A21 21..21

Three papers in the Journal this month consider issues related to outcomes and treatment in first-episode psychosis. Crossley et al (pp. 434–439) reviewed 15 randomised controlled trials of antipsychotic treatment in first-episode psychosis and found no evidence for differences in discontinuation rates or effect on symptoms between atypical and typical antipsychotics. Clear differences in side-effect profile were found, with atypicals causing more weight gain and typicals causing more extrapyramidal sideeffects. In a longitudinal study based in India, Saravanan et al (pp. 454–459) found that although baseline levels of illness insight and psychopathology did not predict outcome at 1 year, early improvement in either did predict a good outcome. The authors also found duration of untreated psychosis to be a predictor of relapse and functional impairment. Schennach-Wolff et al (pp. 460–466) also found that early improvement in symptoms predicted outcome in their sample of individuals identified from centres throughout Germany. The authors concluded that an improvement of at least 30% in Positive and Negative Syndrome Scale total score at week 2 may be necessary to achieve response and remission.