S-43-01

Therapeutic results of early intervention in schizophrenia

J. Klosterkötter, S. Ruhrmann, A. Bechdolf, M. Wagner, W. Maier. Department of Psychiatry University of Cologne, Köln, Germany

Objective: There is a whole body of evidence in the literature showing that overt psychosis is preceded by a long course of prepsychotic symptoms. A longer duration of untreated illness was found to worsen the outcome of schizophrenia. Therefore it is necessary to recognise and treat the illness as early as possible.

Methods: We are investigating the effects of early interventions on prodromal symptoms, social functioning and course of the illness. An early and a late prodromal phase based on clinical and ethical considerations were defined. Criteria of an early stage are either basic symptoms or a combination of declined social functioning plus a genetic or obstetric risk.

Results: For the early prodromal phase a psychological treatment program was developed. The late prodromal phase, defined by transient or attenuated psychotic symptoms, is treated with amisulpride in comparison to a psychologically advanced clinical management. Preliminary results of both early intervention programs will be presented.

Conclusion: First results of the intervention studies in the German Research Network Schizophrenia as well as the international standard of knowledge support the applicability of "indicated prevention".

S-43-02

Outcome of acute treatment with haloperidol or risperidone in first episode schizophrenics

H.-J. Müller, W. Gaebel, R. Bottlender, G. Buchkremer, J. Klosterkötter, W. Maier. Ludwig-Maximilians-Universität Klinik für Psychiatric, Miinchen, Germany

First episode schizophrenics are increasingly seen as a special subgroup under treatment considerations. Based on the literature these patients seem to be very responsive, even to relatively low doses of neuroleptics. On the other side they seem to have an increased risk of extrapyramidal side effects. In the context of the German research network on schizophrenia a randomised, doubleblind, prospective 8-week study was performed to compare haloperidol with risperidone. The design guaranteed that the smallest clinically effective dose was used. The patients were hospitalised in different German university hospitals. The main question of the study was whether under the conditions of the first low dose regimen a second generation antipsychotic like risperidone can demonstrate superiority to a classical neuroleptic like haloperidol in terms of efficacy and tolerability. It was hypothesised that risperidone would be superior in the domains of negative symptoms, depressive symptoms and cognitive disturbances as well as with respect to tolerability. The data set is still blinded. The data from the first sample are quite promising. Altogether they demonstrate an almost favourable outcome of the first episode patients are 8 weeks of treatment. The dataset will be unblinded in the coming weeks. Thus the preliminary results of the comparison risperidone versus haloperidol will be available for the presentation at the congress.

S-43-03

Outcome in first episode patients under naturalistic conditions

R. Bottlender. Psychiatrisehe Klinik der Ludw, München, Germany

S-43-04

Schizophrenia: Neuroplasticity and logitudinal neuroimaging evidence

E. Meisenzahl, T. Zetzsche, G. Schmitt, M. Jäger, R. Bottlender, C. Born, M. Reiser, H.-J. Müller. Psychiatrische Klinik der Ludw, München, Germany

S-43-05

2 year long-term treatment study comparing risperidol with haloperidol in first episode patients

W. Gaebel. Heinrich-Heine University Dues, Duesseldorf Germany

Objective: In first-episode schizophrenia the advantage of long-term treatment with new atypical compared to (low-dose) typical neuroleptics as well as the indicated duration of maintenance treatment has still to be based on empirical evidence. Accordingly, a multi-center study on long-term treatment strategies in first-episode schizophrenia is currently carried out as part of the German Research Network on Schizophrenia.

Methods: In the first treatment year, the relapse preventive efficacy of maintenance treatment with risperidol vs. (low-dose) haloperidol will be compared (randomized double-blind design). In the second treatment year, relapse rates under continued neuroleptic treatment are compared with those under stepwise drug withdrawal substituting instead prodrome-based early intervention (intermittent treatment; randomized design).

Results: By July 2004 159 first episode patients (ICD-10. F20) have been included in the long-term study. Hitherto, no relapse (corresponding to the predefined criteria) was observable in the first treatment year under regular treatment conditions. On average, psychopathological symptoms were moderate after acute treatment and decreased steadily. Drug side-effects measured with various scales were low, and although compliance on average was high, about 65% of the patients dropped out during the first study year. Regarding the second year about 15% were not eligible for drug discontinuation and about 25% chose the converse treatment as assigned.

Conclusion: Treatment in ftrst episode schizophrenia is effective under both neuroleptics however these patients are at high risk for treatment drop-out. This emphasizes the need for a special support program. Additionally, various long-term treatment strategies should be provided to take patients preferences into account.