Am J Psychiatry 1999; 156: 299–303

    PubMed  Google Scholar 

  49. Citrome L, Levine J, Allingham B. Changes in use of valproate and other mood stabilizers for patients with schizophrenia from 1994 to 1998. Psychiatr Serv 2000; 51: 634–8

    Article  PubMed  CAS  Google Scholar 

  50. Christison GW, Kirch DG, Wyatt RJ. When symptoms persist: choosing among alternative somatic treatments for schizophrenia. Schizophr Bull 1991; 17: 217–45

    Article  PubMed  CAS  Google Scholar 

  51. Leucht S, McGrath J, White P, et al. Carbamazepine augmentation for schizophrenia: how good is the evidence? J Clin Psychiatry 2002; 63: 218–24

    Article  PubMed  CAS  Google Scholar 

  52. Linnoila M, Viukari M. Sodium valproate and tardive dyskinesia. Br J Psychiatry 1979; 134: 223–4

    Article  PubMed  CAS  Google Scholar 

  53. Wassef AA, Dott SG, Harris A, et al. Randomized, placebocontrolled pilot study of divalproex sodium in the treatment of acute exacerbations of chronic schizophrenia. J Clin Psychopharmacol 2000; 20: 357–61

    Article  PubMed  CAS  Google Scholar 

  54. Ko GN, Korpi ER, Freed WJ, et al. Effect of valproic acid on behavior and plasma amino acid concentrations in chronic schizophrenic patients. Biol Psychiatry 1985; 20: 209–15

    Article  PubMed  CAS  Google Scholar 

  55. Hafner H, Loffler W, Maurer K, et al. Depression, negative symptoms, social stagnation and social decline in the early course of schizophrenia. Acta Psychiatr Scand 1999; 100: 105–18

    Article  PubMed  CAS  Google Scholar 

  56. Cohen S, Lavelle J, Rich CL, et al. Rates and correlates of suicide attempts in first-admission psychotic patients. Acta Psychiatr Scand 1994; 90: 167–71

    Article  PubMed  CAS  Google Scholar 

  57. Addington D, Addington J, Patten S. Depression in people with first-episode schizophrenia. Br J Psychiatry Suppl 1998; 172: 90–2

    Article  CAS  Google Scholar 

  58. Koreen AR, Siris SG, Chakos M, et al. Depression in firstepisode schizophrenia. Am J Psychiatry 1993; 150: 1643–8

    PubMed  CAS  Google Scholar 

  59. Prusoff BA, Williams DH, Weissman MM, et al. Treatment of secondary depression in schizophrenia: a double-blind, placebo-controlled trial of amitriptyline added to perphenazine. Arch Gen Psychiatry 1979; 36: 569–75

    Article  PubMed  CAS  Google Scholar 

  60. Kramer MS, Vogel WH, DiJohnson C, et al. Antidepressants in ‘depressed’ schizophrenic inpatients: a controlled trial. Arch Gen Psychiatry 1989; 46: 922–8

    Article  PubMed  CAS  Google Scholar 

  61. Levinson DF, Umapathy C, Musthaq M. Treatment of schizoaffective disorder and schizophrenia with mood symptoms. Am J Psychiatry 1999; 156: 1138–48

    PubMed  CAS  Google Scholar 

  62. Shuwall M, Siris SG. Suicidal ideation in postpsychotic depression. Compr Psychiatry 1994; 35: 132–4

    Article  PubMed  CAS  Google Scholar 

  63. Siris SG, Bermanzohn PC, Mason SE, et al. Maintenance imipramine therapy for secondary depression in schizophrenia: a controlled trial. Arch Gen Psychiatry 1994; 51: 109–15

    Article  PubMed  CAS  Google Scholar 

  64. Siris SG, Mason SE, Bermanzohn PC, et al. Adjunctive imipramine maintenance in post-psychotic depression/negative symptoms. Psychopharmacol Bull 1990; 26: 91–4

    PubMed  CAS  Google Scholar 

  65. Silver H, Barash I, Aharon N, et al. Fluvoxamine augmentation of antipsychotics improves negative symptoms in psychotic chronic schizophrenic patients: a placebo-controlled study. Int Clin Psychopharmacol 2000; 15: 257–61

    Article  PubMed  CAS  Google Scholar 

  66. Berk M, Ichim C, Brook S. Efficacy of mirtazapine add on therapy to haloperidol in the treatment of the negative symptoms of schizophrenia: a double-blind randomized placebocontrolled study. Int Clin Psychopharmacol 2001; 16: 87–92

    Article  PubMed  CAS  Google Scholar 

  67. Hogarty GE, McEvoy JP, Ulrich RF, et al. Pharmacotherapy of impaired affect in recovering schizophrenic patients. Arch Gen Psychiatry 1995; 52: 29

    Article  PubMed  CAS  Google Scholar 

  68. Silver H, Nassar A. Fluvoxamine improves negative symptoms in treated chronic schizophrenia: an add-on double-blind, placebo-controlled study. Biol Psychiatry 1992; 31: 698–704

    Article  PubMed  CAS  Google Scholar 

  69. Steinert T, Wiebe C, Gebhardt RP. Aggressive behavior against self and others among first-admission patients with schizophrenia. Psychiatr Serv 1999; 50: 85–90

    PubMed  CAS  Google Scholar 

  70. Axelsson R, Lagerkvist-Briggs M. Factors predicting suicide in psychotic patients. Eur Arch Psychiatry Clin Neurosci 1992; 241: 259–66

    Article  PubMed  CAS  Google Scholar 

  71. Meltzer HY, Alphs L, Green AI, et al. Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT). Arch Gen Psychiatry 2003; 60: 82–91

    Article  PubMed  CAS  Google Scholar 

  72. Sernyak MJ, Desai R, Stolar M, et al. Impact of clozapine on completed suicide. Am I Psychiatry 2001; 158: 931–7

    CAS  Google Scholar 

  73. Reid WH, Mason M, Hogan T. Suicide prevention effects associated with clozapine therapy in schizophrenia and schizoaffective disorder. Psychiatr Serv 1998; 49: 1029–33

    PubMed  CAS  Google Scholar 

  74. Meltzer HY, Okayli G. Reduction of suicidality during clozapine treatment of neuroleptic-resistant schizophrenia: impact on risk-benefit assessment. Am I Psychiatry 1995; 152:183–90

    CAS  Google Scholar 

  75. Hambrecht M, Hafner H. Cannabis, vulnerability, and the onset of schizophrenia: an epidemiological perspective. Aust N Z J Psychiatry 2000; 34: 468–75

    Article  PubMed  CAS  Google Scholar 

  76. Linszen DH, Dingemans PM, Lenior ME. Cannabis abuse and the course of recent-onset schizophrenic disorders. Arch Gen Psychiatry 1994; 51: 273–9

    Article  PubMed  CAS  Google Scholar 

  77. Chouljian TL, Shumway M, Balancio E, et al. Substance use among schizophrenic outpatients: prevalence, course, and relation to functional status. Ann Clin Psychiatry 1995; 7: 19–24

    Article  PubMed  CAS  Google Scholar 

  78. Gupta S, Hendricks S, Kenkel AM, et al. Relapse in schizophrenia: is there a relationship to substance abuse? Schizophr Res 1996; 20: 153–6

    Article  PubMed  CAS  Google Scholar 

  79. DeQuardo JR, Carpenter CF, Tandon R. Patterns of substance abuse in schizophrenia: nature and significance. I Psychiatr Res 1994; 28: 267–75

    Article  CAS  Google Scholar 

  80. Rabinowitz I, Bromet EJ, Lavelle I, et al. Prevalence and severity of substance use disorders and onset of psychosis in first-admission psychotic patients. Psychol Med 1998; 28: 1411–9

    Article  PubMed  CAS  Google Scholar 

  81. Regier DA, Farmer ME, Rae DS, et al. Comorbidity of mental disorders with alcohol and other drug abuse: results from the Epidemiologic Catchment Area (ECA) Study. JAMA 1990; 264: 2511–8

    Article  PubMed  CAS  Google Scholar 

  82. Kendler KS, Gallagher TJ, Abelson JM, et al. Lifetime prevalence, demographic risk factors, and diagnostic validity of nonaffective psychosis as assessed in a US community sample. The National Comorbidity Survey. Arch Gen Psychiatry 1996; 53: 1022–31

    Article  CAS  Google Scholar 

  83. Wiersma D, Wanderling I, Dragomirecka E, et al. Social disability in schizophrenia: its development and prediction over 15 years in incidence cohorts in six European centres. Psychol Med 2000; 30: 1155–67

    Article  PubMed  CAS  Google Scholar 

  84. Wiersma D, Nienhuis FI, Slooff CI, et al. Natural course of schizophrenic disorders: a 15-year follow-up of a Dutch incidence cohort. Schizophr Bull 1998; 24: 75–85

    Article  PubMed  CAS  Google Scholar 

  85. Bleuler M. The schizophrenic disorders: long-term patient and family studies. New Haven (CT): Yale University Press, 1978

    Google Scholar 

  86. Harrison G, Hopper K, Craig T, et al. Recovery from psychotic illness: a 15- and 25-year international follow-up study. Br J Psychiatry 2001; 178: 506–17

    Article  PubMed  CAS  Google Scholar 

  87. Crow TJ, MacMillan JF, Johnson AL, et al. A randomised controlled trial of prophylactic neuroleptic treatment. Br J Psychiatry 1986; 148: 120–7

    Article  PubMed  CAS  Google Scholar 

  88. Kane JM, Rifkin A, Quitkin F, et al. Fluphenazine vs placebo in patients with remitted, acute first-episode schizophrenia. Arch Gen Psychiatry 1982; 39: 70–3

    Article  PubMed  CAS  Google Scholar 

  89. McCreadie RG, Wiles D, Grant S, et al. The Scottish first episode schizophrenia study: VII. two-year follow-up. Scottish Schizophrenia Research Group. Acta Psychiatr Scand 1989; 80: 597–602

    Article  PubMed  CAS  Google Scholar 

  90. Nuechterlein KH, Dawson ME, Ventura I, et al. The vulnerability/stress model of schizophrenic relapse: a longitudinal study. Acta Psychiatr Scand Suppl 1994; 382: 58–64

    Article  CAS  Google Scholar 

  91. Gitlin M, Nuechterlein K, Subotnik KL, et al. Clinical outcome following neuroleptic discontinuation in patients with remitted recent-onset schizophrenia. Am I Psychiatry 2001; 158: 1835–42

    Article  CAS  Google Scholar 

  92. Robinson D, Woerner MG, Alvir JM, et al. Predictors of relapse following response from a first episode of schizophrenia or schizoaffective disorder. Arch Gen Psychiatry 1999; 56: 241–7

    Article  PubMed  CAS  Google Scholar 

  93. Gilbert PL, Harris MJ, McAdams LA, et al. Neuroleptic withdrawal in schizophrenic patients: a review of the literature. Arch Gen Psychiatry 1995; 52: 173–88

    Article  PubMed  CAS  Google Scholar 

  94. Amin S, Singh SP, Brewin I, et al. Diagnostic stability of firstepisode psychosis: comparison of ICD-10 and DSM-III-R systems. Br I Psychiatry 1999; 175: 537–43

    Article  CAS  Google Scholar 

  95. Thompson KN, McGorry PD, Harrigan SM. Reduced awareness of illness in first-episode psychosis. Compr Psychiatry 2001; 42: 498–503

    Article  PubMed  CAS  Google Scholar 

  96. Rose VL. APA practice guideline for the treatment of patients with schizophrenia. Am Fam Physician 1997; 56: 1217–20

    PubMed  CAS  Google Scholar 

  97. Lieberman JA, Perkins D, Beiger A, et al. The early stages of schizophrenia: speculations on pathogenesis, pathophysiology, and therapeutic approaches. Biol Psychiatry 2001; 50: 884–97

    Article  PubMed  CAS  Google Scholar 

  98. McGlashan TH, Miller TJ, Woods SW. Pre-onset detection and intervention research in schizophrenia psychoses: current estimates of benefit and risk. Schizophr Bull 2001; 27: 563–70

    Article  PubMed  CAS  Google Scholar 

  99. Simon AE, Ferrero FP, Merlo MC. Prodromes of first-episode psychosis: how can we challenge nonspecificity? Compr Psychiatry 2001; 42: 382–92

    Article  PubMed  CAS  Google Scholar 

  100. Menezes NM, Milovan E. First-episode psychosis: a comparative review of diagnostic evolution and predictive variables in adolescents versus adults. Can J Psychiatry 2000; 45: 710–6

    PubMed  CAS  Google Scholar 

  101. McGorry PD. The nature of schizophrenia: signposts to prevention. Aust N Z J Psychiatry 2000; 34 Suppl.: S14–21

    PubMed  Google Scholar 

  102. Lieberman JA, Fenton WS. Delayed detection of psychosis: causes, consequences, and effect on public health. Am I Psychiatry 2000; 157: 1727–30

    Article  CAS  Google Scholar 

  103. Heinssen RK, Perkins DO, Appelbaum PS, et al. Informed consent in early psychosis research: National Institute of Mental Health workshop, November 15, 2000. Schizophr Bull 2001; 27: 571–83

    Article  PubMed  CAS  Google Scholar 

  104. Malla AK, Norman RM, Manchanda R, et al. Status of patients with first-episode psychosis after one year of phase-specific community-oriented treatment. Psychiatr Serv 2002; 53: 458–63

    Article  PubMed  Google Scholar 

  105. Andreasen NC. Scale for the Assessment of Positive Symptoms (SAPS). Iowa City (IA): University of Iowa College of Medicine, Department of Psychiatry, 1984

    Google Scholar 

  106. Andreasen NC, Olsen S. Negative vs positive schizophrenia: definition and validation. Arch Gen Psychiatry 1982; 39: 789–94

    Article  PubMed  CAS  Google Scholar 

  107. Jackson H, McGorry P, Edwards J, et al. Cognitively-oriented psychotherapy for early psychosis (COPE): preliminary results. Br J Psychiatry Suppl 1998; 172: 93–100

    CAS  Google Scholar 

  108. Kleinman A. Major conceptual and research issues for cultural (anthropological) psychiatry. Cult Med Psychiatry 1980; 4: 3–13

    Article  PubMed  CAS  Google Scholar 

  109. Levy ST, McGlashan TH, Carpenter Jr WT. Integration and sealing-over as recovery styles from acute psychosis. J Nerv Ment Dis 1975; 161: 307–12

    Article  PubMed  CAS  Google Scholar 

  110. Overall J, Gorham DR. The brief psychiatric rating scale. Psychol Rep 1962; 10: 799–812

    Article  Google Scholar 

  111. Andreasen NC. Scale for the Assessment of Negative Symptoms (SANS). Iowa City: University of Iowa College of Medicine, Department of Psychiatry, 1983

    Google Scholar 

  112. Beck AT, Beck RW. Screening depressed patients in family practice: a rapid technic. Postgrad Med 1972; 52: 81–5

    PubMed  CAS  Google Scholar 

  113. Derogatis LR, Cleary PA. Factorial invariance across gender for the primary symptom dimensions of the SCL-90. Br J Soc Clin Psychol 1977; 16: 347–56

    Article  PubMed  CAS  Google Scholar 

  114. Heinrichs DW, Hanlon TE, Carpenter Jr WT. The Quality of Life Scale: an instrument for rating the schizophrenic deficit syndrome. Schizophr Bull 1984; 10: 388–98

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

This work was supported by the National Institute of Mental Health grants 1 K23 MH01905, 2T32MH019111 and MH64065, the Silvio O. Conte Center for the Neuroscience of Mental Disorders and by the Foundation of Hope of Raleigh (NC). The authors have a significant financial interest in or affiliation with one or more of the following: Bristol-Myers Squibb, Eli Lilly, Pfizer, Otsuka, AstraZeneca, Janssen, Aventis, GlaxoSmithKline and Repligen.

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  1. Thad and Alice Eure Distinguished Professor of Psychiatry, University of North Carolina School of Medicine, 7025 Neurosciences Hospital, Chapel Hill, North Carolina, 27599-7160, USA

    Daniel W. Bradford, Diana O. Perkins &  Jeffrey A. Lieberman

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  1. Daniel W. Bradford
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Correspondence to Jeffrey A. Lieberman.

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Bradford, D.W., Perkins, D.O. & Lieberman, J.A. Pharmacological Management of First-Episode Schizophrenia and Related Nonaffective Psychoses. Drugs 63, 2265–2283 (2003). https://doi.org/10.2165/00003495-200363210-00001

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