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01-11-2003 | Therapy in Practice

Pharmacological Management of First-Episode Schizophrenia and Related Nonaffective Psychoses

Authors: Daniel W. Bradford, Diana O. Perkins, Dr Jeffrey A. Lieberman

Published in: Drugs | Issue 21/2003

Abstract

Schizophrenia is a severe mental illness characterised by abnormalities of thought and perception that affects 1–2% of the population. Patients who experience a first episode of schizophrenia should be treated early and optimally with antipsychotic agents to lessen the morbidity of the initial episode and possibly improve the course of the illness. Positive psychotic symptoms remit in the majority of patients who are treated with adequate trials of antipsychotic medications, but most relapse within 1 year. Non-adherence is strongly related to the likelihood of recurrence of symptoms. Innovative programmes that integrate early intervention, psychosocial treatments and atypical antipsychotic pharmacotherapy show promise in improving outcomes.

The available research supports the use of antipsychotic medications early in the first-episode of schizophrenia and for at least 1 year after remission of positive symptoms. Antidepressants, benzodiazepines and mood stabilisers have roles in the acute and maintenance phases of treatment for some patients. Atypical antipsychotics represent a great advance in the treatment of first-episode schizophrenia with strong evidence for greater tolerability with equal or better therapeutic efficacy. Future research will further define their roles in treatment and hopefully identify targets for prevention of first-episode schizophrenia.

Integration/Sealing Over, Explanatory Model, Scale for the Assessment of Negative Symptoms, Brief Psychiatric Rating Scale, Quality of Life Scale, Symptom Checklist-90-R and Beck Depression Inventory measures.

Bourdon KH, Rae DS, Locke BZ, et al. Estimating the prevalence of mental disorders in US adults from the epidemiologic catchment area survey. Public Health Rep 1992; 107: 663–8PubMed

Hare EH. Epidemiology of schizophrenia and affective psychoses. Br Med Bull 1987; 43: 514–30PubMed

Jablensky A. Epidemiology of schizophrenia: a European perspective. Schizophr Bull 1986; 12: 52–73PubMedCrossRef

Eaton WW. Epidemiology of schizophrenia. Epidemiol Rev 1985; 7: 105–26PubMed

Robins LN, Heizer JE, Weissman MM, et al. Lifetime prevalence of specific psychiatric disorders in three sites. Arch Gen Psychiatry 1984; 41: 949–58PubMedCrossRef

Kramer M. Cross-national study of diagnosis of the mental disorders: origin of the problem. Am J Psychiatry 1969; 10 Suppl.: 1–11PubMed

Tohen M, Stoll AL, Strakowski SM, et al. The McLean First-Episode Psychosis Project: six-month recovery and recurrence outcome. Schizophr Bull 1992; 18: 273–82PubMedCrossRef

Emsley RA. Risperidone in the treatment of first-episode psychotic patients: a double-blind multicenter study. Risperidone Working Group. Schizophr Bull 1999; 25: 721–9CrossRef

Kopala LC, Fredrikson D, Good KP, et al. Symptoms in neuroleptic-naive, first-episode schizophrenia: response to risperidone. Biol Psychiatry 1996; 39: 296–8PubMedCrossRef

10.

Lieberman J, Jody D, Geisler S, et al. Time course and biologic correlates of treatment response in first-episode schizophrenia. Arch Gen Psychiatry 1993; 50: 369–76PubMedCrossRef

11.

May PR, Tuma AH, Yale C, et al. Schizophrenia: a follow-up study of results of treatment. Arch Gen Psychiatry 1976; 33: 481–6PubMedCrossRef

12.

Sanger TM, Lieberman JA, Tohen M, et al. Olanzapine versus haloperidol treatment in first-episode psychosis. Am J Psychiatry 1999; 156: 79–87PubMed

13.

Szymanski S, Masiar S, Mayerhoff D, et al. Clozapine response in treatment-refractory first-episode schizophrenia. Biol Psychiatry 1994; 35: 278–80PubMedCrossRef

14.

Group TS. The Scottish First Episode Schizophrenia Study. II. Treatment: pimozide versus flupenthixol. The Scottish Schizophrenia Research Group. Br J Psychiatry 1987; 150: 334–8CrossRef

15.

Robinson DG, Woerner MG, Alvir JM, et al. Predictors of treatment response from a first episode of schizophrenia or schizoaffective disorder. Am J Psychiatry 1999; 156: 544–9PubMed

16.

Yap HL, Mahendran R, Lim D, et al. Risperidone in the treatment of first episode psychosis. Singapore Med J 2001; 42: 170–3PubMed

17.

Lieberman JA, Phillips M, Gu H, et al. Atypical and conventional antipsychotic drugs in treatment-naive first-episode schizophrenia: a 52-week randomized trial of clozapine vs chlorpromazine. Neuropsychopharmacology 2003 May; 28(5): 995–1003PubMed

18.

Lieberman JA, Tollefson G, Tohen MG, et al. Comparative efficacy and safety of atypical and conventional antipsychotic drugs in first-episode psychosis: a randomized, double-blind trial of olanzapine versus haloperidol. Am J Psychiatry 2003; 160: 1396–404PubMedCrossRef

19.

Mohamed S, Paulsen JS, O’Leary D, et al. Generalized cognitive deficits in schizophrenia: a study of first-episode patients. Arch Gen Psychiatry 1999; 56: 749–54PubMedCrossRef

20.

Addington J, Addington D. Cognitive functioning in first-episode schizophrenia. J Psychiatry Neurosci 2002; 27: 188–92PubMed

21.

Gold S, Arndt S, Nopoulos P, et al. Longitudinal study of cognitive function in first-episode and recent-onset schizophrenia. Am J Psychiatry 1999; 156: 1342–8PubMed

22.

Bilder RM, Goldman RS, Robinson D, et al. Neuropsychology of first-episode schizophrenia: initial characterization and clinical correlates. Am J Psychiatry 2000; 157: 549–59PubMedCrossRef

23.

Townsend LA, Malla AK, Norman RM. Cognitive functioning in stabilized first-episode psychosis patients. Psychiatry Res 2001; 104: 119–31PubMedCrossRef

24.

Riley EM, McGovern D, Mockler D, et al. Neuropsychological functioning in first-episode psychosis: evidence of specific deficits. Schizophr Res 2000; 43: 47–55PubMedCrossRef

25.

Chakos MH, Mayerhoff DI, Loebel AD, et al. Incidence and correlates of acute extrapyramidal symptoms in first episode of schizophrenia. Psychopharmacol Bull 1992; 28: 81–6PubMed

26.

Cullberg J. Integrating intensive psychosocial therapy and low dose medical treatment in a total material of first episode psychotic patients compared to “treatment as usual” a 3 year follow-up. Medicinski Arhiv 1999; 53: 167–70PubMed

27.

Zhang-Wong J, Zipursky RB, Beiser M, et al. Optimal haloperidol dosage in first-episode psychosis. Can J Psychiatry 1999; 44: 164–7PubMed

28.

Merlo MC, Hofer H, Gekle W, et al. Risperidone, 2 mg/day vs 4 mg/day, in first-episode, acutely psychotic patients: treatment efficacy and effects on fine motor functioning. J Clin Psychiatry 2002; 63: 885–91PubMedCrossRef

29.

McEvoy JP, Hogarty GE, Steingard S. Optimal dose of neuroleptic in acute schizophrenia: a controlled study of the neuroleptic threshold and higher haloperidol dose. Arch Gen Psychiatry 1991; 48: 739–45PubMedCrossRef

30.

Jackson H, McGorry P, Henry L, et al. Cognitively oriented psychotherapy for early psychosis (COPE): a 1-year followup. Br J Clin Psychol 2001; 40: 57–70PubMedCrossRef

31.

Lehman AF, Steinwachs DM. Translating research into practice: the Schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations. Schizophr Bull 1998; 24: 1–10PubMedCrossRef

32.

Lieberman JA. Atypical antipsychotic drugs as a first-line treatment of schizophrenia: a rationale and hypothesis. J Clin Psychiatry 1996; 57 Suppl. 11: 68–71PubMed

33.

Bhana N, Foster RH, Olney R, et al. Olanzapine: an updated review of its use in the management of schizophrenia. Drugs 2001; 61: 111–61PubMedCrossRef

34.

Bustillo JR, Lauriello J, Keith SJ. Schizophrenia: improving outcome. Harv Rev Psychiatry 1999; 6: 229–40PubMedCrossRef

35.

Green AI, Schildkraut JJ. Should clozapine be a first-line treatment for schizophrenia? The rationale for a double-blind clinical trial in first-episode patients. Harv Rev Psychiatry 1995; 3:1–9PubMedCrossRef

36.

Addington J. Draft consensus statement-principles and practice in early psychosis. In: Edwards J, McGorry P, editors. Implementing early intervention in psychosis: a guide to establishing early psychosis services. 1st ed. London: Martin Dunitz, 2002: 145–55

37.

Sartorius N, Fleischhacker WW, Gjerris A, et al. The usefulness and use of second-generation antipsychotic medications. Curr Opin Psychiatry 2002; 15: S1–S51CrossRef

38.

National Institute for Excellence. Schizophrenia: core interventions in the treatment and management of schizophrenia in primary and secondary care [online]. Available from URL: http://www.nice.org.uk/pdf/CG1NICEguideline.pdf [Accessed 2002 Aug 13]

39.

Conley RR, Kelly DL. Management of treatment resistance in schizophrenia. Biol Psychiatry 2001; 50: 898–911PubMedCrossRef

40.

Chakos M, Lieberman J, Hoffman E, et al. Effectiveness of second-generation antipsychotics in patients with treatmentresistant schizophrenia: a review and meta-analysis of randomized trials. Am J Psychiatry 2001; 158: 518–26PubMedCrossRef

41.

Bradford D, Stroup S, Lieberman J. Pharmacological treatment of schizophrenia. In: Nathan PE, Gorman JM, editors. A guide to treatments that work. 2nd ed. New York: Oxford University Press, 2001

42.

Edwards J, McGorry P. Implementing early intervention in psychosis: a guide to establishing early psychosis services. London: Martin Dunitz, 2002

43.

Cormac I, Jones C, Campbell C, et al. Cognitive behaviour therapy for schizophrenia. Available in The Cochrane Library [database on disk and CD ROM]. Updated quarterly. The Cochrane Collaboration; issue 1. Oxford: Update Software, 2003

44.

Battaglia J, Moss S, Rush J, et al. Haloperidol, lorazepam, or both for psychotic agitation?: a multicenter, prospective, double-blind, emergency department study. Am J Emerg Med 1997; 15: 335–40PubMedCrossRef

45.

Barbee JG, Mancuso DM, Freed CR, et al. Alprazolam as a neuroleptic adjunct in the emergency treatment of schizophrenia. Am J Psychiatry 1992; 149: 506–10PubMed

46.

Salzman C, Solomon D, Miyawaki E, et al. Parenteral lorazepam versus parenteral haloperidol for the control of psychotic disruptive behavior. J Clin Psychiatry 1991; 52: 177–80PubMed

47.

Kellner R, Wilson RM, Muldawer MD, et al. Anxiety in schizophrenia: the responses to chlordiazepoxide in an intensive design study. Arch Gen Psychiatry 1975; 32: 1246–54PubMedCrossRef

48.

Carpenter Jr WT, Buchanan RW, Kirkpatrick B, et al. Diazepam treatment of early signs of exacerbation in schizophrenia. Am J Psychiatry 1999; 156: 299–303PubMed

49.

Citrome L, Levine J, Allingham B. Changes in use of valproate and other mood stabilizers for patients with schizophrenia from 1994 to 1998. Psychiatr Serv 2000; 51: 634–8PubMedCrossRef

50.

Christison GW, Kirch DG, Wyatt RJ. When symptoms persist: choosing among alternative somatic treatments for schizophrenia. Schizophr Bull 1991; 17: 217–45PubMedCrossRef

51.

Leucht S, McGrath J, White P, et al. Carbamazepine augmentation for schizophrenia: how good is the evidence? J Clin Psychiatry 2002; 63: 218–24PubMedCrossRef

52.

Linnoila M, Viukari M. Sodium valproate and tardive dyskinesia. Br J Psychiatry 1979; 134: 223–4PubMedCrossRef

53.

Wassef AA, Dott SG, Harris A, et al. Randomized, placebocontrolled pilot study of divalproex sodium in the treatment of acute exacerbations of chronic schizophrenia. J Clin Psychopharmacol 2000; 20: 357–61PubMedCrossRef

54.

Ko GN, Korpi ER, Freed WJ, et al. Effect of valproic acid on behavior and plasma amino acid concentrations in chronic schizophrenic patients. Biol Psychiatry 1985; 20: 209–15PubMedCrossRef

55.

Hafner H, Loffler W, Maurer K, et al. Depression, negative symptoms, social stagnation and social decline in the early course of schizophrenia. Acta Psychiatr Scand 1999; 100: 105–18PubMedCrossRef

56.

Cohen S, Lavelle J, Rich CL, et al. Rates and correlates of suicide attempts in first-admission psychotic patients. Acta Psychiatr Scand 1994; 90: 167–71PubMedCrossRef

57.

Addington D, Addington J, Patten S. Depression in people with first-episode schizophrenia. Br J Psychiatry Suppl 1998; 172: 90–2CrossRef

58.

Koreen AR, Siris SG, Chakos M, et al. Depression in firstepisode schizophrenia. Am J Psychiatry 1993; 150: 1643–8PubMed

59.

Prusoff BA, Williams DH, Weissman MM, et al. Treatment of secondary depression in schizophrenia: a double-blind, placebo-controlled trial of amitriptyline added to perphenazine. Arch Gen Psychiatry 1979; 36: 569–75PubMedCrossRef

60.

Kramer MS, Vogel WH, DiJohnson C, et al. Antidepressants in ‘depressed’ schizophrenic inpatients: a controlled trial. Arch Gen Psychiatry 1989; 46: 922–8PubMedCrossRef

61.

Levinson DF, Umapathy C, Musthaq M. Treatment of schizoaffective disorder and schizophrenia with mood symptoms. Am J Psychiatry 1999; 156: 1138–48PubMed

62.

Shuwall M, Siris SG. Suicidal ideation in postpsychotic depression. Compr Psychiatry 1994; 35: 132–4PubMedCrossRef

63.

Siris SG, Bermanzohn PC, Mason SE, et al. Maintenance imipramine therapy for secondary depression in schizophrenia: a controlled trial. Arch Gen Psychiatry 1994; 51: 109–15PubMedCrossRef

64.

Siris SG, Mason SE, Bermanzohn PC, et al. Adjunctive imipramine maintenance in post-psychotic depression/negative symptoms. Psychopharmacol Bull 1990; 26: 91–4PubMed

65.

Silver H, Barash I, Aharon N, et al. Fluvoxamine augmentation of antipsychotics improves negative symptoms in psychotic chronic schizophrenic patients: a placebo-controlled study. Int Clin Psychopharmacol 2000; 15: 257–61PubMedCrossRef

66.

Berk M, Ichim C, Brook S. Efficacy of mirtazapine add on therapy to haloperidol in the treatment of the negative symptoms of schizophrenia: a double-blind randomized placebocontrolled study. Int Clin Psychopharmacol 2001; 16: 87–92PubMedCrossRef

67.

Hogarty GE, McEvoy JP, Ulrich RF, et al. Pharmacotherapy of impaired affect in recovering schizophrenic patients. Arch Gen Psychiatry 1995; 52: 29PubMedCrossRef

68.

Silver H, Nassar A. Fluvoxamine improves negative symptoms in treated chronic schizophrenia: an add-on double-blind, placebo-controlled study. Biol Psychiatry 1992; 31: 698–704PubMedCrossRef

69.

Steinert T, Wiebe C, Gebhardt RP. Aggressive behavior against self and others among first-admission patients with schizophrenia. Psychiatr Serv 1999; 50: 85–90PubMed

70.

Axelsson R, Lagerkvist-Briggs M. Factors predicting suicide in psychotic patients. Eur Arch Psychiatry Clin Neurosci 1992; 241: 259–66PubMedCrossRef

71.

Meltzer HY, Alphs L, Green AI, et al. Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT). Arch Gen Psychiatry 2003; 60: 82–91PubMedCrossRef

72.

Sernyak MJ, Desai R, Stolar M, et al. Impact of clozapine on completed suicide. Am I Psychiatry 2001; 158: 931–7

73.

Reid WH, Mason M, Hogan T. Suicide prevention effects associated with clozapine therapy in schizophrenia and schizoaffective disorder. Psychiatr Serv 1998; 49: 1029–33PubMed

74.

Meltzer HY, Okayli G. Reduction of suicidality during clozapine treatment of neuroleptic-resistant schizophrenia: impact on risk-benefit assessment. Am I Psychiatry 1995; 152:183–90

75.

Hambrecht M, Hafner H. Cannabis, vulnerability, and the onset of schizophrenia: an epidemiological perspective. Aust N Z J Psychiatry 2000; 34: 468–75PubMedCrossRef

76.

Linszen DH, Dingemans PM, Lenior ME. Cannabis abuse and the course of recent-onset schizophrenic disorders. Arch Gen Psychiatry 1994; 51: 273–9PubMedCrossRef

77.

Chouljian TL, Shumway M, Balancio E, et al. Substance use among schizophrenic outpatients: prevalence, course, and relation to functional status. Ann Clin Psychiatry 1995; 7: 19–24PubMedCrossRef

78.

Gupta S, Hendricks S, Kenkel AM, et al. Relapse in schizophrenia: is there a relationship to substance abuse? Schizophr Res 1996; 20: 153–6PubMedCrossRef

79.

DeQuardo JR, Carpenter CF, Tandon R. Patterns of substance abuse in schizophrenia: nature and significance. I Psychiatr Res 1994; 28: 267–75CrossRef

80.

Rabinowitz I, Bromet EJ, Lavelle I, et al. Prevalence and severity of substance use disorders and onset of psychosis in first-admission psychotic patients. Psychol Med 1998; 28: 1411–9PubMedCrossRef

81.

Regier DA, Farmer ME, Rae DS, et al. Comorbidity of mental disorders with alcohol and other drug abuse: results from the Epidemiologic Catchment Area (ECA) Study. JAMA 1990; 264: 2511–8PubMedCrossRef

82.

Kendler KS, Gallagher TJ, Abelson JM, et al. Lifetime prevalence, demographic risk factors, and diagnostic validity of nonaffective psychosis as assessed in a US community sample. The National Comorbidity Survey. Arch Gen Psychiatry 1996; 53: 1022–31CrossRef

83.

Wiersma D, Wanderling I, Dragomirecka E, et al. Social disability in schizophrenia: its development and prediction over 15 years in incidence cohorts in six European centres. Psychol Med 2000; 30: 1155–67PubMedCrossRef

84.

Wiersma D, Nienhuis FI, Slooff CI, et al. Natural course of schizophrenic disorders: a 15-year follow-up of a Dutch incidence cohort. Schizophr Bull 1998; 24: 75–85PubMedCrossRef

85.

Bleuler M. The schizophrenic disorders: long-term patient and family studies. New Haven (CT): Yale University Press, 1978

86.

Harrison G, Hopper K, Craig T, et al. Recovery from psychotic illness: a 15- and 25-year international follow-up study. Br J Psychiatry 2001; 178: 506–17PubMedCrossRef

87.

Crow TJ, MacMillan JF, Johnson AL, et al. A randomised controlled trial of prophylactic neuroleptic treatment. Br J Psychiatry 1986; 148: 120–7PubMedCrossRef

88.

Kane JM, Rifkin A, Quitkin F, et al. Fluphenazine vs placebo in patients with remitted, acute first-episode schizophrenia. Arch Gen Psychiatry 1982; 39: 70–3PubMedCrossRef

89.

McCreadie RG, Wiles D, Grant S, et al. The Scottish first episode schizophrenia study: VII. two-year follow-up. Scottish Schizophrenia Research Group. Acta Psychiatr Scand 1989; 80: 597–602PubMedCrossRef

90.

Nuechterlein KH, Dawson ME, Ventura I, et al. The vulnerability/stress model of schizophrenic relapse: a longitudinal study. Acta Psychiatr Scand Suppl 1994; 382: 58–64CrossRef

91.

Gitlin M, Nuechterlein K, Subotnik KL, et al. Clinical outcome following neuroleptic discontinuation in patients with remitted recent-onset schizophrenia. Am I Psychiatry 2001; 158: 1835–42CrossRef

92.

Robinson D, Woerner MG, Alvir JM, et al. Predictors of relapse following response from a first episode of schizophrenia or schizoaffective disorder. Arch Gen Psychiatry 1999; 56: 241–7PubMedCrossRef

93.

Gilbert PL, Harris MJ, McAdams LA, et al. Neuroleptic withdrawal in schizophrenic patients: a review of the literature. Arch Gen Psychiatry 1995; 52: 173–88PubMedCrossRef

94.

Amin S, Singh SP, Brewin I, et al. Diagnostic stability of firstepisode psychosis: comparison of ICD-10 and DSM-III-R systems. Br I Psychiatry 1999; 175: 537–43CrossRef

95.

Thompson KN, McGorry PD, Harrigan SM. Reduced awareness of illness in first-episode psychosis. Compr Psychiatry 2001; 42: 498–503PubMedCrossRef

96.

Rose VL. APA practice guideline for the treatment of patients with schizophrenia. Am Fam Physician 1997; 56: 1217–20PubMed

97.

Lieberman JA, Perkins D, Beiger A, et al. The early stages of schizophrenia: speculations on pathogenesis, pathophysiology, and therapeutic approaches. Biol Psychiatry 2001; 50: 884–97PubMedCrossRef

98.

McGlashan TH, Miller TJ, Woods SW. Pre-onset detection and intervention research in schizophrenia psychoses: current estimates of benefit and risk. Schizophr Bull 2001; 27: 563–70PubMedCrossRef

99.

Simon AE, Ferrero FP, Merlo MC. Prodromes of first-episode psychosis: how can we challenge nonspecificity? Compr Psychiatry 2001; 42: 382–92PubMedCrossRef

100.

Menezes NM, Milovan E. First-episode psychosis: a comparative review of diagnostic evolution and predictive variables in adolescents versus adults. Can J Psychiatry 2000; 45: 710–6PubMed

101.

McGorry PD. The nature of schizophrenia: signposts to prevention. Aust N Z J Psychiatry 2000; 34 Suppl.: S14–21PubMed

102.

Lieberman JA, Fenton WS. Delayed detection of psychosis: causes, consequences, and effect on public health. Am I Psychiatry 2000; 157: 1727–30CrossRef

103.

Heinssen RK, Perkins DO, Appelbaum PS, et al. Informed consent in early psychosis research: National Institute of Mental Health workshop, November 15, 2000. Schizophr Bull 2001; 27: 571–83PubMedCrossRef

104.

Malla AK, Norman RM, Manchanda R, et al. Status of patients with first-episode psychosis after one year of phase-specific community-oriented treatment. Psychiatr Serv 2002; 53: 458–63PubMedCrossRef

105.

Andreasen NC. Scale for the Assessment of Positive Symptoms (SAPS). Iowa City (IA): University of Iowa College of Medicine, Department of Psychiatry, 1984

106.

Andreasen NC, Olsen S. Negative vs positive schizophrenia: definition and validation. Arch Gen Psychiatry 1982; 39: 789–94PubMedCrossRef

107.

Jackson H, McGorry P, Edwards J, et al. Cognitively-oriented psychotherapy for early psychosis (COPE): preliminary results. Br J Psychiatry Suppl 1998; 172: 93–100

108.

Kleinman A. Major conceptual and research issues for cultural (anthropological) psychiatry. Cult Med Psychiatry 1980; 4: 3–13PubMedCrossRef

109.

Levy ST, McGlashan TH, Carpenter Jr WT. Integration and sealing-over as recovery styles from acute psychosis. J Nerv Ment Dis 1975; 161: 307–12PubMedCrossRef

110.

Overall J, Gorham DR. The brief psychiatric rating scale. Psychol Rep 1962; 10: 799–812CrossRef

111.

Andreasen NC. Scale for the Assessment of Negative Symptoms (SANS). Iowa City: University of Iowa College of Medicine, Department of Psychiatry, 1983

112.

Beck AT, Beck RW. Screening depressed patients in family practice: a rapid technic. Postgrad Med 1972; 52: 81–5PubMed

113.

Derogatis LR, Cleary PA. Factorial invariance across gender for the primary symptom dimensions of the SCL-90. Br J Soc Clin Psychol 1977; 16: 347–56PubMedCrossRef

114.

Heinrichs DW, Hanlon TE, Carpenter Jr WT. The Quality of Life Scale: an instrument for rating the schizophrenic deficit syndrome. Schizophr Bull 1984; 10: 388–98PubMedCrossRef

Title: Pharmacological Management of First-Episode Schizophrenia and Related Nonaffective Psychoses
Authors: Daniel W. Bradford
Diana O. Perkins
Dr Jeffrey A. Lieberman
Publication date: 01-11-2003
Publisher: Springer International Publishing
Published in: Drugs / Issue 21/2003
Print ISSN: 0012-6667
Electronic ISSN: 1179-1950
DOI: https://doi.org/10.2165/00003495-200363210-00001

At a glance: The STEP trials

Springer Medicine

Pharmacological Management of First-Episode Schizophrenia and Related Nonaffective Psychoses

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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