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Professor Robin Emsley asks: “Is there a critical period in schizophrenia?”
Dr Bonga Chiliza of the Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa and Professor Robin Emsley, from the same Department and editor of the Schizophrenia Resource Centre discuss the existence of the so-called critical period in schizophrenia.
Despite treatment the patient outcome is often not satisfactory. Still, most first episode patients respond robustly to treatment, but the improvement is not sustained. Neurobiological evidence indicates schizophrenia is a neurodevelopmental disorder, but new research is showing there is also a neurodegenerative component to schizophrenia. Brain changes are seen before the onset of symptoms and such changes are strongest during the first years of illness. This period should be considered the critical period. The disease is most aggressive and shows most relapse and deterioration in this period. A Dutch cohort study that covers over 15 years showed a strong link between relapse and deterioration, making recurrence of illness the key to deterioration. After each relapse a subset of patients became treatment refractory. This makes relapse prevention a very important issue in the treatment of schizophrenia patients. A Finnish National Cohort study showed that about 50% of schizophrenia patients discontinued or switched treatment, or was non-adherent within months after discharge. This should be at the forefront of all professionals involved with schizophrenia management.
Suggested further reading Predictors of recovery in first episode psychosis: The OPUS cohort at 10 year follow-up