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Probably the most exciting thing in treating schizophrenia has not been conclusively documented yet, although you will see general agreement on the impact of early diagnosis coupled with relapse prevention. Psychotic episodes are beginning to be seen as "toxic" to brain functioning, that is that they appear to damage brain functioning permanently. "Appear" is the key word in that the damage may not be permanent, it's just that there is presently no way to treat the apparent damage.
The longer the delay in treating the first psychotic episode the greater the degree of permanent disability caused by the psychotic episode. Each psychotic episode after the first further increases the damage to brain functioning. With greater deterioration there is a greater disability and therefore a correspondingly greater need for intensive support services in the community. These are expensive services; ACT teams, intensive case management, group homes with 24 hour staff, etc. and most mental health systems have invested in services to help those downstream clients, at the expense of services for upstream clients, because they are young and not as disabled. Evidence for the toxicity of psychotic episodes can be seen in the response to medication. A first psychotic episode generally responds to a much lower dose of medication, but twenty years later four times that amount is less effective in controlling symptoms. At some point patients can become treatment refractory, and are switched to Clozapine which helps about 30%. Each individual is different, and some are treatment refractory from the first psychotic episode, although the length of that first psychotic episode would probably be a factor. I was giving presentations with Dr. Barry Jones from Eli Lilly to groups of psychiatrists and he used a variation of the chart below to explain the dosing of Olanzapine which clinical experience had shown to increase with the age of the patient. Using the middle graph to describe an individual's life with schizophrenia, beginning at age 16 and ending at age 50, Dr Jones pointed out that a first episode generally responded well to 5 mg daily. After five years the dose was more likely to be 10 mg. Five more years and it would be 15 mg and so on to the maximum recommended dose of 20 mg daily. He hypothesized that this was largely a result of relapses. Dr. Jones went on to say that maybe someday it will be possible to have a curve like the first one where an individual only has one psychotic episode and never suffers the decline in functioning level that you can see in the second graph.
The copyright of the article Tantalizing and Exciting in Schizophrenia is owned by . Permission to republish Tantalizing and Exciting in print or online must be granted by the author in writing.
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