Susan M. Matthews

Maintenance treatment of schizophrenia: a review of dose reduction and family treatment strategies.

Maintenance treatment in schizophrenia requires the integration of both medication and psychosocial treatment interventions for maximum effect. We review the recent evidence for strategies drawn from both domains. For the use of anti-psychotic medication we focus on studies of dose reduction using two strategies that differ in assumptions regarding the action of medication. They are: continuous low-dose and targeted, early intervention or intermittent treatment. For psychosocial interventions we focus on studies of family treatment. Regarding dose reduction, we conclude that both strategies are feasible but the targeted strategy incurs higher relapse and rehospitalization rates. Regarding family treatment, we conclude that family treatment provides benefits beyond other psychosocial interventions or usual care, but that there is no evidence for differences in efficacy among family treatments.

First-episode Psychosis: Part I. Editors' Introduction

Until recently, there has been a conspicuous lack of studies regarding the earliest phases of psychotic illness, with most research on schizophrenia and related disorders focusing on chronically ill patients. Currently, however, a number of investigators have turned their attention toward this topic, exploring the conceptual issues involved in defining the onset of psychosis, using case registers and population-based samples to do crucial epidemiologic studies on the course of schizophrenia, and developing mechanisms for identifying patients with first-episode psychosis and entering them into active research protocols. The issue of the Schizophrenia Bulletin is devoted to articles representing this full range of conceptual and empirical work on first-episode psychosis. The ultimate goal is for researchers working in this area to develop a network to enhance the sharing of concepts and data, with the eventual possibility of developing combined data bases and collaborative studies.

Schizophrenia: Implications of the Treatment Approach in Predicting Outcome

Of the major health problems of the twentieth century, none combines the disability, the frequency, and the early onset of schizophrenia. If one were to add the number of person years of wasted human potential, no other health problem would even come close to the impact of schizophrenia. The term itself, schizophrenia, calls forth an image of the sometimes bizarre, isolated, empty shells of human beings we all have known. Somewhere in this nightmare collage, perhaps, is a unifying concept that brings, meaning to this powerful and highly emotional charged term. For many disorders the diagnosis provides this unifying concept, bringing together conceptual understanding, etiologic discrimination, and treatment implication. Unfortunately, the diagnosis of schizophrenia falls short of this. Much of the problem comes from our having no means of validating the diagnosis of schizophrenia as we do for such entities as diabetes or anemia. Because of this absence of validating criteria, a profound effort has been made to establish the reliability of the diagnosis by selecting symptoms that can be rated reliably. And yet, even the very best reliability has failed to bring validity to the diagnosis. To date, no single, multiple, or cluster of biologic, psychophysiologic, psychologic, or social variables can be found in all schizophrenic patients or only in schizophrenics. The basic heterogeneity of the disorder seems inescapable.