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Optimizing outcome with antipsychotic treatment in first-episode schizophrenia: balancing efficacy and side effects

Oliver Freudenreich1, Joseph P McEvoy

  • 1Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA.

Clinical Schizophrenia & Related Psychoses
|September 26, 2012
PubMed

Insights

For first episode psychosis (FEP), a "succeed-first" strategy using well-tolerated first-generation antipsychotics (FGAs) is recommended. Early clozapine is advised for treatment-nonresponsive FEP patients to optimize long-term outcomes.

Area of Science:

  • Psychiatry
  • Pharmacology
  • Clinical Medicine

Background:

  • Initial antipsychotic medication selection for first episode psychosis (FEP) is crucial.
  • Antipsychotics include first-generation (FGAs) and second-generation (SGAs) agents with varying efficacy and side effect profiles.

Purpose of the Study:

  • To review randomized treatment trials of FGAs and SGAs in FEP.
  • To compare therapeutic potentials and side effect profiles of antipsychotics in FEP.
  • To propose an optimal treatment strategy for FEP.

Main Methods:

  • Systematic review of randomized treatment trials.
  • Analysis of efficacy and tolerability data for FGAs and SGAs in FEP.
  • Synthesis of evidence to guide clinical decision-making.

Main Results:

  • FGAs, when well-tolerated at threshold doses, can lead to good treatment response in a subset of FEP patients.
  • This approach may avoid metabolic and endocrine side effects associated with some SGAs.
  • Clozapine shows efficacy in treatment-nonresponsive FEP cases.

Conclusions:

  • A
  • succeed-first
  • strategy prioritizing well-tolerated FGAs for initial FEP treatment is advocated.
  • Early consideration of clozapine for treatment-resistant FEP is recommended for improved long-term outcomes.

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