Clinicians should not be deterred from early pharmacological intervention
schizophrenia because of fear of side effect, agreed a panel of experts at
the annual meeting of the American Psychiatric Association.
The death rate for Agranulocytosis, the most worrisome side effect of
long-term clozapine therapy, is roughly 1 in 10,000. The death rate from
suicide among untreated schizophrenics is approximately 1 in 8, said Dr. Herbert Y.
Meltzer, director of the Center for Psychobiology, Case Western Reserve
University School of Medicine, Cleveland, Ohio.
[editors note: studies show that upwards of 30 to 40% of people with
will eventually attempt suicide at least once and with males the figure is closer to 60%]
Prevention of suicide is only one of the many arguments in favor of
intervention. Growing evidence suggests that the earlier therapy is begun,
the better a patientis clinical, functional, and psychosocial outcomes.
We need to identify patients as early in the disease process as possible,
before psychosis emerges, said Dr. Meltzer at a symposium on improving the
long-term course of schizophrenia sponsored by Zeneca Pharmaceuticals.
According to Dr. Richard J. Wyatt, chief of the neuropsychiatry branch
NIMH, St. Elizabeth Hospital, Washington, immediate anti-psychotic therapy
after first episode schizophrenia positively affects outcomes. Four of the
five published large scale studies show that immediate antipsychotic therapy
decreases hospital stays, reduces numbers of hospitalizations, reduces
disease-related disabilities, and improves overall levels of functioning.
Dr. Wyatt noted that with repeated schizophrenic episodes, the disease
becomes intractable, and patients become increasingly difficult to treat.
A study at Hillside Hospital, Glen Oaks, NY, showed that time to full
therapeutic response following as first episode averaged 48.8 days. After a
second episode, it increased to 58.8 days, and after a third, the time to
complete response was 85.4 days.
According to Dr. Meltzer, this more probably reflects overall duration
the illness, rather than frequency of symptomatic episodes. Either way,
however, the observation supports the earlier treatment.