From first episode to long-term care: The need for sustained clinical commitment

Abstract

There is considerable evidence to suggest that many patients experience difficulties in gaining access to treatment after the onset of significant symptoms and social disability. Delay in obtaining appropriate support and treatment can have profound effects on both the patient and their family and may also be associated with a poorer long-term outcome. As stated in the Principles of Practice, prompt and comprehensive clinical assessment, by a clinician experienced in the recognition and treatment of severe mental illness, is therefore important for achieving the best possible outcome for the patient. The primary objectives of early-stage treatment for schizophrenia are to achieve a full improvement in psychopathological symptoms and a recovery of premorbid levels of function. However, even with optimal treatment, the reality for many patients is that their symptoms and impairment continue. Many patients can therefore be regarded as only partially responsive, or even resistant, to treatment. When assessing the utility of an antipsychotic treatment regimen for such patients, clinicians should not just consider the objective manifestations of the disorder but also the subjective experience of the patient. Relapse of illness is also a common and serious problem for many patients with schizophrenia, despite continual treatment. Prevention and management of relapse are two of the main challenges in the effective treatment of schizophrenia. The optimal use of antipsychotic treatment and the adherence by patients to that treatment offer valuable protection against relapse. Symptoms of depression or low mood affect a high proportion of patients with schizophrenia at some point in their illness and are also associated with an increased risk of relapse. Treatment objectives in the early stages may need to be modified if a pattern of partial response or resistance to treatment, a cycle of relapse of the illness or the presence of depressive symptoms, develops. Clinicians should continue to offer a sustained and positive clinical commitment to all.

Keywords: Schizophrenia Duration Untreated Psychosis Relapse Prodromal Symptoms Partial Response Depressive Symptoms.