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Early Improvement and Its Predictive Validity in First-Episode Schizophrenia Patients

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Handbook of Schizophrenia Spectrum Disorders, Volume III

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Abstract

Despite the ongoing study reports finding early treatment improvement in schizophrenia to be a robust marker of subsequent outcome, research in patients suffering from their first-episode of schizophrenia (FES) has just recently been started. Latest literature reports and newest developments are summarized pointing out the need for future research in terms of early response in FES patients. Data on clinical as well as biological and functional study results are presented and discussed suggesting that early improvement is a significant predictor of subsequent short- as well as long-term outcome in FES patients. The difficulty of the use of different and arbitrarily chosen definitions of early improvement is furthermore addressed and latest study results are shown proposing a systematically analysed early improvement definition for FES patients. Finally, clinical consequences of the identification of early improver and early non-improver are addressed. Today, no clear guidance can be provided regarding the treatment actions that should be taken in early non-improver. Only post-hoc analyses in FES patients are available questioning the study’s conclusions suggesting a change of the antipsychotic rather than a “staying on”-strategy. Future studies are warranted to find a consensus understanding of early improvement and especially to develop treatment strategies for patients not achieving early improvement. Given that the first episode of schizophrenia is a critically and very important time-point in terms of the future course of the illness a proper management during this period will favourably influence the long-term course and outcome of the patients. Therefore, further studies on early treatment improvement and its clinical and scientific consequences should be of highest interest and focus for researchers and care providers.

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Abbreviations

BPRS:

Brief psychotic rating scale

FES:

First-episode schizophrenia

PANSS:

Positive and negative syndrome scale

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Acknowledgements

We kindly thank the British Journal of Psychiatry for their permission to reprint the figures published in the article by Schennach-Wolff et al. [18].

The randomized controlled study comparing risperidone and haloperidol in FES patients was performed within the framework of the German Research Network on Schizophrenia, which is funded by the German Federal Ministry for Education and Research BMBF (grants 01 GI 9932 and 01 GI 0232). The authors thank all who have contributed to this study.

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Authors and Affiliations

  1. Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, 80336, München, Germany

    Michael Riedel, Richard Musil & Rebecca Schennach-Wolff

  2. Psychiatric Clinic, Vinzenz-von-Paul-Hospital, Rottweil, Germany

    Michael Riedel

  3. Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, München, Germany

    Florian Seemüller, Ilja Spellmann & Hans-Jürgen Möller

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  1. Michael Riedel
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  2. Florian Seemüller
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  5. Hans-Jürgen Möller
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  6. Rebecca Schennach-Wolff
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Correspondence to Michael Riedel .

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Editors and Affiliations

  1. , Rappaport Faculty of Medicine, Technion - Israel Institute of Technolog, Haifa, Israel

    Michael S. Ritsner

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Riedel, M., Seemüller, F., Musil, R., Spellmann, I., Möller, HJ., Schennach-Wolff, R. (2011). Early Improvement and Its Predictive Validity in First-Episode Schizophrenia Patients. In: Ritsner, M. (eds) Handbook of Schizophrenia Spectrum Disorders, Volume III. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-0834-1_5

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