John G. Csernansky
Washington University School of Medicine
and Metropolitan St. Louis Psychiatric Center
St. Louis, Missouri
In almost all patients who suffer from schizophrenia, it is a lifelong disorder. After the resolution of an acute episode of psychotic symptoms, treatment must be continued to prevent such episodes in the future. Furthermore, negative symptoms and cognitive deficits often remain after the resolution of a psychotic episode, and become the focus of efforts at rehabilitation. Relapse prevention, the mitigation of negative symptoms, and at least the recognition of cognitive deficits are all essential to improve the quality of life for patients with schizophrenia. The major goal of this chapter is to review current knowledge about maintenance drug treatment for schizophrenia patients and to extract simple principles from this literature as a guide for clinicians.
Today, clinicians and their patients have more and better drugs to choose from in designing their strategies for maintenance treatment. In the United States, the use of clozapine, risperidone, olanzapine, quetiapine and other second-generation drugs has surpassed the use of the first-generation antipsychotic drugs, such as haloperidol, thiothixene, and fluphenazine. Second-generation antipsychotic drugs have been shown to have advantages in the inpatient treatment setting, including improved efficacy and reduced extrapyramidal side effects, and their