Treatment of schizophrenia: An update I. The vulnerability-stress model and biologic treatment modalities

Genetic, neuropathologic, neuroimaging, neurochemical, and psychophysiologic data give strong evidence for a biologic diathesis of schizophrenia. Environmental factors in the family of origin, especially communication deviance, is also related to an increased risk of developing schizophrenia. Physical stressors include drug abuse, coffeine, and possibly certain fatty acids. The most important psychosocial factor contributing to relapse is high level of expressed emotion. The consequences of understimulation have been much less studied. Despite the heterogeneity of this group of patients, practically all should receive neuroleptic maintenance therapy as early as possible in the course. The relapse rate when using neuroleptics is about half that when using placebo. The lowest effective dosage should be given. Continuous low-dose treatment should be tried for stable patients, and this is much safer than intermittent medication. The article suggests how to manage poor compliance, insufficient efficacy, and side-effect problems.