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Guidelines for clinical treatment of early course schizophrenia

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Abstract

Several practice guidelines have been developed for the management of schizophrenia based on the current evidence base, but only a few have focused on the early course of this illness. In this article, we review the current literature on the approaches to management of early schizophrenia (ie, the prodromal, psychotic, and recovery phases of this illness). The efficacy of psychosocial and antipsychotic agents in the prodromal phase is an area of active research. Atypical antipsychotics are the mainstay of treatment for stabilization of the acute psychotic phase. Effective approaches in the recovery phase include combining medications with individual and family interventions, supported employment, assertive community treatment, cognitive remediation, and social skills training. Although evidence-based interventions have generated new optimism among those with the illness, more efforts are needed to increase access to care in community settings.

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References and Recommended Reading

  1. Perkins DO, Gu H, Boteva K, Lieberman JA: Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and metaanalysis. Am J Psychiatry 2005, 162:1785–1804.

    Article  PubMed  Google Scholar 

  2. Thompson PM, Vidal C, Giedd JN, et al.: Mapping adolescent brain change reveals dynamic wave of accelerated gray matter loss in very early-onset schizophrenia. Proc Natl Acad Sci U S A 2001, 98:11650–11655.

    Article  PubMed  CAS  Google Scholar 

  3. McGorry PD, Yung AR, Phillips LJ, et al.: Controlled trial of interventions designed to reduce the risk of progression to first-episode psychosis in a clinical sample with subthreshold symptoms. Arch Gen Psychiatry 2002, 59:921–928.

    Article  PubMed  Google Scholar 

  4. Petersen L, Jeppesen P, Thorup A, et al.: Andomised multicentre trial of integrated versus standard treatment for patients with a first episode of psychotic illness. BMJ 2005, 331:602. This paper provides results of the important OPUS trial, which provided a strong evidence basis for the effectiveness of integrated treatment in the first episode of schizophrenia.

    Article  PubMed  Google Scholar 

  5. American Psychiatric Association: Practice Guidelines for the Treatment of Patients with Schizophrenia. Arlington, VA: American Psychiatric Press; 2004.

    Google Scholar 

  6. Treatment of schizophrenia. The Expert Consensus Panel for Schizophrenia. J Clin Psychiatry 1996, 57(Suppl 12B):3–58.

  7. Royal Australian and New Zealand College of Psychiatrists Clinical Practice Guidelines Team for the Treatment of Schizophrenia and Related Disorders: Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of schizophrenia and related disorders. Aust N Z J Psychiatry 2005, 39:1–30.

    Article  Google Scholar 

  8. Lehman AF, Kreyenbuhl J, Buchanan RW, et al.: The Schizophrenia Patient Outcomes Research Team (PORT): updated treatment recommendations. Schizophr Bull 2004, 30:193–217. This paper provides a valuable set of evidence-based guidelines for the management of schizophrenia.

    PubMed  Google Scholar 

  9. International clinical practice guidelines for early psychosis: IEPA writing group. Br J Psychiatry 2005, 187(Suppl 48): s120–s124. This is a useful review of up-to-date practice guidelines for early schizophrenia.

  10. Yung AR, Phillips LJ, McGorry PD, et al.: Prediction of psychosis: a step towards indicated prevention of schizophrenia. Br J Psychiatry 1998, 172(Suppl 33):14–20.

    CAS  Google Scholar 

  11. Gleeson J, Larsen T, McGorry P: Psychological treatment in pre- and early psychosis. J Am Acad Psychoanal Dyn Psychiatry 2003, 31:229–245.

    Article  PubMed  Google Scholar 

  12. Robinson DG, Woerner MG, Delman HM, Kane JM: Pharmacological treatments for first-episode schizophrenia. Schizophr Bull 2005, 31:705–722. This is an excellent overview of the current literature on the pharmacologic management of the first episode of schizophrenia.

    Article  PubMed  Google Scholar 

  13. Frank AF, Gunderson G: The role of the therapeutic alliance in the treatment of schizophrenia. Relationship to course and outcome. Arch Gen Psychiatry 1990, 47:228–236.

    PubMed  CAS  Google Scholar 

  14. Lieberman JA, Stroup TS, McEvoy JP, et al.: Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med 2005, 353:1209–1223. This is a landmark paper describing comparative efficacy and tolerability of the currently widely used antipsychotics in treatment of schizophrenia.

    Article  PubMed  CAS  Google Scholar 

  15. Fortner RB, Steel C: The history and outcome of my encounter with schizophrenia. In Psychological and Social Aspects of Psychiatric Disability. Edited by Spaniol L, Gagne C, Koehler M. Boston: Boston University Center for Psychiatric Rehabilitation; 1997:112–118.

    Google Scholar 

  16. Hogarty GE: Personal Therapy for Schizophrenia and Related Disorders: A Guide to Individualized Treatment. New York: Guilford Publications; 2002. Hogarty’s book provides the most comprehensive approach to working with people with schizophrenia to date. It covers all the issues described in these guidelines and provides a conceptual framework, research support, and guidelines for intervention.

    Google Scholar 

  17. Csernansky JG, Mahmoud R, Brenner R: Risperidone-USA-79 Study Group. A comparison of risperidone and haloperidol for the prevention of relapse in patients with schizophrenia. N Engl J Med 2002, 346:16–22. [Published erratum appears in N Engl J Med 2002, 346:1424.]

    Article  PubMed  CAS  Google Scholar 

  18. Casey DE: Metabolic issues and cardiovascular disease in patients with psychiatric disorders. Am J Med 2005, 118(Suppl 2):15S-22S.

    PubMed  Google Scholar 

  19. Weiden PJ: Switching antipsychotics: an updated review with a focus on quetiapine. J Psychopharmacol 2006, 20:104–118.

    Article  PubMed  CAS  Google Scholar 

  20. McFarlane WR: Multifamily Groups in the Treatment of Severe Psychiatric Disorders. New York: Guilford Press; 2002. The basic text for those interested in implementing psychoeducation in a mental health setting.

    Google Scholar 

  21. McFarlane WR, Dixon I, Lukens E, Lucksted A: Family psychoeducation in schizophrenia: a review of the literature. J Marital Fam Ther 2003, 29:223–245. This article addresses the issue of implementation of family Psychoeducation—an evidence-based intervention in early Psychosis—in routine clinical settings, a valuable read for clinicians and administrators in mental health programs.

    PubMed  Google Scholar 

  22. Addington J, Williams J, Young J, Addington D: Suicidal behavior in early psychosis. Acta Psychiatr Scand 2004, 109:116–120.

    Article  PubMed  CAS  Google Scholar 

  23. Kingdon DG, Turkington D: Cognitive Psychotherapy of Schizophrenia. New York: Guilford Press; 2005. An easy-to-read guide that combines an empathic attitude with research-based, detailed guidelines for skilled intervention.

    Google Scholar 

  24. Linszen D, Dingemans P, Van der Does J, et al.: Treatment, expressed emotion and relapse in recent onset schizophrenic disorders. Psychol Med 1996, 26:333–342.

    Article  PubMed  CAS  Google Scholar 

  25. Addington J, Burnett P: Working with families in the early stages of psychosis. In Psychological Interventions in Early Psychosis. Edited by Gleeson JFM, McGorry PD. Hoboken, NJ: John Wiley & Sons; 2004:99–116.

    Google Scholar 

  26. Tait L, Birchwood M, Trower P: Adapting to the challenge of psychosis: personal resilience and the use of sealing-over (avoidant) coping strategies. Br J Psychiatry 2004, 185:410–415.

    Article  PubMed  Google Scholar 

  27. Perkins DO: Predictors of noncompliance in patients with schizophrenia. J Clin Psychiatry 2002, 63:1121–1126. A comprehensive review of research literature to date, valuable to both clinicians and researchers.

    PubMed  Google Scholar 

  28. Kemp R, Kirov G, Everitt B, et al.: Randomised controlled trial of compliance therapy. 18-month follow-up. Br J Psychiatry 1998, 172:413–419.

    Article  PubMed  CAS  Google Scholar 

  29. Edwards J, Wade D, Herrmann-Doig T, Gee D: Psychological treatment of persistent positive symptoms in young people with first-episode psychosis. In Psychological Interventions in Early Psychosis. Edited by Gleeson JFM, McGorry PD. Hoboken, NJ: John Wiley & Sons; 2004:191–208.

    Google Scholar 

  30. Bellack AS, Mueser KT, Gingerich S, Agresta J: Social Skills Training for Schizophrenia. A Step-by-Step Guide, edn 2. New York: Guilford Press; 2004. This is a valuable tool for clinicians who would like to start a social skills group. It provides detailed rationale, summary of research, and samples of individual group sessions. Clinician self-rating instruments are also provided.

    Google Scholar 

  31. Hogarty GE, Flesher S, Ulrich Carter M, et al.: Cognitive enhancement therapy for schizophrenia. Arch Gen Psychiatry 2004, 61:866–876. This paper provides important evidence for the efficacy of cognitive remediation in schizophrenia.

    Article  PubMed  Google Scholar 

  32. Roder V, Zorn P, Muller D, Brenner HD: Improving recreational, residential, and vocational outcomes for patients with schizophrenia. Psychiatr Serv 2001, 52:1439–1441.

    Article  PubMed  CAS  Google Scholar 

  33. Marshall M, Lockwood A: Assertive community treatment for people with severe mental disorders. Cochrane Database Syst Rev 2000, 2:CD001089.

    PubMed  Google Scholar 

  34. Hinton M, Elkins K, Edwards J, Donovan K: Cannabis and Psychosis Treatment Manual. Melbourne, Australia: Early Psychosis Prevention and Intervention Center; 2002.

    Google Scholar 

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Neurosciences, Wayne State University, 4201 St. Antoine, University Health Center, 9B, 48201, Detroit, MI, USA

    Matcheri S. Keshavan MD

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  1. Matcheri S. Keshavan MD
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  2. Mary Roberts MD
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  3. Daniela Wittmann MSW
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Correspondence to Matcheri S. Keshavan MD.

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Keshavan, M.S., Roberts, M. & Wittmann, D. Guidelines for clinical treatment of early course schizophrenia. Curr Psychiatry Rep 8, 329–334 (2006). https://doi.org/10.1007/s11920-006-0070-7

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  • DOI: https://doi.org/10.1007/s11920-006-0070-7

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