First-episode schizophrenia: the importance of early intervention and subjective tolerability

The majority of patients with schizophrenia are likely to experience multiple episodes. Furthermore, because schizophrenia may be a progressive encephalopathy, the longer patients experience symptoms, the more likely they are to suffer lasting impairment. Early identification and pharmacologic intervention to relieve symptoms and prevent relapse are likely to have a profound effect on the long-term clinical outcomes. The choice of antipsychotic can be critical in determining long-term treatment outcomes for first-episode patients who are often particularly sensitive to the potential side effects of treatment such as extrapyramidal symptoms (EPS). Atypical antipsychotics have proven efficacy against both the positive and negative symptoms of schizophrenia, have a lower propensity to cause EPS than conventional agents, and may also improve cognitive functioning. Their use is therefore recommended, particularly for those patients experiencing their first episode.