Antipsychotic Drug Treatment in the Prodromal Phase of Schizophrenia

Abstract

These findings are preliminary and should not be used to guide health care decisions at this time. Randomized controlled trials are needed to determine whether antipsychotic drug treatment of prodromal patients can delay or prevent onset or attenuate the clinical course of schizophrenia.

The relation of antipsychotic and antidepressant medication with baseline symptoms and symptom progression: A naturalistic study of the North American Prodrome Longitudinal Sample

“…Although prolactin levels were higher with amisulpride, only a small number developed clinical elevations. Finally, in a non randomized clinical trial of risperidone with a small sample of youth yielded similar results, with greater reductions in positive prodromal symptoms (Cannon et al, 2002). …”

Prophylactic Antipsychotics: Do They Keep You From Catching Schizophrenia?

“…3 In another open study, younger patients aged 15 to 20 years with a prodrome defined as a schizotypal, paranoid, or schizoid personality disorder, and who were presumably on a high-risk pathway to develop schizophrenia, were reportedly improved by risperidone in terms of their thought disorder and attention but not their social withdrawal. 4 Interestingly, a different open study of antidepressants either alone or in combination with mood stabilizers or anxiolytics in prodromal adolescents aged 14 to 22 years also seemed to improve symptoms over a period of 3 years. 5 A controlled trial of prodromal individuals defined as having attenuated positive psychotic symptoms, brief intermittent psychotic symptoms, or genetic risk with recent functional decline reported that olanzapine improved prodromal symptoms better than placebo over 8 weeks.…”

“…[3][4][5][6][7] A "prodrome" of depression, decreased concentration and attention span, lack of motivation, apathy, and social withdrawal can precede the first psychotic symptoms in schizophrenia by as much as 4 or 5 years. 2,9,10 Some patients never progress beyond this phase of the illness.…”

“…Atypical antipsychotics, particularly at low doses, as well as other psychotropic drugs and nonpharmacologic interventions may all contribute to the effects on symptomatic progression reported in the trials published to date. [3][4][5][6][7] At this point, much more information will be required before presymptomatic or prodromal treatment can be recommended as part of current practice guidelines, including more controlled trials, consensus on definitions of the prodrome and functional outcomes, testing of additional atypical antipsychotics, and controlling for other psychotropic medications as well as nonpharmacologic interventions. The well-informed clinician can currently only determine the risks-which are relatively well known-versus the benefits-which are not well known-for each individual patient before deciding to embark on this treatment strategy.…”

“…1 Now comes further evidence that this pretreatment may be possible in schizophrenia, [2][3][4][5][6][7] where it is already known that atypical antipsychotics not only get you better by treating acute symptoms, but also keep you better by preventing relapse. 2,8 Is it possible that giving these agents to high-risk individuals with prodromal symptoms could prevent or delay progression to schizophrenia?…”