title: First vs multiple episode schizophrenia: two-year outcome of intermittent and maintenance medication strategies.
abstract: Results of studies on intermittent neuroleptic treatment strategies in first episode (FE) schizophrenia have not been published. Aims of the present study were to elucidate the comparative efficacy of prodrome-based neuroleptic intervention in first vs multiple episode (ME) schizophrenia. As to the methods, three randomly assigned open neuroleptic treatment strategies were compared over 2 years in 363 schizophrenic outpatients (115 FE, 248 ME; ICD-9, RDC): maintenance medication vs two intermittent medication strategies (prodrome-based intervention and crisis intervention). Concerning relapse prevention, the results demonstrate that ME patients seemed to profit most from maintenance medication compared to both intermittent treatments, whereas FE patients did equally well under maintenance medication and prodrome-based intervention treatment. Psychopathology, social adjustment, subjective well-being, and side-effects after two years did not differ significantly between the FE and ME patients irrespective of treatment strategy. Concerning treatment adherence, FE patients complied better with prodrome-based intervention than with maintenance medication. Cumulative neuroleptic dosage was lowest in FE patients under intermittent treatment. In conclusion, maintenance medication is the best strategy for relapse prevention in ME patients. In FE patients, prodrome-based intermittent intervention seems to be equivalent or even better with respect to compliance and dosage applied.
authors.affiliation: Department of Psychiatry, Heinrich-Heine-University Düsseldorf, Bergische Landstr. 2, 40629 Düsseldorf, Germany. wolfgang.gaebel@uni-duesseldorf.de
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Gaebel
authors.forename: Michaela
authors.initials: M
authors.lastname: Jänner
authors.forename: Nicole
authors.initials: N
authors.lastname: Frommann
authors.forename: Adolf
authors.initials: A
authors.lastname: Pietzcker
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Köpcke
authors.forename: Michael
authors.initials: M
authors.lastname: Linden
authors.forename: Peter
authors.initials: P
authors.lastname: Müller
authors.forename: Franz
authors.initials: F
authors.lastname: Müller-Spahn
authors.forename: Joachim
authors.initials: J
authors.lastname: Tegeler
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D003419:Crisis Intervention; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004361:Drug Tolerance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000187:drug effects; D010359:Patient Readmission; D012008:Recurrence; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy*; D012569:Schizotypal Personality Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D012917:Social Adjustment; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents