Phase Three Maintenance Treatment

The natural course of psychotic symptoms in schizophrenia includes a high rate of relapse, even when symptoms have been brought under good control. Maintenance antipsychotic treatment is essential for relapse prevention (Gilbert et al., 1995; Gre-den and Tandon, 1995). Furthermore, since much worsening of negative symptoms appears related to acute psychotic episodes, the most effective intervention to prevent the functional deterioration associated with these symptoms is to avoid further episodes of active psychosis. Although no treatment at present appears capable of reversing or correcting the premorbid component of dysfunction, effective antipsychotic treatment may prevent or at least limit the abnormalities associated with the deterioration phase. Finally, since the most severe deterioration occurs during the first few episodes of illness, aggressive maintenance therapy should be initiated early in the course of illness. Early, effective antipsychotic treatment can significantly limit deterioration and improve outcome in schizophrenia. Relapse prevention is a critical task in this phase of treatment; the risk of psychotic relapse in stabilized patients is about 75 percent within one year following drug discontinuation, in contrast to 15 to 20 percent if patients continue their prescribed antipsychotic treatment (DeQuardo and Tandon, 1998).

Long-term patient compliance is a major issue. As with other phases of treatment, unacceptable side effects, denial of illness, and inadequate social support are obstacles to treatment. Selection of an antipsychotic with a favorable side effect profile is essential. Long-standing or late-emergent side effects should be addressed with the patient. Patient education is essential during this phase of treatment. A patient with no active symptoms and no appreciation of the risk of relapse is unlikely to continue treatment. In patients whose compliance cannot otherwise be ensured, a depot antipsychotic is the treatment of choice (Kane, 1999).

Anxiety and Depression 101

Anxiety and Depression 101

Everything you ever wanted to know about. We have been discussing depression and anxiety and how different information that is out on the market only seems to target one particular cure for these two common conditions that seem to walk hand in hand.

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