One-Year Outcome and Adherence to Pharmacological Guidelines in First-Episode Schizophrenia: Results From a Consecutive Cohort Study

J Clin Psychopharmacol. 2020 Nov/Dec;40(6):534-540. doi: 10.1097/JCP.0000000000001303.


Background: Remission in schizophrenia is difficult to achieve. Antipsychotic drugs are critical in the treatment of schizophrenia. International guidelines for the pharmacological treatment of schizophrenia recommend a 3-step algorithm with clozapine being the third-line antipsychotic agent. This study investigated the 1-year outcome and the application of the guidelines for the pharmacological treatment of nonremitted first-episode schizophrenia (FES) patients during the first year of follow-up.

Methods: A sample of 78 FES patients from the Norwegian TIPS (Early Treatment and Intervention in Psychosis) 2 study was assessed at the end of the first year of follow-up. The symptom remission criteria were those defined by the Remission in Schizophrenia Working Group. The adherence to the pharmacological guidelines was assessed by reading the medical files and by a digital search of the words "clozapine," "klozapin," and "Leponex" in the hospital electronic data system.

Results: The majority (n = 53, 67.9%) of the patients included were nonremitted at the 1-year follow-up. The majority of the nonremitted patients received either none (7.5%), one (56.6%), or 2 types (15.1%) of antipsychotic drugs during the first year of follow-up. Only 2 (3.8%) received treatment with clozapine, and 3 (5.7%) in total were offered it.

Conclusions: For our FES sample, there was a low 1-year remission rate and a poor adherence to the pharmacological guidelines. Higher adherence to treatment guidelines with a more intensified antipsychotic treatment, which in some cases will include clozapine, will enhance the quality of treatment and may enhance the rates of remission for schizophrenia.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • Algorithms
  • Antipsychotic Agents / adverse effects
  • Antipsychotic Agents / therapeutic use*
  • Clinical Decision-Making
  • Clozapine / adverse effects
  • Clozapine / therapeutic use*
  • Female
  • Follow-Up Studies
  • Guideline Adherence / standards*
  • Humans
  • Male
  • Norway
  • Practice Guidelines as Topic / standards*
  • Practice Patterns, Physicians' / standards*
  • Remission Induction
  • Schizophrenia / diagnosis
  • Schizophrenia / drug therapy*
  • Schizophrenic Psychology*
  • Time Factors
  • Treatment Outcome
  • Young Adult


  • Antipsychotic Agents
  • Clozapine