ABSTRACT
INTRODUCTION The long-term maintenance treatment of schizophrenic patients with antipsychotic/ neuroleptic medication is still limited by treatment dissatisfaction and discontinuation in daily practice (1). From a treatment perspective it is important to focus on the course of schizophrenia, which is characterized by a wide spectrum of symptoms, including hallucination, delusions, hostility (positive symptoms), negative symptoms (flattened affect, anhedonia, avolition), cognitive deficits, depression, and anxiety symptoms (2) (see Table 15.1). Naturalistic long-term studies indicate that 4-6 years before an acute breakdown with positive symptoms, there are already negative, cognitive, and affective symptoms (3, 4). Long-term studies in schizophrenia are indicative that some positive symptoms decline over the long-term, however reality distortions become more prominent and disorganization becomes disassembled to alternative elements (5). Negative symptoms become more prominent and sharply delineated (6) and are correlated with low self-esteem (7) (see Table 15.2). Since schizophrenia is a life-long illness, it therefore requires long-term treatment for the different symptom domains (see Figure 15.1). The treatment aims include the control of acute psychotic and hostility symptoms, and for the long-term treatment phase improved outcomes in patient functions and quality of life are required (8, 9). While in older treatment studies the focus was solely on the psychotic and so-called positive manifestations of the disorder, there is now growing evidence that negative, affective, and cognitive symptoms are important predictors for the long-term treatment outcome. It is apparent that an effective treatment regiment must address the full spectrum of symptoms and not impair patient functions as this often leads to a decrease of patient compliance in treatment.
