” Nevertheless, atypical antipsychotics are recommended as first-choice treatment for both first- and multiple-episode schizophrenia18-19 or for first-episode schizophrenia preferentially.20 However, independent,
long-term studies in first-episode Kinase Inhibitor Library cell line patients substantiating these recommendations are lacking21-22 or are still under way, such as the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) trial in the US23 and the EUropean First Episode Schizophrenia Trial (EUFEST) study in Europe;24 Beyond this uncertainty regarding the best kind of antipsychotic Inhibitors,research,lifescience,medical treatment for the special group of first-episode patients, it is furthermore unclear how long treatment should be continued after cessation of the first, acute phase.25-26 Published guidelines recommend treatment durations of minimum 1 year;27-28 Inhibitors,research,lifescience,medical the appropriate duration of further treatment in case of symptom remission, however, has not been adequately specified. In order to contribute to these open questions, a comprehensive acute and long-term treatment, study in patients with first-episode schizophrenia is currently been conducted in up to 13
German university hospitals within the GRNS.29 The study comprises a prospective doubleblind, randomized, Inhibitors,research,lifescience,medical parallel-group comparison of risperidone as a new-generation antipsychotic with halopcridol as a conventional antipsychotic. Both drugs are administered in rather low daily dosages of 2 to 8 mg per day during the 8 weeks of acute treatment, and thereafter in a reduced dosage-where possiblc-of Inhibitors,research,lifescience,medical 2 to 4 mg per day during a 2-year long-term treatment period. To investigate the necessary duration of long-term treatment in first-episode patients, patients completing the first treatment year without, relapse are randomly
allocated to either maintenance Inhibitors,research,lifescience,medical treatment, or stepwise drug discontinuation in the second treatment year. In case of impending re-exacerbations, prodrome-based early intervention, either by means of resumption or augmentation of neuroleptic treatment (depending on the basic treatment strategy of discontinuation or maintenance treatment) or by means of Carnitine dehydrogenase treatment/additional treatment, with the benzodiazepine lorazepam is applied in the second treatment year to prevent relapses. This randomized, double-blind comparison shall contribute to the open question of whether prodromes are unspecific consequences of stress experience, treatable with benzodiazepines, or have to be regarded as more specific, prepsychotic symptoms requiring neuroleptic treatment.30 Preliminary findings so far suggest that the treatment, with low dosages of antipsychotics is feasible and effective, and leads to a significant improvement, in positive, negative, and prodromal symptoms in first-episode schizophrenia patients. None of the patients has fulfilled the criteria for relapse within the first year of treatment.