Wednesday 22 october 2008

The treatment of individuals during the early phase of a psychotic disorder is critically important. First, it might have a significant impact on subsequent course and outcome, and second, the initial treatment experience can have a powerful effect on patient (and family) attitudes towards the illness and subsequent engagement in appropriate treatment. Pharmacotherapy needs to be thoroughly integrated with psychosocial and psychoeducation intervention strategies as well. It is in this context that we should design and conduct psychopharmacology trails in early phase illness. In addition, these trials involve a number of important challenges that are unique to early phase illness. Given the incidence of psychotic illness, identifying subjects eligible to participate in clinical trials can be a challenge. Generally multicenter studies are required to recruit an adequate number of subjects. Individuals with early phase illness are often lacking in insight or have not fully accepted the need for treatment, making recruitment into trials particularly challenging. Developing appropriate control or comparison conditions can be a challenge from both an ethical and scientific perspective. If true prevention or impact of treatment on illness course is a focus of the investigation, a lengthy trial might be required. Even if an intervention is found to be effective in delaying the onset of a more full blown illness or altering the course of an existing illness, how can we determine if and when it is feasible to discontinue or step down treatment? These are some of the issues and challenges that need to be considered and will be reviewed in more detail.