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How to manage the first episode of schizophrenia

BMJ 2001; 322 doi: (Published 27 January 2001) Cite this as: BMJ 2001;322:234

Authors did not take account of systematically collected information

  1. T J Crow (, professor
  1. University of Oxford Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX
  2. East London and the City Mental Health NHS Trust, Department of Adult Psychiatry, Royal London Hospital, London E1 1BB
  3. Division of Psychological Medicine, Institute of Psychiatry, London SE5 8AF
  4. South London and Maudsley Trust, London SE5 8AZ

    EDITOR—Frangou and Byrne review recent descriptive work on how to manage the first episode of schizophrenia but omit to note that some of the treatment issues discussed have been systematically investigated.1

    The authors are apparently unaware that the efficacy of drug treatment and its correlates was examined in a controlled clinical trial following first episodes of psychosis conducted at the Medical Research Council Centre at Northwick Park.2 This study established that by two years following discharge after the first episode, 46% of patients taking active drug treatment had relapsed compared with 62% taking placebo.3 Response to treatment was not predicted by the features of the illness—a point of practical importance.

    An important determinant of relapse was the duration of illness before the start of neuroleptic treatment, a finding that has been well established in the literature subsequently. Of those who had experienced symptoms for one year before admission, only 18% given active treatment were relapse free at two years and all the patients given placebo had relapsed. The meaning of this finding—whether long duration of illness before admission is a correlate of poor outcome or whether early treatment prevents deterioration—remains obscure.

    Other findings in this study are relevant to Frangou and Byrne's recommendations regarding family therapy.4 Some forms of such …

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