Early Neuroleptic Intervention in Schizophrenia: Are Prodromal Symptoms Valid Predictors of Relapse?

Abstract

All recently completed controlled two-year studies on intermittent, early neuroleptic intervention treatment have failed to compare favourably with studies on maintenance treatment concerning relapse prevention. The reason for this failure is still unclear. Therefore the implicit, but as yet unproven, hypothesis that a relapse can be predicted from prodromal symptoms was tested from the perspective of our German multicentre study. Results demonstrate that this is not the case. Possible reasons for and clinical implications of this negative finding are discussed.

Schizophrenia: early warning signs

“…Intermittent medication initiated only at detection of early warning signs has been shown to be inferior to continuous medication in preventing psychotic relapse and is not generally recommended (Carpenter et al, 1990;Gaebel et al, 1993). However, medication initiated on the development of early warning signs in combination with maintenance medication has been shown to reduce psychotic relapse rates to 12-23% over two years (Marder et al, 1984(Marder et al, , 1987Jolley et al, 1990;Gaebel et al, 1993).…”

“…However, medication initiated on the development of early warning signs in combination with maintenance medication has been shown to reduce psychotic relapse rates to 12-23% over two years (Marder et al, 1984(Marder et al, , 1987Jolley et al, 1990;Gaebel et al, 1993). Furthermore, in most cases this strategy has allowed a low maintenance dose of medication to be successfully used.…”

The early warning symptom intervention for patients with bipolar affective disorder

“…This should be discouraged if there is a clinical need for maintenance medication; a number of trials in schizophrenia show that recognition of early warning symptoms and intermittent use of medication is generally less effective than continuous medication (e.g. Jolley et al, 1990;Gaebel et al, 1993). Sometimes when patients monitor their symptoms, they dwell on how depressed they are and seek further treatment for their depression.…”

Early intervention for relapse in schizophrenia: results of a 12-month randomized controlled trial of cognitive behavioural therapy

“…One welldeveloped strategy for the prevention of relapse in schizophrenia is the monitoring of prodromes or ' early signs ' of relapse (Birchwood & Spencer, 2001). Eight prospective studies of early signs (Subotnik & Neuchterlein, 1988 ;Birchwood et al 1989 ;Jolley et al 1990 ;Marder et al 1991Marder et al , 1994Tarrier et al 1991;Gaebel et al 1993 ;Jorgensen, 1998) confirm that relapse is almost always preceded by non-psychotic symptoms such as anxiety and depression, and low-level psychotic symptoms such as ideas of reference. However, the occurrence of early signs does not necessarily mean that relapse is inevitable.…”