Early stages of schizophrenia

Vol 7 n° 1 - Early stages of schizophrenia

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ecause schizophrenia is a progressively deterio-

rating disease that irreversibly affects quality of life, life

expectancy itself, as well as cognitive, social, and voca-

tional performance, attempts to detect it and treat it as

early as possible are obvious goals of therapy.The impor-

tance of early detection and treatment is underscored by

the fact that the onset and aggravation of psychosis occur

in late adolescence and early adulthood, a time when

many life-long vocational and social milestones are

determined. Hence, it is reasonable to assume that any

action that postpones the onset or aggravation of active

The notion of early treatment of psychosis and schizo-

phrenia was brought to the forefront of clinical research

by an article by Wyatt, ¹ who, after comparing the out-

come of patients whose illness started before and after

the availability of antipsychotic drugs, concluded that the

latter had a better long-term outcome. Coupled with the

observation that, in the years before psychosis and schiz-

ophrenia fully manifest, other less severe and less puta-

tive manifestations emerge, this raised the hope that

these earlier manifestations could be used to diagnose

impending illness and possibly prevent it or ameliorate

its prognosis. Furthermore, as clues about the patho-

physiology of schizophrenia are emerging, such as genes

of predisposition, it becomes reasonable to hypothesize

that, if these clues translate into reliable biological mark-

ers, they will assist early detection and, moreover, earlier

treatment. Similarly, identification of environmental

effects increasing (or decreasing) the risk for schizo-

phrenia raised the hope that these risk factors could be

manipulated toward primary or secondary prevention.

Moreover, the observation that, even after the first psy-

chotic episode has occurred, persistent pharmacological

treatment can produce lengthy psychosis-free periods in

most patients led investigators and clinicians to view the

Michael Davidson, MD; Asaf Caspi, MD; Shlomo Noy, MD, PhD

To achieve the best therapeutic results in schizophrenia—

like most other disorders—primary prevention is prefer-

able to early and prompt treatment, which, in turn, is

preferable to treatment of chronically established illness.

Unfortunately, there currently exist no accurate markers

that can provide information regarding the future course

of illness and guide treatment in asymptomatic or mildly

symptomatic individuals. Therefore, most treatment

efforts are currently focused on patients who have already

experienced their first psychotic episode. This paper

reviews the efforts to identify accurate markers heralding

psychotic illness, as well as treatment considerations in the

Keywords: schizophrenia; recent-onset psychosis; first episode; treatment;

Author affiliations: Sackler School of Medicine, Tel Aviv University, Tel Aviv,

Address for correspondence:

Michael Davidson, MD, Chaim Sheba Medical