title: Optimizing outcome with antipsychotic treatment in first-episode schizophrenia: balancing efficacy and side effects.
abstract: The initial tailoring of antipsychotic medication for an individual experiencing a first episode of psychosis (FEP) is a critical empirical process with potentially far-reaching consequences. This article reviews the results of randomized treatment trials of clinically available first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs) in individuals experiencing FEP, addressing these medications' relative therapeutic potentials and their proclivities to produce a range of unwanted side effects. The authors will argue that the best clinical long-term outcomes will be achieved with: 1) a "succeed-first" strategy of identifying those treatment-responsive individuals who will have a good response to neuroleptic threshold doses of well-tolerated FGAs (thereby avoiding weight gain, insulin resistance, and prolactin-induced changes in gender-specific physiology); and, 2) an early trial of clozapine in treatment-nonresponsive FEP patients.
authors.affiliation: Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA.
authors.forename: Oliver
authors.initials: O
authors.lastname: Freudenreich
authors.forename: Joseph P
authors.initials: JP
authors.lastname: McEvoy
mesh_terms: D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D042241:Early Diagnosis; D006801:Humans; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D014150:Antipsychotic Agents