Early, targeted pharmacotherapeutic intervention in schizophrenia.

Potential problems of long-term, substantial-dose neuroleptic exposure include development of adverse effects, undesirable interaction between drugs and the negative symptoms of schizophrenia, masking of diagnostic indicators, and an iatrogenic increase in the positive symptoms of schizophrenia. The clinical application of approaches that reduce medication is supported by preliminary evidence from controlled studies. Preliminary data of an ongoing study show that a new, reduced-medication approach (i.e., early intervention, targeted pharmacotherapy) may prove to be a feasible treatment strategy. Treatment includes the early detection of warning or prodromal signs of relapse followed by a rapid pharmacotherapeutic intervention. Drug therapy is limited to psychotic episodes rather than continuous pharmacotherapy for prophylactic purposes. This treatment approach is enhanced by the careful selection of patients, for which some guidelines are given, and full integration with a wide range of psychosocial treatment procedures. Study results of the efficacy of the targeted approach versus the traditional pharmacotherapeutic approaches show similar outcomes over a 2-year course of treatment.