Research and treatment strategies in first-episode psychoses. The Pittsburgh experience.
BACKGROUND
Studies of first-episode patients allow investigation of the biological basis of psychotic disorders without the potential confounds of prior treatment and illness chronicity. Prospective studies of this population can clarify the impact of illness course and treatment on neurobiology.


METHODS
We summarise preliminary findings from our ongoing magnetic resonance imaging and spectroscopy studies of first-episode schizophrenia patients being conducted prospectively from index evaluations through a period of two years; during this period, patients were treated with either a conventional antipsychotic such as haloperidol, or the atypical risperidone.


RESULTS
Baseline neurobiological evaluations in first-episode schizophrenia patients have revealed evidence for structural and functional brain abnormalities consistent with a neurodevelopmental model of this illness. Our preliminary data support the value of risperidone as an antipsychotic drug of first choice among patients with early schizophrenic illness.


CONCLUSIONS
Focused studies of first-episode patients have the potential to unravel pathophysiology of schizophrenic illness. Such knowledge is critical for more effective early detection, intervention and even prevention of this enigmatic disorder.
Keshavan
M S
MS
Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213, USA. keshavan+@pitt.edu
Schooler
N R
NR
Sweeney
J A
JA
Haas
G L
GL
Pettegrew
J W
JW
D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001927:Brain Diseases / Q000523:psychology; D002658:Developmental Disabilities / Q000523:psychology; D017050:Episode of Care; D005260:Female; D006220:Haloperidol / Q000627:therapeutic use; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D011446:Prospective Studies; D018967:Risperidone / Q000627:therapeutic use; D012559:Schizophrenia / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology
D014150:Antipsychotic Agents; D006220:Haloperidol; D018967:Risperidone