Schizophrenia: new aspects of management

Most of the impairment, disability and handicap of schizophrenia arises between 2 and 5 years after the first psychotic episode. Recent studies suggest that 25-40% of people who suffer a psychotic episode recover and never have another episode. A number of non-specific cognitive, affective and behavioural changes often herald the onset of psychosis. Higher than recommended doses of antipsychotics do not produce quicker or better outcomes, only more side-effects. Maintenance antipsychotic medication is required to reduce the risk of relapse. Psychosocial interventions must accompany medication. The most serious psychiatric complications are depression and suicide. GPs are well placed to promote good health and provide advice on minimising risk factors such as smoking. It is important to actively involve the patient in all aspects of his or her care and not to place excessive emphasis on 'compliance'. (author abstract)