First-episode schizophrenia. A window of opportunity for optimizing care and outcomes.

The pernicious course of schizophrenia has spurred efforts to identify and effectively treat this condition as early as possible. This assertive therapeutic stance is supported by epidemiologic data suggesting a substantial time lag between onset of illness and therapeutic intervention, and by neurobiologic data suggesting that brain changes present in first-episode psychosis are comparable to those in chronic schizophrenia. The proposal that atypical antipsychotic medications may prevent illness deterioration and/or be a restorative intervention is an appealing, but as yet unproven, hypothesis. Major challenges to maximizing treatment outcomes in first-episode schizophrenia include optimizing timing and effectiveness of pharmacologic interventions, service coordination, and access to care. We present data on the onset and presentation of first-episode schizophrenia and emerging findings about the neurobiology of first episodes, review nonpharmacologic and pharmacologic management, and summarize clinical research data on use of atypical antipsychotics in first-episode patients.