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The British Journal of Psychiatry (2005) 187: s77-s84
© 2005 The Royal College of Psychiatrists

Rational pharmacotherapy in early psychosis*

GARY REMINGTON, MD, PhD, FRCP(C)

Medical Assessment Program for Schizophrenia, Centre for Addiction and Mental Health, Clarke Site, 250 College Street, Toronto, Ontario M5T 1R8, and Department of Psychiatry, University of Toronto, Canada.

Correspondence: E-mail: gary_remington{at}camh.net

Declaration of interest In the past year G.R. has received research support from Janssen, Merck, Pfizer and Shire, and has acted as a consultant for Janssen.

* Paper presented at the Third International Early Psychosis Conference, Copenhagen, Denmark, September 2002.

Background An increased focus in research specific to first-episode schizophrenia has provided a rapidly growing body of evidence that can be directly translated to clinical practice.

Aims To provide clinical recommendations specific to effective pharmacotherapy of first-episode schizophrenia.

Method Evidence from clinical trials focused on the first-episode population is combined with data from other areas of investigation.

Results In first-episode psychosis, when to initiate treatment is not always clear, being intimately linked to challenges regarding early detection and diagnosis. There may be differences in antipsychotic dosing, patterns of response and sensitivity to side-effects. Adherence appears to be even more problematic at this stage.

Conclusions Clinicians currently treating early psychosis have considerably more information to guide their decision-making. However, the speed at which the field is growing is a reminder to treat this knowledge as a work in progress.