LVR-Klinikum Düsseldorf Hospital of the Heinrich-Heine University ...

investigations of different questions on the optimisation
of the long-term treatment of patients with
schizophrenia (Figure 14):
s Benefits of (“atypical”‘) second generation antipsychotic
drugs compared with those of the first generation
(“typicals”);
s Necessary period of continuous maintenance
medication for further stabilisation and relapse
prophylaxis;
s Opportunities afforded by an improved use of
prodromal symptoms for early diagnosis and
intervention;
s Improvement of the risk estimation for relapses and
residual course developments, as well as
s The effectiveness of psychological intervention
strategies with regard to relapse prophylaxis and other
outcome criteria through the modification of individual
vulnerability, stress response and coping skills.
Pharmacotherapeutic strategies for relapse prevention in
first-episode patients with schizophrenia
Director: W. Gaebel, H.J. Möller (Psychiatric Department of
Ludwig-Maximilian University, Munich)
Project period: 1999–2005
Financing: FMER funding 01 GI 9932/01 GI 0232
A core element of the above network projects was the
2-phase pharmacotherapeutic long-term study (cf. Figure
15). After an eight-week period of acute treatment (Möller
et al. 2008), drug treatment was continued with either
the typical antipsychotic drug haloperidol or the atypical
drug risperidone at a low maintenance dose for one year
Cumulative frequency
1.0
0.8
0.6
0.4
0.2
0.0
Risperidone (n = 77)
Kaplan-Meier estimated mean time to appearance
of clinical deterioration: 38.8 weeks
Haloperidol (n = 74)
Kaplan-Meier estimated mean time to appearance
of clinical deterioration: 40.5 weeks
Log Rank = 0.1; df = 1; p > 0.05
0 10 20 30 40 50 60
Time (weeks) in a long-term study (first year)
ReseaRch
(randomised, double-blind design). Afterwards, at the start
of the second year, patients (after sufficient stabilisation)
were again randomised before continuing with either
maintenance treatment or phased withdrawal of the
antipsychotic drug. In both types of treatment, an early
intervention took place if early signs of relapse occurred
(i.e. prodromal symptoms) (see below). The main results
of the first year (maintenance treatment continued with a
typical vs. atypical antipsychotic drug) were as follows: Both
medications are equally (i.e. very) effective with regard to
relapse prophylaxis and further symptom improvement.
However, there was a considerable drop-out rate in both
arms of the study. The results of the second year are
as follows: In first-episode patients with schizophrenia
(sufficiently stabilised after one year of maintenance
therapy) the risk for relapse or clinical deterioration is 5-10
times higher after intermittent treatment (after phased
withdrawal of the antipsychotic drugs) than with continued
maintenance therapy. However, in the intermittent treatment
arm, around half of the patients remain stable. Around 20%
of all patients demand the discontinuation of maintenance
therapy after one year.
Prodrome-supported relapse prediction and early
intervention in patients with first-episode schizophrenia
Director: W. Gaebel, W. Wölwer, M. Riesbeck
Project period: 1999–2005
Financing: FMER funding 01 GI 9932/01 GI 0232
According to the VSC model, persons with schizophrenia
display increased vulnerability which leads, in the presence
of (persistent) stress and maladaptive coping strategies,
Figure 15: Proportion of patients
with no clinical deterioration
in the course of treatment with
risperidone and haloperidol (based
on Gaebel et al., J Clin Res, 2007)
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