Pharmacological treatment strategies in acute schizophrenia

It may be helpful for clinicians to consider the management of schizophrenia as occurring in three different phases: an acute phase which lasts about 4-8 weeks, a resolving phase which lasts about 4-6 months and a stable phase which lasts as long as the patient remains in remission. During the acute phase, patients demonstrate active symptoms of schizophrenia. The goal of treatment during this phase is to reduce the most severe symptoms of the illness, particularly positive symptoms. Nearly all acute episodes should be treated with an antipsychotic medication. Moreover, drug treatment should occur as early in this phase as possible. Certain treatment principles should guide management: an antipsychotic drug and dose should be used that appropriately balances side effects and efficacy. Trial of the selected drug(s) should last at least 4-6 weeks before the medication is changed. Newer antipsychotics have clear advantages over older drugs in terms of side effects and efficacy. Greater use of these agents may improve the outcome in acute schizophrenia.