II. A Randomised Controlled Trial of Prophylactic Neuroleptic Treatment

Crow, T J; MacMillan, J F; Johnson, Anthony L.; Johnstone, E. C.

doi:10.1192/bjp.148.2.120

Cited by 442 publications

(147 citation statements)

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“…Evidence for a progressive deterioration has also been found in studies of first episode schizophrenia patients who were then followed prospectively from 1 to 5 years. [44][45][46] Those studies found that the length of time a person experienced psychotic symptoms in their first episode of illness, prior to receiving pharmacologic treatment, was a significant predictor of the time to treatment response, 44 relapse, 46 and long term outcome. 45 Specifically, the longer the duration of psychosis the poorer the treatment response and outcome.…”

Section: Sensitization and Schizophreniamentioning

confidence: 99%

Neurobiological basis of relapse prediction in stimulant-induced psychosis and schizophrenia: the role of sensitization

et al. 1999

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A number of consistent clinical observations provide direction for the hypothesis that pathological sensitization of neuronal systems may be an important factor for relapse or the onset of stimulant-induced psychosis (eg, methamphetamine or amphetamine psychosis, cocaine psychosis and phencyclidine psychosis) and schizophrenia. First, psychotic symptoms can be produced in normal subjects by stimulants. Secondly, a large portion of schizophrenic patients exhibit exacerbation of psychotic symptoms in response to stimulants at doses which would not be psychotogenic in normal subjects. Lastly, the ability of stress to precipitate the onset and relapse of schizophrenia is well documented. In this regard, acute responses to stimulants provide useful information for relapse prediction of schizophrenia and substance abuse. This paper addresses the nature and role of pathological sensitization in relapse of stimulant-and phencyclidine-induced psychosis and schizophrenia, and its relation to pathophysiology of schizophrenia.

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Section: Sensitization and Schizophreniamentioning

confidence: 99%

Neurobiological basis of relapse prediction in stimulant-induced psychosis and schizophrenia: the role of sensitization

et al. 1999

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“…Although there has been very little study of factors that act to maintain recovery in remitted first-episode patients, evidence suggests that antipsychotics are highly effective in prevention of relapse (APA 2004). In patients for whom antipsychotics are prescribed, 1-year relapse risk varies from 0 to 46%, with relapse rates of patients who discontinue taking medication being up to five times higher than for those who continue treatment (e.g., Kane et al 1982;Crow et al 1986;McCreadie et al 1989;Robinson et al 1999b) (Level A ). The varying relapse rates found in these studies may be due to differences in the criteria used to define relapse, different study populations and different lengths of follow-up, and could in part be explained by different adherence to maintenance medication.…”

Section: Relapse Prevention In First Episode Patientsmentioning

confidence: 99%

“…In another study there were significantly fewer relapsed patients treated with flupenthixol decanoate (at least 40 mg/month i.m. ), chlorpromazine (at least 200 mg/day), haloperidol (at least 3 mg/day), pimozide (at least 4 mg/day) or trifluoperazine (at least 5 mg/day) compared to placebo over a period of 6Á/24 months (46 versus 62%) (Crow et al 1986). …”

Section: Relapse Prevention In First Episode Patientsmentioning

confidence: 99%

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia, Part 2: Long-term treatment of schizophrenia

Falkai

Wobrock

Lieberman

et al. 2006

The World Journal of Biological Psychiatry

201

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These guidelines for the biological treatment of schizophrenia were developed by an international Task Force of the World Federation of Societies of Biological Psychiatry (WFSBP). The goal during the development of these guidelines was to review systematically all available evidence pertaining to the treatment of schizophrenia, and to reach a consensus on a series of practice recommendations that are clinically and scientifically meaningful based on the available evidence. These guidelines are intended for use by all physicians seeing and treating people with schizophrenia. The data used for developing these guidelines have been extracted primarily from various national treatment guidelines and panels for schizophrenia, as well as from meta-analyses, reviews and randomised clinical trials on the efficacy of pharmacological and other biological treatment interventions identified by a search of the MEDLINE database and Cochrane Library. The identified literature was evaluated with respect to the strength of evidence for its efficacy and then categorised into four levels of evidence (A Á/D). This second part of the guidelines covers the long-term treatment as well as the management of relevant side effects. These guidelines are primarily concerned with the biological treatment (including antipsychotic medication, other pharmacological treatment options, electroconvulsive therapy, adjunctive and novel therapeutic strategies) of adults suffering from schizophrenia.Key words: Schizophrenia, long-term treatment, evidence-based medicine, practice guidelines, biological treatment, antipsychotics EXECUTIVE SUMMARY OF RECOMMENDATIONS General recommendationsSpecific treatment strategies are required not only for patients suffering from acute schizophrenia, but also in the stabilisation and stable phase of the disease. The stabilisation period follows the acute phase and constitutes a time-limited transition to continuing treatment in the stable phase. The stable phase represents a prolonged period of treatment and rehabilitation during which symptoms are under adequate control and the focus is on improving functioning and recovery. The goals of long-term therapy have to be discussed with the patient on the background of adequately provided information and his personal goals in order to find common ground to encourage a long-term medication strategy (shared-decision making). In this regard a treatment plan must be formulated and implemented. During the stabilisation phase, the main goals of treatment are to facilitate continued reduction in symptoms, consolidate remission, and promote the process of recovery. The main goals of treatment during the stable phase are to ensure that symptom remission or control is sustained, that the patient is maintaining or improving the level of functioning and quality of life, to prevent relapse, and to ensure that monitoring for adverse treatment effects continues. The antipsychotic pharmacological therapy should be accompanied by psychosocial interventions. A number of psychosocial...

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“…Firstepisode patients were, after a period of stabilization on antipsychotic medications, assigned to continue treatment with either antipsychotic medications or placebo (Crow et al, 1986). In both groups, patients who had been ill longer than 1 year at the time of their first hospital admission were more likely to relapse than patients who had been ill for less than a year; patients who received placebo substitution were more likely to relapse than patients who continued to receive antipsychotic medications.…”

Section: Evidence From Discontinuation Studiesmentioning

confidence: 99%

The effects of early and sustained intervention on the long-term morbidity of schizophrenia

Wyatt

Henter

1998

Journal of Psychiatric Research

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By examining the literature concerning early intervention with antipsychotic medications, and how it affects long-term morbidity, this article will review the concept that early intervention with antipsychotic medications improves the long-term course of schizophrenia. It also looks at the potential long-term effects of discontinuing antipsychotic medications early in the course of schizophrenia. It appears that early intervention with antipsychotic medications decreases some of the long-term morbidity associated with schizophrenia. Some of the implications of this finding are discussed in the context of both clinical practice and clinical research."For simple weak-mindedness, which signifies a kind of recovery with defect, it is distinctly enlightening and often confirmed by experience that, sooner or later, a fresh exacerbation of the disease may follow and bring about a higher degree and another form of dementia." (Kraepelin,

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II. A Randomised Controlled Trial of Prophylactic Neuroleptic Treatment

Cited by 442 publications

References 0 publications

Neurobiological basis of relapse prediction in stimulant-induced psychosis and schizophrenia: the role of sensitization

Neurobiological basis of relapse prediction in stimulant-induced psychosis and schizophrenia: the role of sensitization

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia, Part 2: Long-term treatment of schizophrenia

The effects of early and sustained intervention on the long-term morbidity of schizophrenia

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